MTW NHS Trust West Kent CCG

Drug Status Key

  • Preferred
  • Second Line
  • Third Line
  • Specialist Initiation
  • Hospital Only
  • Not Approved for Formulary

Cytotoxic responsive malignancy

Important safety information

The CSM advice has warned that there have been reports of blood dyscrasias and liver cirrhosis with low dose methotrexate. A full blood count, renal function and LFTs should be done before starting treatment and repeated weekly until the patient is stabilised. Thereafter monitor 2-3 months. Patients should be advised to report all symptoms suggestive of infection, especially sore throat and also signs of liver toxicity, e.g. nausea, vomiting, abdominal discomfort, dark urine.

Drug safety update

 December 2014: Mercaptamine and mercaptopurine: confusion between drug names

 NG100: Rheumatoid arthritis in adults: management, July 2018

 CG153: Psoriasis: assessment and management, September 2017

Mercaptopurine/Methotrexate for inflammatory bowel disease should be initiated by a specialist and used according to  NICE guidelines  and local shared care guidelines listed below. Mercaptopurine for inflammatory bowel disease is an unlicensed use.

 Shared care guideline: Mercaptopurine (Puri-Nethol®) for Inflammatory Bowel Disease

 Shared care guideline: Disease Modifying Antirheumatic Drugs (DMARDs) including dermatology indications

Not licensed for use in severe ulcerative colitis and Crohn's disease

Pack Price
25 tablet £49.15

Note: when used to treat active rheumatoid arthritis, severe Crohn's disease and severe psoriasis the dose is a WEEKLY dose. To avoid error it is recommended that:

the patient is carefully advised of the dose and the frequency and the reasons for taking methotrexate and any other co-prescribed medication eg. folic acid.

only one strength of methotrexate tablet is prescribed and dispensed usually 2.5mg

the prescription and the dispensing label clearly show the dose and the frequency of administration

the patient is warned to report immediately the onset of any feature of blood disorders, liver toxicity and respiratory effects

Pack Price
100 tablet £5.71
24 tablet £1.80
28 tablet £2.27
Pack Price
35 ml £95.00
Pack Price
1 pre-filled disposable injection £12.87
Pack Price
1 pre-filled disposable injection £13.26
Pack Price
1 pre-filled disposable injection £14.35
Pack Price
1 pre-filled disposable injection £14.41
Pack Price
1 pre-filled disposable injection £15.25
Pack Price
1 pre-filled disposable injection £15.56
Pack Price
1 pre-filled disposable injection £16.11
Pack Price
1 pre-filled disposable injection £16.13
Pack Price
1 pre-filled disposable injection £16.50
Pack Price
1 vial £72.63
Pack Price
1 vial £85.00