Methotrexate (Non-Cancer)

• Methotrexate should be taken as prescribed by the doctor. It is usually given orally once weekly, taken at the same day of each week. Occasionally, the dose is split into 2 doses taken at 2 different days of the week, to improve absorption or avoid side effects such as nausea.
• A typical adult dose ranges from 7.5 milligrams to 25 milligrams per week. For children , the dose is usually calculated based on body weight or body surface area. The dose varies for each person depending upon many factors such as how active your disease is and how you respond to or tolerate the medicine. Your doctor may reduce the dose if you have kidney or liver problem.
• To maximise the absorption, Methotrexate should be taken on empty stomach (an hour before food or 2 hours after food). However, if you experience stomach discomfort taking Methotrexate on empty stomach, you may take it with food. If you vomit within a few hours of taking Methotrexate, do not take another dose. Make a note and let your doctor know if this happens again the following week.
• Drink plenty of water (preferably at least 8 glasses of water per day, unless otherwise advised by your doctor) while you are taking Methotrexate.
• Methotrexate tablets should be swallowed whole, with a glass of water. The tablets should not be crushed or chewed.
• However, for people who are unable to swallow tablets whole, your pharmacist may advise you to soak the tablets in water for a few minutes before grinding them  to minimise the inhalation of medicine powder. Talk to your pharmacist for further details if you have difficulty swallowing.
• Rarely, your doctor may prescribe Methotrexate injection to replace the oral tablet to achieve better result. It is to be given via injection under the skin (subcutaneously) of your stomach, thigh or upper outer arm. You or your carer should receive training on how to inject Methotrexate from your doctor, pharmacist or specialty nurse prior to attempting the administration on your own. Always remember to rotate the injection site.
• You may start to see improvement within a few weeks, but it may take up to 3 months to experience its full benefit.

If you forget to take a dose, take it as soon as you remember if this is within two days of the scheduled dose. For example, scheduled dose is on Monday, you remember on Wednesday, take Methotrexate on Wednesday and return to Monday schedule the next week.

Otherwise, skip the forgotten dose and continue with your regular dosing schedule. For example, scheduled dose is on Monday, you remember on Friday, skip dose and take usual dose next Monday.

Do not take a double dose to make up for the forgotten dose.