Methatraxate question

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Specializes in Cardiolgy.

What is Methatraxate used for? I looked it up in my BNF, but the only uses it had listed were for the treatment of childhood lukemia, which the patient I came accross did not have ( he was an adult with triple vessel disease).

So does anyone have a newer BNF,which gives more details? I tried the BNF website, I couldn't get any indications to come up though!

Whisper

P.S please excuse any spelling errors,my cold has actually turned into a chest infection, and I don't want to leave my cacoon of blankets to get up and get my dictionary to check the spellings.

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Specializes in ER CCU MICU SICU LTC/SNF.

You mean Methotrexate?

http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202355.html

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Specializes in Cardiolgy.

It sounds like it could be, not sure if the spelling is my mistake or just one of those instances where the US and UK just like to differ!

Thanks

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Specializes in midwifery, ophthalmics, general practice.

methotrexate is one nasty drug. used in crohns, rheumatic disease, psoriasis and malignant disease. its a cytotoxic drug.. so I dont normally deal in it!! It inhibits the enzyme dihydrofolate redutase, essential for the synthesis of purines adn pyrimdines. can be given orally, IV, IM or intrathecally. is uses as maintence therapy in childhood acute lymphoblastic leukaemia. I could go on.. get a new BNF! or try an index medicus- should have one in the library. there is about 2 pages on it!! Its basically a nasty drug which is prepared under controlled conditions and should be given very carefully!!

if you cant find more info- let me know- I can always photocopy some stuff and send it to you!!

Karen

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Specializes in Cardiolgy.

Thanks Karen.

I shouldn't really complain about my BNF as it was a freebie! I will try and scrounge a newer one after march when the wards get their new ones... the only trouble is with the medical school opening there is a lot more competition for the books!!

I will try and get a look at an index medicus, I went into uni for an hour today and ended up back in bed, hence the pestering for information.

Methotrexate had me wondering because a patient I admitted came in on it, I got the staff grade to write it up onto the drugcard, and pharmacy rang to check the dose. Which lead to me being paranoid, I asked the pt, and they told me the same dose on three occasions, I couldn't find the pts drug card form the transfering ward, but I did find the consultants letter in the medical notes which stated the dose.

I started to really worry when I couldn't find any info on it, I was really worried in case I had got the guy written up for a leukaemia drug, no matter how many people I got to check it with me. But he did have a history of Ca. so it must have been for that.

Thanks for the offer of photocopying, I will try and see what I can find, I don't want to make more work than my usualy questions for anyone :)

Whisper

P.s. if I do end up having to buy a new BNF, where could I order one from, my uni book store and amazon always seem to be about two editions behind... and if I am going to shell out for one,I might as well try and get the newest possible :)

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Things you must know about Methotrexate. It has to be given with a rescue drug called Leukovorin. http://www.tirgan.com/leucvrn.htm

It is a rescue drug, Metho. will completely wipe out all white blood cells, and Leucovorin saves them.

There is also a silent practice using Metho. off label use in conjunction with cytotec to terminate pregnancy

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Specializes in Cardiolgy.

I hadn't heard of Leucovorin, but I am almost sure the pt was on folic acid the rest of the week apart from the one day he was on Methotrexate.

Thanks for the interesting link

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Specializes in midwifery, ophthalmics, general practice.
Things you must know about Methotrexate. It has to be given with a rescue drug called Leukovorin. http://www.tirgan.com/leucvrn.htm

It is a rescue drug, Metho. will completely wipe out all white blood cells, and Leucovorin saves them.

There is also a silent practice using Metho. off label use in conjunction with cytotec to terminate pregnancy

actually I dont think we do that here but I will check as I do have a couple of patients who are on it and I am fairly sure theyre not on leukovorin. will check though. - take that back........just looked.. its calcium folinate, given to counteract the folate- antagonist action of methotrexate. NOW I am going to have to check.. except my patients are on it for moderate to severe rheumatoid arthritis and no mention in the BNF about needing to give calcium folinate with it in such circumstances. ok- off to find my Rang, Dale and Ritter pharmocology text book!!

and whisper.. I can send you an more up to date BNF- we always have some kicking around when the docs get their new ones.. ok it will be 6mth out of date but its free!! let me know if you want me to send it. I can let you have a nurse prescribers BNF!!

Karen

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Used as a chemotherapy, IV, the patient will die without Leukovorin

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Specializes in Cardiolgy.

Oh yes please!

started to do happy dance around room.... collapsing into coughing fit! that would be wonderful, only sixth months out, that would be fantastic:)

Can I PM you with my address?

whisper

:)

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I shouldn't really complain about my BNF as it was a freebie! I will try and scrounge a newer one after march when the wards get their new ones... the only trouble is with the medical school opening there is a lot more competition for the books!!

P.s. if I do end up having to buy a new BNF, where could I order one from, my uni book store and amazon always seem to be about two editions behind... and if I am going to shell out for one,I might as well try and get the newest possible :)

Whisper

Try your local chemist ,rather than the Hospital, my local pharmacist is a endless source of info and BNF's.

Tip

I wandered in uniform the first time. (but that will probely be contray to your local uniform Policy)

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There is also a silent practice using Metho. off label use in conjunction with cytotec to terminate pregnancy

Not so much silent. It is an accepted and approved practice to use it for ectopic pregnancy. With the side effects, I am not sure anyone would want to use it for routine termination of pregnancy. It is quite effective though, I believe it is used more in Canada for non-ectopic pregnancy termination than it is in the US. There are several other effective methods without the associated risks of methotrexate.

http://www.fpnotebook.com/OB118.htm

A long read on ectopic pregnancy, including a discussion of methotrexate:

http://www.emedicine.com/med/topic3212.htm

Methotrexate is an antimetabolite chemotherapeutic agent that binds to the enzyme dihydrofolate reductase, which is involved in the synthesis of purine nucleotides. This interferes with DNA synthesis and disrupts cell multiplication. Methotrexate has long been known to be effective in the treatment of leukemias, lymphomas, and carcinomas of the head, neck, breast, ovary, and bladder. It has also been used as an immunosuppressive agent in the prevention of graft versus host disease and in the treatment of severe psoriasis and rheumatoid arthritis. Its effectiveness on trophoblastic tissue has been well established and is derived from experience gained in using methotrexate in the treatment of hydatiform moles and choriocarcinomas. Methotrexate is used in the treatment of ectopic pregnancy as single or multiple intramuscular injections.

bob

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