When your immune system responds in an abnormal manner, it can give way to an autoimmune medical condition. The list of such conditions includes ailments such as diabetes, cancers, arthritis (rheumatoid), lupus, multiple sclerosis, bowel related disorders, etc. Conditions such as arthritis can make your joints to swell and can lead to stiffening of muscles. The causes for many of these autoimmune medical conditions remain largely unknown. However, hereditary factors are attributed to lupus; while external factors such as environment, infections, etc. also are some of the other causes. Treatments accorded to these conditions include administration of immunity suppressing drugs as well as a few types of non-steroidal anti-inflammatory drugs (referred as NSAIDs). Methotrexate is a commonly prescribed drug for the treatment of autoimmune conditions such as arthritis, etc. It is recommended to understand the side effects of this drug before its intake.

Methotrexate is widely prescribed for the treatment of autoimmune conditions like psoriatic as well as rheumatoid arthritis. The initial use of this drug was however restricted to treatment of cancers – especially, cancers in head & neck, lungs, breasts and lymph nodes. This drug is used in its high-strength forms while being administered as part of chemotherapy. In extremely lower dosage forms, methotrexate is a common drug for rheumatoid-arthritis. In order to enhance the management of pain, it is used in combination with analgesic drugs or with non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, etc. As an extended advantage, when people living with autoimmune disorders (such as arthritis) take methotrexate, they witnessed reduced risks of strokes or cardiac arrests and such myocardial problems.

As a chemotherapeutic drug it functions very differently while it is administered for treating arthritis. While treating cancers, it inhibits enzymes responsible for the synthesis of proteins as well as RNA and DNA. In case of arthritis (rheumatoid), it works mainly on the T cells – i.e., lymphocytes which are critical for the development of an adaptive and flexible immunity. In essence, it reduces the functioning as well as effects of your immune system to help treat arthritis. Methotrexate forms part of a family of medications called as antimetabolites; such drugs essentially stop the growth of cells through division (cellular divisions). As this drug can interfere in the absorption of folate (or folic acid), its action is considered as very similar to several anti-folate substances.

Side effects of methotrexate

Methotrexate can cause a few adverse side effects. Some of its side effects are common and may go away once your body adapts well to this drug; however, if these common side effects do not go away in a few days, you are advised to talk to your treating doctor without any further delay. On the other hand, a few of its side effects can be serious or very acute in nature. Most commonly experienced side effects of methotrexate are drowsiness, chronic headaches, feeling dizzy, changes in appetite or pain in stomach, nausea, and loss of hair as well as discoloration of eyes. In equally common instances, people have reported softening of oral parts such as gums and also inflammation. Hair lost while taking this drug may only be a temporary condition; lost hair may regrow after you stop taking this medication.

A few serious side effects of methotrexate

As mentioned, a few of the side effects may be serious; such serious side effects include epileptic fits, convulsions, blurring of eyesight, excessive spells of tiredness or weakness. Acute side effects may also include passing out, sudden and inexplicable loss of eyesight, etc. Other adverse conditions this drug may trigger are symptoms of anemia – which include weakness, excessive weariness or blighting of skin, etc., signs of hepatic conditions (like discoloration of eyes, darkened urine, pain in abdomen, etc.), symptoms of renal disorders (pain in lower part of stomach, altered output of urine, discoloration of urine, etc.) and enlargement of lymph-nodes. In rare instances, a few other acute side effects such as persistence of vomiting or nausea, indigestion, diarrhea, oral sores, etc. have also been reported. If you experience any of these side effects, you are advised to seek medical attention on an emergency basis. You can also promptly call 911 or reach out to a local poison control center located close to your home. It is also a good practice to call the emergency helpline numbers of the food and drug administration (FDA) in the US and report these acute side effects as soon as possible.

Allergic reactions methotrexate may trigger

In very rare instances, methotrexate may trigger some allergies. So, it is important to tell your doctor about any known allergies associated with the intake of this drug. In some cases, the active ingredients of a drug may not trigger any major side effects; on the contrary, a few inactive or passive items present in the drug may trigger some adverse allergic reactions. Some of the likely allergic reactions are inflammation of body parts – such as face, throat, tongue or lips; an acute spell of drowsiness or dizziness, rashes on skin, respiratory problems such as wheezing, gasping or passing out. So, if you notice any of these allergies, you are advised to talk to your doctor immediately or call 911 for help.

