Trexall (Rheumatrex®, Methotrexate)

Warning: In rare case, this medication has caused serious and sometimes fatal side effects. It should only be used to treat cancer or other diseases diagnosed by your doctor.  It has also caused birth defects and death in unborn babies and should not be taken by pregnant women.  Avoid becoming pregnant while taking this medication. Women of child bearing age should talk to their doctor about reliable forms of birth control.

Indications:  Trexall is used to treat various types of cancers or to control severe psoriasis or rheumatoid arthritis.  It works by blocking cell growth and suppressing the immune system.  It can help reduce further damage to joints if used with other aggressive types of therapy. It can also help you maintain joint function. In some cases, this drug has helped patients with lupus or psoriatic arthritis. Do not use this drug for these diseases unless instructed by your doctor.

Common cancers that Trexall is used to treat include:

  • leukemia
  • breast cancer
  • psoriasis
  • head and neck cancer
  • lung cancer
  • stomach cancer
  • non-Hodgkin’s lymphoma
  • gestational trophoblastic cancer
  • esophageal cancer( cancer of theesophagus)
  • osteosarcoma ( a common form of bone cancer)
  • Cutaneous T-cell lymphoma (also known as mycosis fungoides).

Dosage: Trexall can be taken by mouth, in pill form; intravenous infusion (into the vein IV); intramuscular injection (into the muscle); intraventricular infusion (within a ventricle); and Intrathecal infusion (inside the spinal canal).

Your doctor will determine the dosage of this medication and how often you need to take it by looking at several different factors. These include your medical condition and how you are responding to therapy.  There are many different doses and ways this medicine can be given so it is important to follow the instructions and schedule given by your doctor or pharmacist on how to use this medicine. Drink plenty of fluids unless your doctor tells you otherwise. Drinking lots of fluids can help minimize side effects by helping the kidneys flush out this medicine from your body.

Overdose:  Overdosing  Trexall can cause a serious decrease in the number of blood cells in your bone marrow, which can lead to severe health problems and even death. Even in absence of therapeutic overdose, Trexall intoxication can lead to:

  • damage to the lining of the mouth, stomach or intestines
  • severe skin reactions
  • lung Infections such as pneumonia
  • bone and soft tissue damage
  • severe damage to the liver, kidney, lungs, and gastrointestinal tract
  • lymphoma, a cancer that rises in the lymphocytes of the immune system
  • Tumor lysis syndrome, a life-threatening complication of cancer treatment.

Missing dose: when Trexall is given by injection, it is administered in hospital; missing dose is basically difficult if you keep all your doctor’s appointments. If for some reasons you cannot be present at the hospital for the treatment, contact your health care provider before the date scheduled for the injection.

If you are recommended to take Trexall by mouth in tablet form, it may happen you forget to take it. If you miss a dose, take it as soon as you remember it if it is not almost time to take the next dose. If you forgot to take the medicine, and it is almost time for the nest dose, wait for the next one; in any case, do not double the dose.

Contraindications: This medicine should not be used if you have certain medical conditions such as liver disease, kidney disease, lung disease or diseases of the immune system and bone marrow disorders. Give your complete medical history to your doctor before taking this medication. Do not have immunizations or vaccinations while taking this medication and avoid people who have recently had the oral polio vaccine. A list of allergies should be given to your doctor or pharmacist prior to taking Trexall.   Do not use while pregnant. If you think you may become pregnant, use one or two reliable forms of birth controll during and at least 3 months after you stop using this medication.  This medication may pass through breast milk so do not breastfeed while taking it. It could cause potential risks for your baby.

Mechanism of action (MOA): Trexall is classified as an “antimetabolite”; it slows the proliferation of cancer cells by blocking DNA synthesis aswell as regeneration and replication of cancer cells.

Interactions:   Taking other medications or herbal products while using Trexall can affect how this medication works or can increase your risks of side effects. Talk to your doctor about the medicines you are taking (prescription, non-prescription and herbal) before you begin taking this medication. Certain antibiotics may interfere with blood tests when taking Trexall so talk to the laboratory staff to make sure they are aware you are taking this medication.  There are several other drugs that may have interactions with this medication so keep a list of medicines you are on so you can give it to a doctor or pharmacist to check for interactions. For a complete list of interacting drugs, talk to your pharmacist.

Side effects: Trexall not only attack cancer cells but also healthy cells, which often leads to, in most patients, the following side effects:

  • skin problemes: dryness, itching, rash, acne…
  • mouth sores
  • weight loss
  • weakness
  • hair loss
  • decreased appetite
  • trouble sleeping
  • Mild nausea and vomiting.

The medication can damage certain organs in your body which can be fetal. Contact your doctor immediately if you experience ymptoms that indicate:

Damage to the liver, heart or lung: persistent nausea, extreme tiredness, pain in the upper right part of the stomach, dry cough, fast and irregular heartbeat, fever, shortness of breath or any flu-like symptom.

Damage to the lining of the mouth, stomach or intestine: mouth sores, persistent diarrhea, black, tarry or bloody stools, sore throat, or bloody vomitting.

Damage to the skin or bone: bone pain, fever, rash, blisters, peeling skin, yellowing of the skin or eyes, or  purple, blue or black discoloration of the skin.

Other problems  : anxiety, depression,  dehydration, nose bleeding, vision changes, red itchy eye, or intense headaches

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