Methotrexate: -Class -Indication -Patient -Dose -Toxicitites & Monitioring -Excretion -NSAIDs -Folic acid

-DMARD - Rheumatoid arthritis, IBD, etc -Taken once a week (take it same day every week at around same time) - Blood toxicity- regular blood test monitoring is needed- shouldn’t dispense it if we don’t know when last monitoring was done or what the results were (need a follow-up monitoring) – Liver toxicity- monitor LFTs – Pulmonary toxicity- check if they have SOB (red flag) – Monitoring should be done every 1–2 weeks initially until stable, then should be monitored every 2–3 months -renally excreted- regularly monitor renal function – Caution with interacting drugs that may reduce renal excretion of methotrexate (e.g. NSAIDs, diuretics, ACEi) -DON’T sell NSAIDs to methotrexate patient- they reduce renal blood flow- reduces renal excretion of methotrexate - They have anti-folate activity- need folic acid to reduce toxicity – Folic acid is given once a week- take it a few days apart from the methotrexate