- May 11, 2022
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Brand Name :
Folitrax, Mexate, Biotrexate, Xatmep, Rasuvo, Oncotrex, Imutrex, Merex, Meditrex, Remtrex, Trexall, RediTrex
Synonyms :
Amethopterin, methotrexate sodium
Class :
Anticancer: antimetabolites: folate antagonists
Dosage forms & Strengths
Solution, Oral
Xatmep: 2.5mg/ml (60ml, 120ml)
Injectable solution
25mg/ml (2ml, 10ml, 20ml, 40ml, 100ml, 200ml)
5mg/2ml (2ml)
10mg/ml (2ml)
Solution Prefilled Syringe, Injection
7.5mg/0.75ml (0.75ml),
10mg/ml,
15mg/1.5ml
7.5mg/0.3ml (0.3ml),
10mg/0.4ml (0.4ml),
15mg/0.6ml (0.6ml),
20mg/0.8ml, 25mg/ml
Solution Prefilled Syringe, subcutaneous
7.5mg/0.3ml (0.3ml),
10mg/0.4ml (0.4ml),
15mg/0.6ml (0.6ml),
17.5mg/0.7ml
20mg/0.8ml
22.5mg/0.9ml
Powder injection
1g/vial
Tablet
2.5mg
10mg
Note: Provide antiemetics for methotrexate doses > 250mg/m2 to avoid adverse effects such as nausea and vomiting
Methotrexate doses between 100 to 500 mg/m2 require folic acid or leucovorin calcium rescue
Acute lymphoblastic leukemia:
Meningeal leukemia:
Single component therapy: 12 to 15mg intrathecal every 2 to 7 days
Combination therapy:
15mg intrathecal on days 1, 8, 15, 22, and 29
20mg/m2 oral on days 36, 43, 50, 57, and 64
Intensive dose regimen: 200mg/m2 IV was administered slowly over 2 hours, followed by 800mg/m2 over 24 hours and leucovorin rescue starting from day 1 of even-numbered cycles in combination with cytarabine
Maintenance dose regimen: 10mg/m2 IV per day for 5 days every month for 2 years in combination with purine antagonists antineoplastic agents
Bladder cancer:
30mg/m2 IV on day 1 of the 14-day course in combination with vincristine, doxorubicin, cisplatin, and growth factor support or
30mg/m2 IV in combination with vinblastine, doxorubicin, and cisplatin for up to 6 cycles
Neoadjuvant therapy: 30mg/m2 IV on day 1 of the 14-day course in combination with vinblastine, doxorubicin, cisplatin, and pegfilgrastim for 3 or 4 cycles
Breast cancer:
40mg/m2 IV days 1 and 8 every 4 weeks in combination with fluorouracil and cyclophosphamide
Gestational trophoblastic neoplasia:
For low-risk disease:
5-day regimen: 0.4mg/kg IV/IM per day for five days repeat every 14 days
8-day regimen: 1mg/kg IM every 48 hours followed by leucovorin 30 hours after each dose on days 1, 3, 5, and 7, repeat cycle every 14 days, monitor closely for HCG level
For high-risk disease:
100 mg/m2 IV followed by 200 mg/m2 over 12 hours with leucovorin on day 1 every 2 weeks in combination with dactinomycin, etoposide, vincristine and cyclophosphamide
Osteosarcoma:
For adults <30 years: 12 g/m2 over 4 hours followed by leucovorin rescue (do not exceed more than 20 g/dose)
Primary cutaneous anaplastic large cell lymphoma:
15 to 25 mg orally once weekly or 5 to 50 mg once weekly, dose interval can be optimized to once every 2 weeks based on the response or unacceptable toxicity
Advanced soft tissue sarcoma:
30 mg/m2 IV every 7 to 10 days for 1 year in combination with vincristine
Nononcology uses:
15 mg once per week oral or 15 mg once per week administered parenterally by dividing in 2 to 3 doses over 12 hours
Treat with folic acid or leucovorin to avoid adverse effects
Primary CNS lymphoma: (newly diagnosed)
8 g/m2 IV over 4 hours followed by leucovorin rescue or
3.5 g/m2 IV followed by leucovorin or folic acid over 2 hours on day 2 every 2 weeks in combination with other chemotherapeutic derivatives
Non-Hodgkin lymphomas:
50 mg/m2 IV on day 1 every 21 days in combination with cyclophosphamide, vincristine, and prednisone
Dosage forms & Strengths
Solution, Oral
Xatmep: 2.5mg/ml (60ml, 120ml)
Injectable solution
25mg/ml (2ml, 10ml, 20ml, 40ml, 100ml, 200ml)
5mg/2ml (2ml)
10mg/ml (2ml)
Solution Prefilled Syringe, Injection
7.5mg/0.75ml (0.75ml),
10mg/ml,
15mg/1.5ml
7.5mg/0.3ml (0.3ml),
10mg/0.4ml (0.4ml),
15mg/0.6ml (0.6ml),
20mg/0.8ml, 25mg/ml
Solution Prefilled Syringe, subcutaneous
7.5mg/0.3ml (0.3ml),
10mg/0.4ml (0.4ml),
15mg/0.6ml (0.6ml),
17.5mg/0.7ml
20mg/0.8ml
22.5mg/0.9ml
Powder injection
1g/vial
Tablet
2.5mg
10mg
Note: Provide antiemetics for methotrexate doses > 250mg/m2 to avoid adverse effects such as nausea and vomiting
Methotrexate doses between 100 to 500 mg/m2 require leucovorin calcium rescue
