Methotrexate is a chemotherapy drug used to treat many types of cancer.

HOW IS METHOTREXATE ADMINISTERED?

Methotrexate is given in the chemotherapy day unit or during a hospital stay. A chemotherapy nurse will give it to you.

Before the day of treatment, a nurse will take a blood sample from you to see if you are fit for chemotherapy.

You will also be able to see a doctor or nurse before having chemotherapy. They will ask you how you have been feeling. If the results of your blood test are good on the day of your treatment, the pharmacist will prepare your chemotherapy. Your nurse will give you medication for nausea and, sometimes, steroids administered intravenously. Chemotherapy drugs may be given in the following ways:

• Through a thin tube (line) inserted into a vein in the arm or hand by a nurse
• Through a tube that goes below the skin of your chest to a nearby vein (central line)
• Through a thin tube that is placed in a vein of the arm and goes up through a vein toward the chest (PICC)

Your nurse may give you methotrexate as a slow injection or drip (infusion) into your cannula or line. They usually run the drip through a pump, giving you the treatment over a set time. Normally, you will receive fluids through a drip at the same time.

Methotrexate can also be given in the following ways:

• as an injection into a muscle (intramuscular injection)
• in tablet form
• by injection into the fluid that surrounds the spinal cord (intrathecally)
• rarely, by injection into an artery.

When the chemotherapy is administered

Some people may have side effects while they are receiving chemotherapy.

DRUG LEAKAGE OUTSIDE THE VEIN

If this happens when you are receiving methotrexate, it can damage the tissue surrounding the vein. This is called extravasation. Inform the nurse immediately if you have stinging, pain, redness, or swelling around the vein. Extravasation is not common, but if it happens it is important that it be treated quickly.

If you have any of these symptoms after you get home, contact your doctor or nurse immediately.

FOLINIC ACID RESCUE

A drug called folinic acid (leucovorin) is normally given 24 hours after treament with methotrexate is started; this is done to reduce the side effects. Folinic acid can be given through your line while you are connected to a drip. You will receive fluids regularly until the methotrexate is out of your system.

Folinic acid is sometimes given in tablet form. It is very important to take all the tablets at the time you are told to and in the way you have been instructed.

TAKING YOUR METHOTREXATE TABLETS

If you are taking methotrexate in tablets, you should always take them as you are told to. This is important to ensure that it is working as well as possible. You should swallow the tablets whole, taking them with a full glass of water.

If you vomit right after taking the pills, get in touch with your hospital. You may have to take another dose. If you forget to take a pill, do not take a double dose. Keep your normal schedule and tell your doctor or nurse.

Other things to keep in mind about pills:

• Keep them in their original packaging.
• Keep them at room temperature and away from heat and direct sunlight.
• Keep them safe and out of the reach of children.
• Return the remaining pills to the hospital if the treatment is discontinued.

CHEMOTHERAPY INJECTED DIRECTLY INTO THE CEREBROSPINAL FLUID

Methotrexate can be given into the cerebrospinal fluid so that the drug can reach the spinal cord and the brain. This is called intrathecal chemotherapy.

The doctor numbs an area of skin over your spinal column using a local anesthetic. A needle is gently inserted between two of the bones of the spinal column into the cerebrospinal fluid (lumbar puncture). Chemotherapy medication is injected through this needle into the cerebrospinal fluid.

After a lumbar puncture, you may get a headache. To help prevent this from happening, you will need to lie down for a few hours after the procedure and drink lots of fluids.

YOUR METHOTREXATE CYCLE

You will have chemotherapy as part of a course or cycle, consisting of several treatment sessions and lasting several months. Your doctor or nurse will tell you how many cycles you are likely to have.

POSSIBLE SIDE EFFECTS OF METHOTREXATE

You may experience some of the side effects mentioned here, though it is rare for a patient to have all of them. If you receive other chemotherapy drugs, you may have other side effects that are not mentioned here. Always inform your doctor of the effects you experience.

