DRUG | SUPPLIED | DOSE | COMMENTS |
---|---|---|---|
METHOTREXATE (Paeds) (MTX) Mechanism of action: Immune suppressant; antimetabolite (antifolate); disease modifying antirheumatic drug (DMARD) Ref: 138, 139, 384 Sandhu BK, Fell JME, Beattie RM, et al. Guidelines for the management of inflammatory bowel disease in children in the United Kingdom. JPGN. 2010;50:S1-S13. Colman RJ et al. Methotrexate for the treatment of pediatric Crohn's disease: a systematic review and meta-analysis. Inflamm Bowel Dis 2018; 24: 2135-2141. Last update: 2021-08-02 |
tablet: 2.5 mg, 10 mg tablets injection (25 mg/mL): 20 mL, 40 mL, 100 mL vials injection for IT use (10 mg/mL): 2 mL vial |
Oncology: Refer to individual treatment protocols. Rheumatic diseases: Juvenile Idiopathic Arthritis (JIA), juvenile dermatomyositis, vasculitis, uveitis, localized and generalized scleroderma Initial: 10-15 mg/m2 /week PO/SC. (Doses may be increased to 20-30 mg/m2 /week in refractory disease) or 0.3-0.6 mg/kg/week PO/SC (Max initial dose 15 mg/dose). Doses may be increased to 1.1 mg/kg/week in refractory disease (Max 30 mg/dose). Crohn's Disease: 15 mg/m2 SC once a week (Max: 25 mg/dose) |
Adverse effects include mucositis, GI upset, alopecia myelosuppression, hepatotoxicity, pneumonitis (rare), and photosensitivity. Folic acid 1 mg/day or 5 mg once or twice weekly (except on the day of methotrexate) may reduce mucosal and GI toxicities. SC administration may be preferred for doses > 15 mg/m2 or to reduce GI adverse effects. IM injection is much more painful than SC and should be avoided. RNs throughout the hospital may administer methotrexate SC for rheumatic or Crohn's diseases; chemotherapy certification is not required. Note: concomitant use of methotrexate and NSAID is a standard of care for treating JIA. Refer to Nursing Policies under "Cytotoxic Drugs" and the BCCH parenteral monograph for detailed information on safe handling, administration, etc. Standard Prescription: methotrexate__PO/SC weekly (__mg/m2/week) or (__mg/kg/week) |