Acute lymphoblastic leukemia
Infants: < 1 year: 4 to 5 g/m2 IV administered parenterally slowly over 24 hours every 7 days for 2 doses
Children and adolescents: 5 g/m2 IV administered slowly over 24 hours followed by leucovorin rescue on days 1, 15, 29, and 43
Maintenance dose: 20 mg/m2 orally once a week
CNS prophylaxis therapy: Intrathecal dosing based on age
For < 1 year: 6mg
For 1 to <2 years: 8 mg
For 2 to <3 years: 10 mg
For 3 to 9 years: 12 mg
For > 9 years: 15 mg
Crohn disease:
Fixed dosing for children and adolescents intolerant or unresponsive to purine analog therapy: oral or SUBQ
20 to 29 kg: 10 mg/week
30 to 39 kg: 15 mg/week
40 to 49 kg: 20 mg/week
> 50 kg: 25 mg/week
BSA-directed dosing: 15 mg/m2 once weekly (maximum 25 mg/dose)
Dermatomyositis:
Children and adolescents: 15 to 20 mg/m2 or 1 mg/kg once weekly (whichever is less) in combination with corticosteroid and folic acid supplements
Juvenile idiopathic arthritis:
Children and adolescents: 0.5 mg/kg once weekly oral or SUBQ, increase the dose to 1 mg/kg if symptoms worse or remain unchanged after 4 weeks
Non-Hodgkin lymphoma B-cell:
Children and adolescents: 3 g/m2 IV over 3 hours with leucovorin rescue in combination with other chemotherapeutic agents
High-risk lymphoma in infants> 6 months, children, and adolescents:
8 g/m2 IV over 4 hours followed by leucovorin rescue with other chemotherapeutic agents
Osteosarcoma:
12 g/m2 over 4 hours followed by leucovorin rescue
Psoriasis therapy:
Children and adolescents: 0.2 to 0.4 mg/kg oral or SUBQ once weekly
Scleroderma:
Children and adolescents: 1 mg/kg oral or SUBQ once weekly for 12 months
Dosage forms & Strengths
Solution, Oral
Xatmep: 2.5mg/ml (60ml, 120ml)
Injectable solution
25mg/ml (2ml, 10ml, 20ml, 40ml, 100ml, 200ml)
5mg/2ml (2ml)
10mg/ml (2ml)
Solution Prefilled Syringe, Injection
7.5mg/0.75ml (0.75ml),
10mg/ml,
15mg/1.5ml
7.5mg/0.3ml (0.3ml),
10mg/0.4ml (0.4ml),
15mg/0.6ml (0.6ml),
20mg/0.8ml, 25mg/ml
Solution Prefilled Syringe, subcutaneous
7.5mg/0.3ml (0.3ml),
10mg/0.4ml (0.4ml),
15mg/0.6ml (0.6ml),
17.5mg/0.7ml
20mg/0.8ml
22.5mg/0.9ml
Powder injection
1g/vial
Tablet
2.5mg
10mg
Note: Provide antiemetics for methotrexate doses > 250mg/m2 to avoid adverse effects such as nausea and vomiting
Methotrexate doses between 100 to 500 mg/m2 require leucovorin calcium rescue
Breast cancer:
30 mg/m2 IV on days 1 and 8 every 4 weeks in combination with cyclophosphamide and fluorouracil
Non-Hodgkin lymphoma:
100 mg/m2 IV over 1 hour on day 10 followed by leucovorin rescue
Primary CNS lymphoma:
3 g/m2 IV over 4 hours with leucovorin rescue
Meningeal leukemia:
12 mg intrathecal once weekly
may have an increased immunosuppressive effect when combined with upadacitinib
may enhance the serum concentration when combined with methotrexate
may enhance the serum concentration when combined with methotrexate
may enhance the serum concentration when combined with methotrexate
may enhance the serum concentration when combined with methotrexate
may enhance the serum concentration when combined with methotrexate
methotrexate: they may decrease the therapeutic effect of sipuleucel-T
it may reduce the therapeutic effect of covid-19 vaccines
may decrease the therapeutic effect of COVID-19 vaccine
may increase the immunosuppressive effect of tacrolimus
may have an increased neutropenic effect when combined with deferiprone
may have an increased myelosuppressive effect when combined with ropeginterferon alfa-2b
may increase the Myelosuppressive effect of each other when combined
may enhance the hepatotoxic adverse effects of methotrexate
methotrexate may diminish the therapeutic effects of BCG vaccine
interaction with methotrexate may diminish the therapeutic effects of the vaccine, avoid combination
interaction with methotrexate may increase the neutropenic adverse effect of deferiprone
increases the risk of serious infection as a result of the immunosuppressive effect
interaction may increase the serum concentration of methotrexate
take vaccine at least 2 week prior to methotrexate initiation to avoid interaction. The interaction may reduce therapeutic effect of vaccine
interaction with proton pump inhibitors may cause delayed elimination of methotrexate.