Your doctor can prescribe medication to help control some of the side effects. It is very important to take the medication exactly as your doctor says for it to have the highest chance of working well. Your nurse will advise you on managing the side effects. After treatment, the side effects start to get better.

RISK OF INFECTION

Methotrexate may lower the number of white blood cells in your blood. This will make you more susceptible to infection. Your nurse can tell you when you might have the lowest levels of these cells. When the number of white blood cells is low, this is called neutropenia.

Contact your hospital immediately if any of the following happens:

• your temperature goes above 38 ° C
• you suddenly feel unwell, even if your temperature is normal.
• You have symptoms of infection, which may include sore throat, coughing, or the need to urinate frequently.

The number of white blood cells normally increases gradually, returning to normal before your next chemotherapy session. You will have a blood test before your next chemotherapy. If your white blood cells are still low, your doctor may postpone the treatment for a short period of time.

BRUISING AND BLEEDING

Methotrexate may lower the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor if you have any unexplained bleeding or bruising. This includes nosebleeds, bleeding gums, blood spots, or skin eruptions (rashes). Some people may require additional platelets.

ANEMIA

Methotrexate may lower the number of red blood cells in your blood. Red blood cells transport oxygen throughout the body. If you have a low number of red blood cells, you may be tired and short of breath. Tell your doctor or nurse if you feel like this. If you are very anemic, it's possible you will require a blood transfusion.

NAUSEA

This can happen on the first few days after chemotherapy. Your doctor will prescribe you antiemetic drugs to help prevent or control your nausea. It is easier to prevent nausea than it is to treat it once it has begun.

If you still have nausea or are vomiting, get in touch with the hospital as soon as possible. They can give you advice and change your medication to one that works better.

LOSS OF APPETITE

You may lose your appetite during the treatment. Try to eat in small quantities and have frequent meals. Don't worry if you don't eat much for a day or two. If your appetite doesn't get any better after a few days, tell your nurse or dietitian. They can give you nutritional supplements or good-tasting meal-replacement drinks.

DIARRHEA

Your doctor can prescribe medicines to control diarrhea. Let them know if your diarrhea is severe or if it doesn't get better. Make sure you drink at least two liters of fluids each day if you have diarrhea.

TIREDNESS

Feeling very tired is a common side effect. Fatigue is often worst toward the end of treatment and for a few months after the treatment has finished. Try to pace yourself and rest as much as you need to. Help balance this with a bit of light exercise, such as short walks. If you feel drowsy, don't drive or operate heavy machinery.

HAIR LOSS

Usually, people lose all of their hair. Also, the eyelashes, eyebrows, and other parts of the body may lose their hair. This normally starts after your first or second cycle of chemotherapy. It is almost always temporary, and the hair will continue to grow after you finish your chemotherapy. Until the time when you hair grows back, it is important to cover your head so as to protect the scalp while it is exposed to the sun's rays. Your nurse can give you advice on how to cope with losing your hair.

Scalp cooling is a way to lower the scalp's temperature and help slow hair loss. Your nurse can tell you if this is a good option in your case.

SORENESS OF THE MOUTH

You may have a sore mouth or mouth ulcers, which could make you more prone to getting a mouth infection. Lightly brush your teeth and/or dentures in the morning and night and after meals. Use a soft-bristle toothbrush. Your nurse might ask you to rinse your mouth out regularly or use mouthwash. It is important that you follow all the instructions you are given and that you drink a lot of fluids.

Tell your nurse or doctor if you have any mouth problems. They can prescribe you drugs to prevent or treat infections of the mouth and to treat any kind of pain.

SKIN CHANGES

Chemotherapy can affect your skin. Methotrexate can produce a rash, which may cause itchiness. If your skin is dry, try to use a fragrance-free moisturizing cream every day. Always tell your doctor about any change to your skin. These changes can be temporary, improving once the treatment is over.

CHANGES IN THE KIDNEYS

Methotrexate can affect the way the kidneys work, though normally this only happens when it is administered in high doses. You will have blood tests before and during the treatment to see if this is the case. Before and after chemotherapy, you will receive additional fluids through a drip to protect your kidneys.

