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Methotrexate is used alone or in combination with other anticancer agents to treat many cancers, including breast cancer, head and neck cancer, cutaneous T-cell lymphoma, lung cancer, and non-Hodgkin lymphoma. Methotrexate may be used in treating noncancerous conditions and autoimmune diseases.

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Page 1 METHOTREXATE ORAL CHEMOTHERAPY EDUCATION Name of your medication Generic name methotrexate (meh thuh TREK sayt) Approved uses Methotrexate is used alone or in combination with other anticancer agents to treat many cancers, including breast cancer, head and neck cancer, cutaneous T cell lymphoma, lung cancer, and non Hodgkin lymphoma. Methotrexate may be used in treating noncancerous conditions and autoimmune diseases. Dose and schedule Taking methotrexate as instructed is important to allow your treatment to be as effective as possible, so here are some key points to remember. Your dose is based on many factors, including your height and weight, overall health, and diagnosis. Methotrexate can be taken with or without food, but at the same time each week. Methotrexate should be taken whole and not crushed, cut, or dissolved. If you are unable to swallow methotrexate, talk to your care provider or pharmacist for possible options. If you miss a dose of methotrexate, do not take an extra dose or two doses at one time. Simply take your next dose at the regularly scheduled time. If you miss a dose of this medication, contact your care team for further information. Storage and handling Handle methotrexate with care. Just like when chemotherapy is given into the vein, this drug can be toxic, and exposure of the drug to others should be limited. Store methotrexate at room temperature (68°F–77°F) in a dry location away from light. Keep methotrexate out of reach of children and pets. Leave methotrexate in the provided packaging until it is ready to be taken. Whenever possible, you should give methotrexate to yourself and follow the steps below. If a family member, friend, or caregiver needs to give the methotrexate to you, they also need to follow these steps. 1. Wash hands with soap and water. 2. Put on gloves to avoid touching the medication. (Gloves are not necessary if you give the drug to yourself.) 3. Gently transfer the methotrexate from its package to a small medicine or other disposable cup. 4. Administer the medicine immediately by mouth with water. 5. Remove gloves and do not use them for anything else. 6. Throw gloves and medicine cup in household trash. 7. Wash hands with soap and water. METHOTREXATE ORAL CHEMOTHERAPY EDUCATION Page 2 If a daily pill box or pill reminder is used, a separate one should be used for methotrexate. Do not mix other medications into the box with methotrexate. The person filling the box or reminder should wear gloves. (Gloves are not necessary if you are filling the box or reminder.) When empty, the box or reminder should be washed with soap and water before refilling. Be sure to wash hands with soap and water after the task is complete, whether or not gloves are worn. If you have any unused methotrexate, do not throw it in the trash and do not flush it down the sink or toilet. Talk to your care provider or pharmacist about proper disposal of methotrexate. If you are traveling, put your methotrexate in a sealed plastic bag. Ask your pharmacist if any additional travel precautions are needed. Handling body fluids and waste Since methotrexate remains in your body for several days after it is taken, some of the drug may be present in urine, stool, sweat, or vomit. Once you have started to take methotrexate, it is important to know the following instructions every day for as long as your treatment lasts. This is to keep yourself, loved ones, and the environment as safe as possible. Pregnant women should avoid touching anything that may be soiled with body fluids from the patient. Toilet and septic systems You may use the same toilet, septic tank, and/or sewer that you usually use. If you have a low flow toilet, close the lid and flush twice to ensure all waste has been discarded. If the toilet or toilet seat becomes soiled with urine, stool, or vomit, clean the surfaces before other people use the toilet. Wash hands with soap and water after using the toilet. If you need a bedpan, be sure your caregiver knows to wear gloves to assist with cleanup and to wash the bedpan with soap and water every day. If you do not have good control of bladder or bowels, use a disposable pad with a plastic back, a diaper, or a sheet to absorb body waste. Wash any skin that has been exposed to body waste or methotrexate with soap and water. Linens or clothing that are soiled with body fluids or body waste should be washed separately from other linens and clothing. If you do not have a washer, place the soiled linens in a plastic bag until they can be washed. Wash hands with soap and water after touching linens or clothing that may be soiled with body fluids. Drug and food interactions Methotrexate has many drug interactions. Please inform your care providers of all prescription