Methotrexate

Patient Information

Methotrexate   – In Inflammatory Bowel Disease

Why am I being prescribed Methotrexate?

Some patients with resistant Crohn’s disease (and possibly some cases of resistant ulcerative colitis) are considered for treatment with methotrexate when other treatments have failed. Studies have demonstrated that about 40 % of patients with steroid dependent Crohn’s disease will respond to methotrexate and be able to stop steroids. Treatment has been based on experience with this drug in other inflammatory conditions such as rheumatoid arthritis.Methotrexate does not work immediately; it may be 4-12 weeks before you notice any direct benefit from the treatment. You should therefore continue to take any other medication that has been prescribed for you unless instructed otherwise.

Fertility

It is important to tell you doctor if you are pregnant or breast feeding, or wishing to become pregnant or father a child. Pregnancy should be avoided whilst you are on methotrexate and for 6 months after stopping the drug. Men should not try to father a child whilst taking methotrexate, and for 6 months after stopping it.

What dose of methotrexate will I receive?

Patients are initially prescribed a dose of 25mg to be given once each week. This will usually be in the form of an intra-muscular injection for the first 12 weeks. Most GP practices are not happy to initiate this treatment so you will be required to attend an outpatient appointment for this. If you appear to be responding, a switch is then made to a 15mg maintenance dose given orally once a week.

Folic Acid.

There is good evidence that taking a regular dose of folic acid may reduce the risk of some of the gastrointestinal side effects. You’re doctor will prescribed this for you.

What are the possible side effects associated with this drug?

The most frequent side effects are nausea, vomiting, inflammation of the mouth and diarrhoea. Methotrexate can also suppress the levels of white blood cells (responsible in defending against infection); so regular blood tests are required. Long-term use has been associated with liver and lung fibrosis.Methotrexate is not advised for use in patients with known significant renal impairment because it is excreted primarily by the kidneys. It is also contra-indicated in patients with severe liver disease.

Can I drink alcohol whilst taking methotrexate?

 You should be careful with your alcohol intake whilst you are on methotrexate, but this does not mean you need to stop it completely.

Other things you need to know about methotrexate.

If you develop mouth ulcers, a sore throat, bruising, a dry cough or become breathless, you should tell your doctor.

You should tell your doctor urgently if you come into contact with someone who has chickenpox or shingles, or if you catch either of these.

You should avoid immunizations that involve any of the live vaccines whilst you are taking methotrexate.

What if I have other questions?

Please contact your specialist nurse or consultant.

Patient.co.uk is a useful website:

http://www.patient.co.uk/medicine/Methotrexate

Summary of efficacy

Although corticosteroids are effective for treating Crohn’s disease, approximately 20% of patients who respond become sick again when steroids are withdrawn and become steroid dependent. Furthermore, corticosteroids exhibit significant adverse effects. This review shows that methotrexate (25 mg/week) injected intramuscularly for 16 weeks among patients with active treatment resistant Crohn’s disease may be an effective treatment. Although mild side effects are more common with high dose methotrexate therapy, no serious side effects have been observed. Lower doses of methotrexate (12.5 to 15 mg/week) taken orally are not effective treatment for Crohn’s disease. There is also evidence that methotrexate reduces the need for steroid treatment. This reduction in steroid use could reduce steroid induced side effects for people with chronic Crohn’s disease.