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Methotrexate

Amethopterin, MTX
Folex PFS, Rheumatrex Dose Pak (treatment of psoriasis or rheumatoid arthritis)

Pregnancy Category X

Drug classes

Mechanism of action

Inhibits folic acid reductase, leading to inhibition of DNA synthesis and inhibition of cellular replication; selectively affects the most rapidly dividing cells (neoplastic and psoriatic cells).

Indications

Treatment of gestational choriocarcinoma, chorioadenoma destruens, hydatidiform mole
Treatment and prophylaxis of meningeal leukemia
Symptomatic control of severe, recalcitrant, disabling psoriasis
Management of severe, active, classical, or definite rheumatoid arthritis

Unlabeled uses: high-dose regimen followed by leucovorin rescue for adjuvant therapy of nonmetastatic osteosarcoma (orphan drug designation); to reduce corticosteriod requirements in patients with severe corticosteroid-dependent asthma.

Contraindications

Allergy to methotrexate
Lactation
Proriasis with renal or hepatic disorders
Pregnancy or childbearing age

Use caution in the presence of hematopoietic depression; leukopenia, thrombocytopenia, anemia, severe hepatic or renal disease, infection, peptic ulcer, ulcerative colitis, debility.

Adverse effects

CNS: Headache, drowsiness, blurred vision, aphasia, hemiparesis, paresis, seizures, fatigue, malaise, dizziness
GI: Ulcerative stomatitis, gingivitis, pharyngitis, anorexia, nausea, vomiting, diarrhea, hematemesis, melena, GI ulceration and bleeding, enteritis, hepatic toxicity
Respiratory: Interstitial pneumonitis, chronic interstitial obstructive pulmonary disease
Hematologic: Bone marrow depression, increased susceptibility to infection
GU: Renal failure, effects on fertility (defective oogenesis, defective spermatogenesis, transient oligospermia, menstrual dysfunction, infertility, abortion, fetal defects)
Dermatologic: Erythematous rashes, pruritus, urticaria, photosensitivity, depigmentation, alopecia, ecchymosis, telangiectasia, ance, furunculosi
Hypersensitivity: Anaphylaxis, sudden death
Other: Chills and fever, metabolic changes (diabetes, osteoporosis), cancer

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