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Methotrexate is a medication that can lead to serious, potentially fatal side effects and should be used solely for treating severe conditions caused by an overactive immune system, such as psoriasis and rheumatoid arthritis. Below are crucial safety warnings and precautions to consider when using this medication:

• Risks to Unborn Babies: Methotrexate can cause severe harm, including birth defects and death, to an unborn baby. Pregnant women or those planning to become pregnant must not use this medication. Effective birth control is advised during treatment and for at least six months afterwards for females and three months for males.

• Impact on Blood Cells: This drug can decrease blood cell production, increasing the risk of infections, anemia, and bleeding. Regular blood tests are recommended to monitor your blood cell counts. If you experience symptoms like muscle weakness, unexplained bruising, or fever, contact your healthcare provider immediately.

• Potential for Severe Reactions: In rare cases, methotrexate can cause life-threatening allergic and skin reactions. Seek medical assistance if you encounter trouble breathing, facial swelling, rash, or peeling skin.

• Liver and Kidney Concerns: Long-term use may lead to liver issues, potentially requiring a liver biopsy. Individuals with kidney problems or fluid retention may need dose adjustments or more frequent monitoring.

• Interactions with NSAIDs: High-dose methotrexate can lead to serious complications when combined with NSAIDs. Only use NSAIDs or aspirin with methotrexate under medical guidance.

• Risk of Cancer: There is a possibility of developing cancers such as skin and blood cancers. Report any unusual symptoms like unexplained fever, fatigue, or unusual skin changes to your doctor.

• Tumor Lysis Syndrome: Methotrexate can cause tumor lysis syndrome (TLS) in patients with tumors. Symptoms include nausea, vomiting, muscle cramps, and changes in urination. Contact your doctor if these occur.

• Possible Infertility: Methotrexate may affect fertility, potentially causing menstrual issues or low sperm count. Discuss these risks with your healthcare provider if you plan to have children.

• Contraindications: Methotrexate should not be used by individuals who are pregnant, have alcohol use disorder, liver problems, a weak immune system, or blood issues such as low platelets or anemia.

In case of an overdose, seek emergency medical attention promptly. Always consult with your healthcare provider regarding any concerns or questions about using methotrexate safely.

When using this medication, some common side effects may include nausea, vomiting, diarrhea, and stomach pain. These are generally mild, but if they persist or worsen, it is advisable to consult a healthcare provider. Temporary hair loss may also occur, but normal hair growth typically resumes after the treatment concludes. Some individuals may experience dizziness, drowsiness, or headaches. Additionally, the skin may become more sensitive to sunlight, and there may be changes in liver test results or low platelet levels.

More serious side effects, though rare, require immediate medical attention. These include severe allergic reactions such as rash, trouble breathing, and swelling of the face or throat. Serious skin reactions like blisters, peeling skin, and sores in the mouth, as well as lung issues like trouble breathing and fever, also fall under this category. Liver damage can manifest as stomach pain, persistent nausea, yellowing of the skin or eyes, and dark urine. Kidney problems might present as reduced urination, itchy skin, or bloody urine.

Serious neurological effects include seizures, confusion, vision changes, and weakness on one side of the body. The medication may lower blood cell counts, leading to symptoms like tiredness, easy bruising, and pale skin. Infections may become more likely or severe, with symptoms such as fever, persistent cough, chills, and muscle weakness. Although very rare, the development of cancerous tumors has been reported. Always seek prompt medical attention if you experience any severe or unusual symptoms.

Methotrexate may interact with various medications, potentially leading to increased side effects or reduced effectiveness. It's important to inform your doctor and pharmacist about all the medications and supplements you are taking, including prescription, over-the-counter, vitamins, and herbal products.

Certain drugs, such as those that reduce stomach acid like esomeprazole, omeprazole, and pantoprazole, can raise methotrexate levels in your blood, heightening the risk of side effects, especially with high doses. Additionally, medications like acitretin, asparaginase, leflunomide, penicillins, phenytoin, probenecid, procarbazine, pyrimethamine, sulfa drugs, and tetracyclines may interact with methotrexate.

Live vaccines (such as measles, mumps, rubella, varicella, and zoster vaccines) should generally be avoided while on methotrexate. Use of NSAIDs like ibuprofen, aspirin, and other similar drugs may require careful monitoring or dosage adjustments by your doctor.

Moreover, combining methotrexate with certain other medications, such as amiodarone, cyclosporine, eltrombopag, and theophylline, may increase side effect risks, but might be necessary for optimal treatment. Always consult your healthcare provider for guidance on managing these interactions safely.