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Below is a rephrased version of critical safety and warning information for methotrexate. Please read carefully and consult your healthcare provider with any questions or concerns.

• Risk to Unborn Babies: Methotrexate poses a significant risk to unborn children, potentially causing harm or miscarriage. Therefore, it is contraindicated for non-cancer conditions during pregnancy.

• Allergic Reactions: Some individuals may experience allergic reactions, including symptoms like itching, fever, nausea, difficulty breathing, or a rapid heartbeat. Seek immediate medical attention if symptoms of anaphylaxis, such as hives, facial swelling, or throat tightness, occur.

• Preservative Concerns: Certain methotrexate injections contain benzyl alcohol, which can be harmful, particularly to newborns, individuals receiving high doses, or those undergoing intrathecal injections. These groups should avoid benzyl alcohol-containing formulations due to potential neurological risks.

• Blood Cell Count Reduction: Methotrexate may lead to decreased blood cell counts, elevating the risk of fatigue, bleeding, and infections, especially at cancer treatment dosages.

• Infection Risk: The medication increases susceptibility to infections, including opportunistic infections. Preventative treatments, like antibiotics, might be prescribed based on your condition and concurrent medications. Contact your provider promptly if you exhibit symptoms such as fever, severe fatigue, or respiratory difficulties.

• Kidney Damage: The drug can potentially damage the kidneys, with an increased risk for those with pre-existing kidney issues or on high-dose methotrexate. Regular monitoring of kidney function is essential, and protective measures such as intravenous hydration may be recommended.

• Liver Damage: Although rare, methotrexate can cause liver issues, including cirrhosis or liver failure. Discuss the risks and benefits with your provider if you have liver concerns, particularly with heavy alcohol consumption.

• Nervous System Complications: Serious conditions like seizures, vision changes, or coma can occur, especially with high doses or intrathecal injections. Past brain radiation therapy may elevate this risk.

• Gastrointestinal Issues: Methotrexate can cause digestive tract damage, leading to symptoms like vomiting or stomach bleeding. Immediate care is required for sudden abdominal pain or bloody stools.

• Lung Issues: Some users develop interstitial lung disease, a serious condition that can be life-threatening. Report new or worsening respiratory symptoms to your provider at once.

• Severe Skin Reactions: Serious skin conditions, such as Stevens-Johnson syndrome, may develop. Notify your provider immediately if blisters or skin peeling occurs.

• Folic Acid Levels: Methotrexate reduces folic acid in the body, critical for cell growth. Avoid folic acid supplements when using methotrexate for cancer treatment, as they can reduce the drug's effectiveness.

• Potential New Cancers: Rarely, methotrexate use has been linked to the development of new cancers, especially in the white blood cells.

• Tumor Lysis Syndrome: This potentially dangerous condition can occur with cancer treatment, leading to elevated uric acid and potassium levels.

• Infertility Risks: Methotrexate might affect fertility, causing issues like low sperm count or menstrual problems. Discuss fertility preservation with your provider if future family planning is a concern.

• Radiation Therapy Risks: When combined with radiation treatment, methotrexate may increase the risk of tissue and bone damage.

• Fluid Retention Concerns: Methotrexate can accumulate in body fluids, prolonging its presence and increasing side effects. Your provider will monitor and manage any fluid buildup.

• Dosing Errors: Methotrexate dosages vary significantly between cancer and non-cancer uses. Incorrect dosing can lead to severe side effects, emphasizing the need for careful adherence to prescribed amounts.

Contraindications:

• Do not use methotrexate if you have had a severe allergic reaction to it.
• Pregnant individuals should not take methotrexate for non-cancer conditions.

Always discuss any health conditions or concerns with your healthcare provider before starting methotrexate.

Common side effects:

• Mouth sores
• Nausea or vomiting
• Diarrhea
• Stomach pain
• Tiredness
• Dizziness
• Chills
• Fever

Less common but important to monitor:

• Infections
• Elevated liver enzymes
• Low white blood cell counts
• Low platelet levels

Serious side effects:

• Serious infections due to low white blood cell counts
• Blood in urine or stool
• Nosebleeds
• Unexplained or persistent bruising or bleeding
• Severe lung problems
• Serious liver issues
• Nervous system complications
• Serious skin reactions
• Allergic reaction