Is Methotrexate for RA Safe During Pregnancy

What is Methotrexate Used For?

Methotrexate (methotrexate) is used to treat some types of cancer. It is given intravenously or intramuscularly into the blood stream. It works by killing certain kinds of cells called “metastases” which are caused by abnormal cell growths in the body. Metastasis means “growth out of place”. Some forms of cancer have been found to spread from one part of the body to another. These cancers are called metastatic. When these cancers grow outside their original location they become dangerous because they may cause other parts of your body to be affected too. Methylprednisolone (also known as prednisone) is a drug used for treating rheumatoid arthritis and psoriasis. It is used to reduce inflammation and pain associated with these conditions. Methylprednisolone is also used to prevent organ damage when it is administered during surgery.

How Does Methotrexate Work?

The main mechanism of action of methotrexate involves inhibiting the activity of a protein called p21. This protein plays a role in regulating the proliferation of various cells throughout the body including those that make up tumors. Methotrexate also works by altering the rate of cell division.

How do I Take Methotrexate?

It is important to take this medication exactly as prescribed by your physician. Methotrexate is usually given via injection or intramuscularly or intravenously. It can also be injected directly into an affected area. Precautions should be taken when administering methotrexate to areas near the eyes, genitals, or a burn. This medication should not be injected in these areas as it can affect the skin, eyes, or genitals. Your physician may give you a self-injection training before use.

What are the Side Effects of Methotrexate?

The following are some of the side effects that may occur from taking Methotrexate. Just because a side effect is stated here does not mean you will experience that or any side effect. Side effects are variable, and depend on the amount of medication you take, other medications you are taking, and your own physiology. Not all possible side effects are listed here.

Most common side effects of methotrexate include: loss of appetite, vomiting, nausea, mouth sores, diarrhea, rash, fever, chills and fatigue. Other side effects include hair loss, inflammation of the lining of the heart, liver damage, decreased white blood cells or platelets and anemia. More severe side effects may require medical assistance.

What if I Am Pregnant and Take Methotrexate?

Because methotrexate is a chemotherapy agent, it should not be used during pregnancy. While there are instances of women unintentionally being on the drug while pregnant and having a healthy baby, there are also cases of babies dying in utero or being born with birth defects. It is always best to discuss methotrexate use with your physician before becoming pregnant.

How Do I Store Methotrexate?

Methotrexate is best stored at room temperature between 59 and 86 degrees Fahrenheit away from sunlight. Leftover medication should be discarded after treatment ends.

What Happens If I Miss a Dose of Methotrexate?

If you miss a dose of this medication, take it as soon as you remember. If it is almost time for your next dose, skip the one you missed and go back to your regular dosing schedule. Do not take a double dose.

What Should I Avoid While Taking Methotrexate?

You should avoid drinking alcohol while taking methotrexate. Alcohol can increase the upset stomach, loss of appetite, muscle weakness, and fatigue caused by the medication.

Methotrexate is commonly used in combination with other medications given directly into the bladder, or even directly into the affected area such as psoriasis. When this is done, care should be taken to avoid injecting the medication into the blood vessels. If methotrexate is injected into a blood vessel it can cause severe damage.

You should also not receive immunizations while taking methotrexate due to the risk of decreased white blood cells. You should also be careful to avoid being near people who have contagious diseases.

What Happens When I Finish Methotrexate?

Your physician will monitor you for several months after you finish taking methotrexate. This is to ensure that your cancer does not return. You may also experience a delay in the onset of menopause, or an exacerbation of pre-existing conditions such as psoriasis and inflammatory bowel disease.

Over 99% of methotrexate is eliminated from the body through the kidneys. As such, if you have had kidney disease or kidney failure in the past, your doctor will most likely only give you a short treatment with low doses of methotrexate.

Are There Any Drugs That Should Not Be Taken With Methotrexate?

Yes, there are a number of drugs that should not be taken with methotrexate. These include: folic acid, leucovorin, and pyrimidinamine. There are also a few cases in which the use of paracetamol (acetaminophen) is recommended after taking methotrexate. Before taking any medication, it is best to check with your physician or pharmacist.

What Should I Do if I Forget to Take a Dose of Methotrexate?

If you forget to take a dose of methotrexate and it is almost time for your next dose, just take the dose when it is due. If it is the day before or after your dose, skip the one you missed and go back to your regular dosing schedule. Never take a double dose.

What Should I Do if I Overdose on Methotrexate?

An overdose of methotrexate can be serious and may require hospitalization. If you experience nausea, vomiting, upset stomach, loss of appetite, diarrhea, or yellowing of the skin or eyes, seek medical attention immediately.

What Happens If I Take Methotrexate With Other Medications?

Although unlikely, there is a small chance that methotrexate can react with other medications and cause an overdose. Be sure to inform your physician of all the over-the-counter and prescription medications you are taking.

Are There Any Long-Term Side Effects?

After you have completed your treatment with methotrexate, it is possible that you will have a temporary or permanent decrease in the functioning of your liver, kidneys, and white blood cells. There is also a small risk of certain cancers such as skin cancer. These effects can be lessened by having regular check-ups with your physician after treatment.

Is There Anything I Can Do To Minimize The Side Effects?

Often, side effects of methotrexate are lessened if you are given the medication in smaller doses. If side effects do occur, they may be lessened by taking the folic acid and paracetamol (acetaminophen). It is also important that you drink a lot of fluids while on treatment and avoid alcohol, NSAIDS, and acetaminophen.

Is Methotrexate Successful In Treating Cancer?

Methotrexate is most commonly used in the palliative treatment of solid tumors. It is not usually used to treat leukemia, lymphoma, or other blood cancers.

There are a number of different protocols for methotrexate, each with their own pros and cons. It is best to discuss these with your medical oncologist.

Talking With Your Doctor

It is important that you discuss all of your concerns with your medical oncologist and that you are frank about your expectations. Together you can come up with the best treatment plan for you.

Remember, you are not alone in this. There are many others who have successfully undergone methotrexate treatment and have survived to live long and full lives. There are also a number of groups you can contact for information, support, and advice, such as the American Cancer Society and the Leukemia & Lymphoma Society.

Sources & references used in this article:

Rheumatoid Arthritis and Pregnancy by A Makol, K Wright, S Amin – Drugs, 2011 – Springer

Immunosuppressive drug use during pregnancy by R Ramsey-Goldman, E Schilling – Rheumatic Disease Clinics of North …, 1997 – Elsevier

Treatment of rheumatoid arthritis during pregnancy: present and future by F Förger, PM Villiger – Expert review of clinical immunology, 2016 – Taylor & Francis

Use of methotrexate in young patients with respect to the reproductive system by E Gromnica-Ihle, K Kruger – Clinical and Experimental …, 2010 –

Systematic review on the safety of methotrexate in rheumatoid arthritis regarding the reproductive system (fertility, pregnancy, and breastfeeding) by JAM Lopez, E Loza, L Carmona – … of Abstracts of Reviews of Effects …, 2009 –

The treatment of rheumatoid arthritis during pregnancy by R Partlett, E Roussou – Rheumatology international, 2011 – Springer