Tell your nurse if there are any changes in the amount of urine you produce. You may be given a sodium-bicarbonate drip or tablets during treatment to lower the risk of kidney problems. The nurses will also test your urine regularly.

EYE PROBLEMS

You may feel soreness in your eyes and your eyes may become more sensitive to light. Your doctor can prescribe eye drops to help this. If your eyes become red and inflamed (conjunctivitis), tell your doctor, as you may need antibiotic drops. Methotrexate can cause blurry vision or soreness of the eyes. Always tell your doctor or nurse if you have soreness in the eyes or notice any changes in your vision.

MUSCLE AND JOINT PAIN

You may have pain in your joints or muscles for a few days after chemotherapy. Tell your doctor if this happens so they can prescribe you some painkillers. Let them know if your pain doesn't go away. Try to get lots of rest. Taking warm baths on a regular basis can help.

ABDOMINAL PAIN

You may have stomach pain or discomfort, feel bloated, have indigestion or feel gassy. Your doctor can prescribe medication to help these symptoms get better. Let them know if your pain doesn't go away or if it worsens.

CHANGES IN THE LIVER

Methotrexate can affect the functioning of your liver. These changes are normally mild and return to normal after the treatment. You will have blood tests done to see how your liver is working.

HEADACHES

Methotrexate can cause headaches. If this happens, tell your doctor or nurse. They can give you painkillers for this.

LESS COMMON SIDE EFFECTS OF METHOTREXATE

EFFECTS ON THE NERVOUS SYSTEM

When taken in high doses, methotrexate can affect the nervous system. You may feel drowsy or confused. Tell your doctor or nurse immediately if you have any of these symptoms. It is important not to drive or operate machinery if you notice these effects. In rare cases, methotrexate can cause seizures. Your doctor or nurse will tell you more about this.

EFFECTS ON THE LUNGS

Methotrexate can cause changes in the lungs. Always let your doctor know if you have wheezing, coughing, fever, or if you are out of breath. If necessary, tests can be done to check your lungs.

INTRATHECAL CHEMOTHERAPY

If you have intrathecal chemotherapy, you may have different side effects from those mentioned above. Intrathecal methotrexate can cause headaches, dizziness, tiredness, blurry bision, and loss of balance for several hours. Tell your doctor if you have any of these symptoms.

MORE INFORMATION ABOUT METHOTREXATE

BLOOD CLOT RISK

Cancer and chemotherapy increase the chances of a blood (thrombosis). The symptoms include pain, reddening or swelling in a leg, difficulty breathing, and pain in the chest. Get in touch with your doctor immediately if you have any of these symptoms.

OTHER DRUGS

Some medicines can interact with chemotherapy or be harmful if they are taken alongside chemotherapy. This includes medications that can be purchased in a store or pharmacy. Tell your doctor the medicines you are taking, including over-the-counter medications, complementary therapies, and herbal medicines.

ALCOHOL

Your doctor will advise you against drinking alcohol while taking methotrexate, as it can interact with the medication.

FERTILITY

Methotrexate may affect your fertility. If this worries you, you can talk to your doctor before beginning treatment.

CONTRACEPTION

Your doctor will advise you not to become pregnant during the treatment. This is because the drugs can harm developing babies. It is important to use contraception during chemotherapy and for a few months after the treatment ends.

SEX

If you have sex within the first few days after chemotherapy, it is necessary to use a condom. This is to protect your partner in case there is chemotherapy in semen or vaginal fluid.

BREASTFEEDING

Women are recommended not to breastfeed during treatment and for a few months after chemotherapy has concluded. This is in case the chemotherapy enters their breast milk.

MEDICAL AND DENTAL TREATMENT

If you have to go to the hospital for whatever reason other than cancer, always tell the doctors and nurses that you are having chemotherapy.

Talk to your cancer doctor or nurse if you think you need dental treatment. Always let your dentist know that you are having chemotherapy.