Oral methotrexate for haematology and oncology conditions

Methotrexate is a medicine which is used to treat certain types of cancer and leukaemia.

How is oral methotrexate given?

Oral methotrexate is given by mouth in tablet or liquid form, once a week. Your child should take methotrexate on the same day each week. If your child is also taking co-trimoxazole, he or she should not take the methotrexate on the same day.

What are the side effects of oral methotrexate?

Bone marrow suppression

This only tends to occur with higher doses. 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.  Please tell your doctor if your child seems unusually tired, has bruising or bleeding, or any signs of infection, especially a high temperature. Your child's blood count will be checked regularly to see how the bone marrow is working. Oral methotrexate doses may be changed weekly according to your child's blood count. Advice will be given by your doctor, nurse or pharmacist. Advice will be given by your doctor, nurse or pharmacist

Sensitivity of the 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.

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.

Skin rash

Please tell your doctor or nurse if your child develops a rash. They will advise you on the appropriate treatment to use.

Itchy eyes

Just as your child can develop a rash on the skin, they can get red, itchy eyes. Please tell your doctor or nurse if this occurs.

Temporary effect on liver function

Methotrexate can cause some mild 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).

Mouth sores and ulcers

You will be given advice about appropriate mouthcare including a copy of the mouth care leaflet. If your child complains of having a sore mouth, please tell your doctor or nurse.

Diarrhoea

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.

Interactions with other medicines

Some medicines can interact 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 oral methotrexate

  • Keep all medicines and tablets in a safe place where children cannot reach them.
  • Store in a cool, dry place away from direct sunlight or heat.
  • You should handle these medicines with care. Avoid touching the medicines wherever possible. If you are pregnant or think you could be pregnant, please discuss handling instructions with your doctor, nurse or pharmacist. Please see our special handling requirements information sheet for further details.
  • Methotrexate should never be given more than once a week.
  • Methotrexate tablets are made in two different strengths – 2.5mg and 10mg. They are different shapes but a similar colour so always check you have been given the correct strength by your doctor or pharmacist. Do not take the tablets if you think you have the wrong strength. Check with your doctor or pharmacist first.
  • Methotrexate is also available in liquid form. It is important to check with your doctor or pharmacist that you are giving the correct volume.
  • If your child is taking methotrexate liquid, it can only be used for four weeks once opened. Write the date you opened the bottle on the label to remind you.
  • Methotrexate should be taken as directed by your doctor, nurse or pharmacist.
  • If your child vomits after taking the dose, inform the doctor or nurse as your child may need to take another dose. Do not give them another dose without informing the doctor or nurse.
  • If you forget to give your child their dose, do not give them a double dose. Inform your doctor or nurse and keep to your child's regular dose schedule.
  • Sometimes it is necessary to halve tablets to get the correct dose. A tablet cutter may be used for this, but you should keep it only for cutting chemotherapy tablets.
  • If your child cannot swallow tablets, you can ask the pharmacist for the liquid preparation. If this is unsuitable, you can make tablets into a mixture as follows: 
    • You will need a small container such as a medicine pot and an oral syringe.
    • If you prefer you can wear a pair of household rubber gloves to protect yourself. Do not use them for any other purpose.
    • Tip the required number of tablets into a clean container.
    • Pour a little water on the tablets and allow to disperse. This may take a few minutes. Do not try to make the tablets disperse faster by stirring or shaking the container.
    • Draw up the dose using the oral syringe and give to your child.
    • Wash the syringe and container in warm, soapy water and do not use for any other purpose. 
  • If you accidentally spill the tablets or mixture, wash the area thoroughly with plenty of water.
  • If the mixture accidentally gets into your eyes, wash with plenty of running water for at least 10 minutes.
  • Used paper towels, masks, vomit and dirty disposable nappies should be placed inside two rubbish bags and disposed of along with your normal rubbish.
  • If your doctor decides to stop treatment with methotrexate or the medicine passes its expiry date, return any remaining medicine to the pharmacist. Do not flush it down the toilet or throw it away.
Compiled by: 
The Pharmacy Department in collaboration with the Child and Family Information Group.
Last review date: 
February 2017
Ref: 
2016F0734

Disclaimer

Please read this information sheet from GOSH alongside the patient information leaflet (PIL) provided by the manufacturer. If you do not have a copy of the manufacturer’s patient information leaflet please talk to your pharmacist. A few products do not have a marketing authorisation (licence) as a medicine and therefore there is no PIL.

For children in particular, there may be conflicts of information between the manufacturer’s patient information leaflet (PIL) and guidance provided by GOSH and other healthcare providers. For example, some manufacturers may recommend, in the patient information leaflet, that a medicine is not given to children aged under 12 years. In most cases, this is because the manufacturer will recruit adults to clinical trials in the first instance and therefore the initial marketing authorisation (licence) only covers adults and older children.  

For new medicines, the manufacturer then has to recruit children and newborns into trials (unless the medicine is not going to be used in children and newborns) and subsequently amend the PIL with the approved information. Older medicines may have been used effectively for many years in children without problems but the manufacturer has not been required to collect data and amend the licence. This does not mean that it is unsafe for children and young people to be prescribed such a medicine ‘off-licence/off-label’. However, if you are concerned about any conflicts of information, please discuss with your doctor, nurse or pharmacist.