may reduce the time of elimination and increase the serum concentration of methotrexate
the interaction may enhance hepatotoxic and haematotoxic effects of methotrexate
methotrexate may decrease the therapeutic effects of lenograstim, avoid within 24 hours of administration of antineoplastic agents
may diminish the therapeutic effects of lipegfilgrastim
may enhance the severity of oral mucositis
avoid interaction, as it may increase hepatotoxicity and serum concentration of methotrexate
interaction may lead to bone marrow suppression, avoid interaction with sulfonamide antibiotics
high risk of serious infection due to immunosuppressive effects
may enhance the toxic effect of methotrexate, avoid combination
risk of severe infection due to immunosuppressive effects, avoid combination
it increases the toxicity of varicella or rubella-containing live vaccines
measles, mumps, rubella, and varicella vaccine, live (Rx)
may enhance the adverse/toxic effect of rubella, and varicella vaccine, live
measles mumps and rubella vaccine, live
may enhance the adverse/toxic effect of rubella, and varicella vaccine, live
may enhance the adverse/toxic effect of rubella, and varicella vaccine, live
vaccinia immune globulin intravenous (Rx)
may enhance the adverse/toxic effect of rubella, and varicella vaccine, live
may enhance the adverse/toxic effect of rubella, and varicella vaccine, live
methotrexate can also enhance the immunosuppressive effect of tacrolimus (Topical)
methotrexate can also enhance the immunosuppressive effect of tacrolimus (Topical)
methotrexate can also enhance the immunosuppressive effect of tacrolimus (Topical)
methotrexate can also enhance the immunosuppressive effect of tacrolimus (Topical)
methotrexate can also enhance the immunosuppressive effect of tacrolimus (Topical)
may have an increasingly adverse effect when combined with BCG products
myelosuppressive agents may diminish the therapeutic effect of BCG
measles, mumps, rubella and varicella vaccine, live
may increase the toxic effects of varicella virus containing vaccine
may increase the immunosuppressive effects
may have an increased myelosuppressive effect when combined with fexinidazole
may increase the immunosuppressive effect of tacrolimus
may enhance the serum concentration of tafamidis
may have an increasingly adverse effect when combined with talimogene laherparepvec
may enhance the concentration of serum when combined with OAT1/3 substrates
may enhance the risk of serious infection by increasing immunosuppressive effect of methotrexate
may enhance the risk of serious infection by increasing the immunosuppressive effect of methotrexate
may enhance the hepatotoxic effect of methotrexate
methotrexate may diminish the therapeutic effect of brincidofovir
may diminish the therapeutic effect of methotrexate
may enhance the adverse myelosuppressive effects of chloramphenicol
may increase the serum concentration of methotrexate
may enhance the adverse myelosuppressive effects of clozapine
may diminish the therapeutic effect of the covid-19 vaccine
may increase the hepatotoxic adverse effects of methotrexate by enhancing the serum concentration
may increase the serum concentration of methotrexate
may enhance the adverse toxic effects of methotrexate
the interaction may decrease the serum concentration of fosphenytoin by increasing the unbound protein metabolites. It also increases the serum concentration of methotrexate
may increase the serum concentration of methotrexate
methotrexate may enhance the immunosuppressive effect of inebilizumab
may increase the serum concentration of methotrexate
methotrexate may increase the serum concentration of mercaptopurine
may enhance the hepatotoxic effect of methotrexate
may decrease the serum concentration of methotrexate
may increase serum concentration of OAT1/3 substrates
may enhance the immunosuppressive effects of ocrelizumab
may enhance immunosuppressive effects of methotrexate
myelosup
