How is intravenous methotrexate given?
Intravenous methotrexate is given as an infusion into a vein (intra-venously or IV) through a cannula, central venous catheter or implantable port.
What are the side effects of intravenous methotrexate?
Many of the side effects mentioned are minimised by giving a drug called folinic acid. Your child may be given this 24 to 36 hours after the start of treatment with intravenous methotrexate. Please ask your doctor, nurse or pharmacist to explain this to you in more detail.
Mouth sores and ulcers
You will be given advice about appropriate mouth care and a copy of the mouth care leaflet. If your child complains of having a sore mouth, please tell your doctor or nurse.
Loss of appetite
It is possible that your child’s appetite may decrease while having treatment. If you are concerned about your child’s diet please ask to speak to one of the dietitians.
Sensitivity of skin to sunlight
While your child is having methotrexate, his or her skin may burn more easily than usual. You should avoid your child being exposed to sunlight and other forms of ultraviolet light. If your child does go out in the sun, always use a good sunblock of SPF 25 or higher and ensure they wear a sun hat.
The following side effects occur when higher doses of the drug are given:
Nausea and vomiting
Anti-sickness drugs can be given to reduce or prevent these symptoms. Please tell your doctor or nurse if your child’s sickness is not controlled or persists.
Altered kidney function
Methotrexate may change how well your child’s kidneys work over a period of time. Your child may have a blood and urine test or a GFR (Glomerular Filtration Rate) before treatment is started and then at stages during and after treatment to monitor kidney function.
Temporary effect on liver function
Methotrexate can sometimes cause changes to your child’s liver function. This should return to normal when the treatment is finished. Blood tests may be taken to monitor your child’s liver function (LFTs).
Bone marrow suppression
There will be a temporary reduction in how well your child’s bone marrow works. This means he or she may become anaemic, bruise or bleed more easily than usual, and have a higher risk of infection. Your child’s blood count will be checked regularly to see how the bone marrow is working. Please tell your doctor if your child seems unusually tired, has bruising or bleeding, or any signs of infection, especially a high temperature.
Please tell your doctor or nurse if your child has diarrhoea which is not controlled or persists. It is important that your child drinks lots of fluids.
Your child may complain of feeling dizzy while receiving high dose methotrexate. This is temporary. Please tell your doctor if your child experiences any dizziness.
Intravenous methotrexate and interactions with other medicines
Some medicines can react with methotrexate, altering how well it works. Always check with your doctor or pharmacist before giving your child any other medicine, including medicines on prescription from your family doctor (GP), medicines bought from a pharmacy (chemist) or any herbal or complementary medicines.
Important information you should know about intravenous methotrexate
If your child is taking co-trimoxazole, this should be stopped before treatment with intravenous methotrexate. Your doctor or nurse will explain this to you in more detail.
Last reviewed by Great Ormond Street Hospital: November 2009
Ref: 09F0487 © GOSH Trust November 2009
Compiled by the Pharmacy department in collaboration with the Child and Family Information Group
Please read this information in conjunction with any patient information leaflet provided by the manufacturer. However, please note that this information explains about the use of medicines in children and young people so may differ from the manufacturer’s information. Each person reacts differently to medicines so your child will not necessarily suffer every side effect mentioned. This information does not constitute health or medical advice and will not necessarily reflect treatment at other hospitals. If you have any questions, please ask your doctor. No liability can be taken as a result of using this information.