Prior medical conditions and the risks of side effects

It is important to remember that all the aforesaid side effects do not constitute a complete list. It is hence possible to witness new or unknown side effects – i.e., effects not listed here. So, upon experiencing any unknown symptoms or signs, it is a safe practice to tell your physician and pharmacist about them. You may also need to tell your medical team about your medical history as well as your family’s clinical history before starting to take methotrexate. If such history includes conditions such as respiratory disorders, hepatic conditions like say, cirrhosis or inflammation (hepatitis), ulcers and other intestinal problems, inadequacy of folate, anemia or other blood related disorders, renal dysfunction, etc., you need to tell your doctor before initiating the medication plan.

Safe use of methotrexate to minimise / avoid major side effects

It is likely that your doctor has prescribed methotrexate to treat arthritis (rheumatoid) or psoriasis. This drug is taken orally. The usual dosage form is once per week; the medication plan may need to be continued for several weeks for some tangible results to show up. This drug is also available as a liquid variant; care must however be taken to consume it after measuring it properly.

For measurements of liquid doses, always use the measuring device or spoon provided along with the pack. Never use a spoon or ladle from your kitchen; these practices may lead to risks of an overdose. It is also important to strictly adhere to the dosage instructions of your treating physician. You must not alter the strength of doses or increase / decrease the frequency of intake without consulting your caregiver. Always remember that such practices may not expedite the healing process.

One of the common side effects of methotrexate includes drowsiness or dizziness. It is strongly recommended not to pursue activities demanding a high level of mental agility or focus. For example, do not work on heavy equipment or machinery, and more importantly, do not drive. You also need to remember that the intake of intoxicants such as alcohol, cannabis (i.e., marijuana) can worsen the dizziness levels. Your physician may hence advise you to limit the intake or even discontinue the use of intoxicants such as alcohol.

Pregnant and breastfeeding women

This drug is very likely to harm your fetus – i.e., unborn baby. So, women who are pregnant must not use this drug. The active substances in this drug may get absorbed onto your body either through your lungs (as part of inhalation of the pill’s finer dust) or through your skin. If you are pregnant, you are advised to stay away from this drug by all possible means. As a generally accepted practice, you are advised to consume a lot of fluids while you are taking methotrexate. This will ensure that this drug and its residue are completely flushed out of your system. Presence of some remnants or residue can only trigger several adverse side effects.

The active ingredients of methotrexate are likely to get into your breastmilk. Hence, women who are nursing their infants are advised not to take this drug while breastfeeding. If you are planning to start breastfeeding, you need to wait for at least 10 days after stopping the doses of methotrexate. In general, you are advised to talk to your treating doctor if you are either pregnant or planning to breastfeed your infant.

Hypersensitivity to sunlight and related side effects on skin

You need to stay aware that methotrexate can make you additionally sensitive to sun’s rays. It is strongly advised to stay away from sun-lamps or tan-booths while using this drug. It is a very good practice to start using a sun-screen lotion as well as carry additional garments to protect you from a direct exposure to sun’s light. If you notice a discoloration of skin, or development of rashes, you need to immediately report about such changes to your treating physician or pharmacist.

Possible interactions of methotrexate with other drugs

Methotrexate may work adversely when taken along with other medications. Tell your doctor about your current medication plan; especially, if the list of medicines you already consume includes drugs like phenytoin (an anticonvulsant; also used as an anti-seizure / antiepileptic medication), cisplatin (a drug used commonly for chemotherapy), antimicrobial drugs or vaccines such as penicillin, etc. You may need to stay very careful with the use of stomach acid reducing drugs such as omeprazole or other such “azole”- genre proton pump inhibiting (PPIs) drugs. PPIs are known to enhance the residue levels of methotrexate in your system, especially in the blood. Those who take higher dosage levels of methotrexate need to talk to their physician if they have also taken medications to treat excessive build-up of stomach acids.

Above all, this drug can reduce your body’s ability to fight external attacks of microbes and the infections such attacks cause. A mild infection may hence turn into a near-fatal condition due to this factor. So, it is important to report even minor signs of a likely infection – say, symptoms such as tremors, chills, soreness of throat, coughing, increase in body temperature, etc. Extremely serious reactions are very rare. But, if you experience adverse reactions including erratic heartbeats, mood shifts, epileptic fits or convulsions, stiffness of neck, weariness felt on a particular side of your body, etc., you need to take medical attention at the soonest possible time.

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