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
August 2023: Methotrexate: advise patients to take precautions in the sun to avoid photosensitivity reactions
September 2020: Methotrexate once-weekly for autoimmune diseases: new measures to reduce risk of fatal overdose due to inadvertent daily instead of weekly dosing
December 2014: Mercaptamine and mercaptopurine: confusion between drug names
NG100: Rheumatoid arthritis in adults: management, updated October 2020
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. Mercaptopurine for inflammatory bowel disease and methotrexate for severe Crohn's disease are unlicensed uses.
Also refer to the Kent and Medway position statement for prescribing oral methotrexate.
Not licensed for use in severe ulcerative colitis and Crohn's disease
| Pack | Price |
|---|---|
| 25 tablet | £9.42 |
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, the frequency and the reasons for taking methotrexate and any other co-prescribed medication e.g. 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
- See drug safety update Sept 2020 (link above) for further advice
| Pack | Price |
|---|---|
| 100 tablet | |
| 24 tablet | |
| 28 tablet |
| Pack | Price |
|---|---|
| 35 ml | £250.80 |
| 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 |