Methotrexate

Why have I been started on methotrexate?

Methotrexate is used in patients with Crohn’s disease or ulcerative colitis to induce and maintain remission. The doctor prescribing methotrexate feels that either your child has not tolerated other medications well or they have not worked.

How does methotrexate work?

Methotrexate is known as an immunosuppressant. The immune system is our body’s way of fighting off infections, but sometimes the immune process attacks our bodies own tissue, triggering inflammation. Methotrexate works by dampening down your child’s immune system. By dampening down your child’s immune system, the activity of inflammation is reduced, making them feel better.

How long does methotrexate take to work?

Methotrexate does not work instantly. It can take up to 12 weeks for your child to start to feel better so it is very important that they continue to take methotrexate regularly.

How do I take methotrexate?

Methotrexate is taken either by mouth or by injection. Both are only to be taken once a week and on the same day each week. If your child needs to have Methotrexate by injection, they will need to come to medical day-care at Sheffield Children’s.

If you are happy to, the nursing staff can teach you or a relative to give this medicine. You will need to complete a competency package to do this and at the end of your training you will be able to take a supply of medication to give at home.

Your chid will also be prescribed folic acid. This is a vitamin, that is taken by the mouth, once a week (not on the same day as your Methotrexate). It will help their body to cope with methotrexate and can help with side effects such as nausea.

Your child will also be prescribed and anti-sickness medication call Ondansetron to take on the morning of their injection and again after their injection if needed.

What checks will need to be carried out?

Before your child is given methotrexate they will need to do some tests including blood tests and a chest x-ray.

When they start methotrexate, they will need weekly blood tests to monitor the effectiveness of the medication.

They will need to attend either your GP, local hospital or the blood room at Sheffield Children’s to have the blood test.

After the initial 4 weeks, if your child’s blood tests are stable, they can be carried out monthly, decreasing to every 3 months.

It is important that you inform the gastro nurses when your child has had their blood test done, so the results can be checked. If you need more blood forms please contact the gastro nurses.

Where can I get the methotrexate from if I am having it at home?

This medication is only available from the pharmacy at Sheffield Children’s. You will need to contact the gastro nurses at least a week before you run out of medication to order a repeat prescription. You will then be able to collect the medication from our pharmacy.

Alternatively we can register you with Healthcare at Home who can deliver your injections to your house. Please be aware that for your safety we can only issue repeat prescriptions if your blood tests are up to date.

What precautions are necessary when on methotrexate?

As methotrexate suppresses your child’s immune system, it is important that they do not receive any live vaccines whilst on methotrexate. They must also not have the live nasal spray version of the vaccine.

It is recommended that they have the annual winter flu vaccination. They will need to have the inactivated (dead) form of the vaccine which is available as an injection from your GP.

Try to avoid other people if you know they have an active infection. If your child has been exposed to someone who has had chickenpox or shingles you need to contact the gastroenterology nurse specialists.

Methotrexate can cause your skin to become sensitive, therefore, high factor sunscreens should be used and sun beds avoided.

What are the side effects of methotrexate?

As with all medications, methotrexate can have some side effects. Your child may develop an allergic reaction to methotrexate such as:

• skin rashes
• hives (swollen red patches of skin)
• headaches
• wheezing
• tummy pain
• nausea or vomiting – try giving your child their medication at night and make sure they have folic acid
• swelling of the mouth and lips
• sore mouth
• thinning of the hair. On completion of treatment, hair growth will usually return to normal. If any of these occur, contact your gastroenterology nurse specialist for further information
• infections

Your child may get infections more easily while on this medication. This is because your child’s immune system that fights off infections has been dampened down. If your child is suffering with a fever or feeling generally unwell, sore throat or have the chills, please contact the gastroenterology nurse.