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Methotrexate is a powerful medication used to treat certain cancers and severe autoimmune disorders like psoriasis and rheumatoid arthritis. However, it carries significant risks that require careful consideration and monitoring. Here are important safety details to understand:

• Pregnancy Risks: Methotrexate can cause severe harm to an unborn child, including birth defects and miscarriage. Women should not become pregnant while using this drug, and pregnant women with non-cancer conditions must avoid it.

• Allergic Reactions: Some individuals may experience allergic reactions. Seek immediate medical attention if you notice symptoms like itching, fever, nausea, trouble breathing, or a rapid heartbeat.

• Blood Cell Counts: This medication can lead to low blood cell counts, increasing the risk of infections, fatigue, and bleeding. Regular monitoring is essential, especially at higher doses.

• Digestive Tract Issues: Methotrexate can cause gastrointestinal problems like vomiting, diarrhea, mouth sores, and stomach bleeding. Report any severe symptoms to your healthcare provider promptly.

• Liver Health: Long-term use can lead to liver damage. Regular liver function tests are recommended, and alcohol consumption should be minimized to reduce risk.

• Lung Conditions: Serious lung issues, including interstitial lung disease, may occur. Notify your doctor if you experience a persistent cough, breathing difficulties, or fever.

• Skin Reactions: Severe skin problems, such as Stevens-Johnson syndrome, may arise. Immediate medical intervention is necessary if you develop painful blisters or peeling skin.

• Kidney Function: Methotrexate can impair kidney function. Monitoring kidney health is crucial, and adjustments in therapy may be needed if issues arise.

• Dosage Accuracy: Strict adherence to prescribed dosages is vital to prevent life-threatening side effects. Methotrexate is typically not taken daily, so careful adherence to your prescribed schedule is critical.

• Folic Acid Levels: This drug affects folic acid levels. While it is used to treat cancer by reducing folic acid, supplements should be avoided unless specifically directed by your doctor.

• Infection Risk: The risk of infections increases, particularly with opportunistic infections. Report any signs of infection, such as fever or cough, immediately.

• Nervous System Effects: Serious neurological issues can develop, including headaches, confusion, and seizures. These may be temporary or permanent, so regular evaluation is important.

• Cancer Risks: New cancers have been reported in some patients, particularly involving white blood cells. Discuss any concerns with your healthcare provider.

• Tumor Lysis Syndrome: For cancer patients, this syndrome can occur and must be managed by staying hydrated and possibly taking additional medications.

• Infertility Concerns: Methotrexate may affect fertility in both men and women. Discuss fertility preservation options with your doctor if future childbearing is a consideration.

• Fluid Retention: Extra body fluid can increase the risk of side effects. Your healthcare provider will manage any fluid retention issues before starting treatment.

If any contraindications apply, such as having a history of severe allergic reactions to methotrexate or current pregnancy (when used for non-cancer conditions), consult your healthcare provider immediately. Always discuss the risks and benefits with your healthcare provider to ensure safe and effective treatment.

When taking this medication, you may experience some common side effects that are typically mild but should be addressed if they persist or worsen. These include nausea, vomiting, stomach pain, dizziness, drowsiness, and temporary hair loss, which usually resolves after treatment. Some individuals may also encounter mouth sores, diarrhea, or feel unusually tired. It's important to monitor for any signs of infection, such as fever, chills, or a sore throat, as this medication can lower your ability to fight infections.

In rare cases, more serious side effects may occur, requiring immediate medical attention. These include severe liver issues characterized by persistent nausea, vomiting, dark urine, stomach pain, or yellowing of the skin and eyes. Kidney problems may manifest as changes in urine output, while severe allergic reactions can cause rash, swelling, or difficulty breathing. Neurological symptoms such as severe headache, vision changes, or seizures, and cardiovascular issues like an irregular heartbeat, are also considered serious.

Additionally, the medication can lead to serious infections due to low white blood cell counts, marked by a high fever, fast heartbeat, or confusion. Serious lung complications may present with sudden cough or difficulty breathing. If you notice any of these severe side effects, it is crucial to seek urgent medical care. Always stay vigilant for any unusual symptoms and contact your healthcare provider if you have concerns.

Methotrexate, also known as Trexall, can interact with several other medications. It is crucial to inform your doctor and pharmacist about all the medicines and supplements you are currently taking, including prescription drugs, over-the-counter medications, vitamins, and herbal supplements. Not all possible interactions are listed here, but these are some key ones to be aware of:

1. Avoid Concurrent Use:

   • Methotrexate should not be used with live vaccines such as those for measles, mumps, rubella, varicella, and zoster, as these can interact unfavorably.

2. Use with Caution:

   • Drugs like Acitretin, asparaginase, Leflunomide, penicillins, Phenytoin, Probenecid, procarbazine, pyrimethamine, sulfa medications, tetracyclines, and certain others may not be recommended. However, if necessary, your doctor might adjust dosages or alter your treatment plan.
   • Proton pump inhibitors (PPIs) such as esomeprazole, Omeprazole, and Pantoprazole can increase methotrexate levels in your blood, heightening the risk of side effects, particularly with high doses of methotrexate. Discuss with your healthcare professional how to minimize these risks.

3. Increased Side Effect Risk:

   • Medications like Amiodarone, Cyclosporine, eltrombopag, etoricoxib, Mercaptopurine, procarbazine, rofecoxib, and Theophylline might raise the likelihood of side effects when used with methotrexate. Your doctor may modify how you take one or both medications to safely incorporate them into your treatment plan.

Always consult with your healthcare provider before making any changes to your medication regimen.