Methotrexate Injections

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Patient information leaflet on Methotrexate Injections

Your child has been prescribed weekly injections of Methotrexate. This leaflet contains information about how you are supplied with the drug, and about its storage, handling and how to administer it.

What is Methotrexate?
Methotrexate is a cytotoxic drug which belongs to a group of drugs known as “antimetabolites”. Methotrexate is used in high dose to treat a vast range of diseases. However, in rheumatoid arthritis and juvenile arthritis, Methotrexate is used in much smaller doses to produce an anti-inflammatory effect and “damp down” the disease activity. It is supplied in syringes and it is yellow in colour.
It is safe to be given as part of the treatment plan prescribed by your Consultant but special precautions are necessary as explained further in this leaflet.

Your Consultant will prescribe the injections and they will be supplied through the hospital pharmacy. They are normally dispensed every 4 weeks [4 syringes], one for each week, however some patient may get some dispensed more or less. A community nurse will collect them from pharmacy and deliver to the family when she next visits.

Methotrexate is a clear yellow solution that should be stored out of direct sunlight. Each dose [pre-filled syringe] is in its own sealed package, which should not be opened until it is due to be
administered. The injections should be kept in a leak-proof plastic container and stored in a cupboard, (preferably locked) and at room temperature. The storage of Methotrexate syringes, needles, waste disposable bins and spillage kits should be kept out of reach and sight of children and pets.

The injection is usually given once weekly on the same day each week. The injections may be administered by the trained parent, young person or responsible adult. However, until they have undertaken the training, a nurse qualified in administrating cytotoxic drugs will either visit at home or administer the drug in hospital. Protective gloves must be worn at all times when handling
Methotrexate. There is a small team of children’s community nurses who are qualified to give cytotoxic medication in Milton Keynes

Please ensure the nurse is qualified to administer the Methotrexate injection to your child.

Please dispose of used injections and syringes using the yellow cytotoxic disposal bins provided. Keep the disposal bins out of reach of children and pets.

Surface contamination around the home should also be avoided.

If a syringe should get broken and the drug spills out, special precautions should be taken. If Methotrexate comes in contact with the skin, then wash the affected areas straight away using a copious amount of water for 10 minutes. If it gets into the eyes, the eyes should be flushed thoroughly for at least five minutes with large amounts of cold tap water and seek medical advice. In the event of spillage onto a surface, wear a pair of gloves before attempting to clean up the spillage.

The fluid spillage should be circled using absorbent towel to contain the fluid. If necessary, use additional towels. Once all the fluid has been adequately absorbed the towels should be disposed
of into the cytotoxic waste bin.

 Wash all the contaminated surface with copious amounts of water and wipe clean and discard of the paper towels used to do this into the cytotoxic waste bin. Repeat the process five times working from just outside the spillage into the central area.
 The area should be routinely cleaned with hot soapy water.
 Remove protective gloves and dispose of in cytotoxic waste bin and wash hands. Liquid spillage on clothing Wear a pair of gloves before attempting to remove spillage on clothing. If Methotrexate is spilt onto protective clothing, it should be removed promptly and replaced. Ordinary clothing should be rinsed using running tap water and squeezed dry before being washed separately in the hottest wash cycle twice.

When not to administer
Methotrexate will be temporarily discontinued if your child develops chicken pox, Please inform your GP or the hospital team for appropriate advice. Usual childhood coughs, colds and minor
infections do not warrant stopping Methotrexate, however, if your child is unwell, for example, with a high fever (over 38.5oC) or a rash (that is different to any usual fevers or rash, please seek
medical opinion.

Further Information
Please contact the hospital pharmacy 01908 995721 or the Children’s Community Nursing team 01908 996521.

RCN 2004 administering subcutaneous Methotrexate for inflammatory arthritis.
The Cytotoxics Handbook, Fourth Edition, edited by Allwood M, Stanley A, Wright P, 2002.
MKUH Pharmacy department Aseptic production unit Standard operating procedure How to manage cytotoxic spillage.