medications, over thecounter medications, vitamins, and herbal products. Talk with your care provider or pharmacist before taking new medications or supplements, or receiving any vaccines. Avoid live vaccines during treatment with methotrexate. METHOTREXATE ORAL CHEMOTHERAPY EDUCATION Page 3 Side Effects of Methotrexate The common side effects that have been known to happen in more than 30% of patients taking methotrexate are listed in the left side of this table. You MAY NOT experience these side effects. Options to help manage any side effects that do occur are included on the right side of this table. These should be discussed with your care provider. If you experience any side effect you cannot manage or that is not listed here, contact your care provider. Possible Side Effect Management Decreased white blood cells (WBCs) and increased risk for infection Your WBCs should be monitored by a simple blood test. When your WBCs are low, you are at a greater risk of having an infection. Take the following precautions to protect yourself from infection. Wash your hands often, especially before eating and after using the bathroom. Avoid crowds and people with fevers, flu, or other infection. Bathe regularly to keep good personal hygiene. Contact your care provider if you experience any signs or symptoms of an infection: Fever (temperature more than 100.4°F or 38°C) Chills Sore throat Burning with urination Unusual tiredness A sore that becomes red, is draining, or does not heal Check with your care provider before taking any medicine for a fever or chills. Serious side effects Methotrexate can cause serious side effects that can be life threatening. Your doctor may do tests regularly to check how methotrexate is affecting your body. It is important that you remain in your doctor’s care while taking methotrexate. Liver problems can occur. Contact your healthcare team if you notice yellowing of the skin or whites of your eyes, dark or brown urine, or unusual bleeding or bruising. Your kidney function will be checked periodically with a blood test. Contact your care team if you notice decreased urination or unusual swelling in your legs and feet. Lung problems can occur. Report any shortness of breath or difficulty breathing. Severe skin reactions can occur. Report any new rashes. Methotrexate can cause diarrhea and mouth sores. Contact your care team if you experience these. Infertility can occur. METHOTREXATE ORAL CHEMOTHERAPY EDUCATION Page 4 If you experience ANY uncontrolled side effect, call your physician or healthcare center immediately: (INSTITUTIONAL CONTACT INFO) Pregnancy, sexual activity, and contraception Women should not become pregnant and men should not get a partner pregnant while taking methotrexate. Men and women of childbearing age and potential should use effective contraception during therapy and for a minimum of three months after the last dose of methotrexate. Do not breastfeed while taking methotrexate and for three months after the last dose of methotrexate. Please inform your care provider if you become pregnant or plan to have a baby after taking methotrexate. It is safe to hug and kiss. Special precautions may be needed for sexual activity while on oral chemotherapy, and you are encouraged to ask your care provider. Obtaining medication Talk with your care provider about the process for obtaining your methotrexate. (PHARMACY OR SPECIALTY PHARMACY CONTACT INFO) Additional resources Product prescribing information: docs/ label/2016/008085s066lbl.pdf Updated – October 19, 2018 Additional instructions METHOTREXATE ORAL CHEMOTHERAPY EDUCATION Page 5 Important notice: The Association of Community Cancer Centers (ACCC), Hematology/Oncology Pharmacy Association (HOPA), National Community Oncology Dispensing Association, Inc. (NCODA), and Oncology Nursing Society (ONS) have collaborated in gathering information for and developing this patient education guide. This guide represents a brief summary of the medication derived from information provided by the drug manufacturer and other resources. This guide does not cover all existing information related to the possible uses, directions, doses, precautions, warnings, interactions, adverse effects, or risks associated with this medication and should not substitute for the advice of a qualified healthcare professional. Provision of this guide is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this medication by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the medications whatsoever, and any and all decisions, with respect to such medications, are at the sole risk of the individual consuming the medication. All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Oral Chemotherapy Education (OCE) sheets are provided as a free educational resource for patients with cancer in need of concise, easy to understand information about oral cancer drugs. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to This email address is being protected from spambots. You need JavaScript enabled to view it.. Copyright © 2019 by Hematology/Oncology Pharmacy Association. All rights reserved.

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