Methotrexate Nursing Considerations, Implications & Interventions

Methotrexate is an immunosuppressant medication used for decades to treat various conditions. It works by blocking the production of specific proteins essential for cell growth and division. This article will discuss the uses, side effects, and other important information related to methotrexate.

What is Methotrexate?

Methotrexate is a prescription medication used to treat certain types of cancer, autoimmune diseases such as rheumatoid arthritis, psoriasis, Crohn’s disease, and other medical conditions. It is one of the most commonly used chemotherapy medications in cancer treatment and has been around for over five decades. Methotrexate blocks cells from making specific proteins essential for growth and replication.

It is usually taken as a tablet or injection once or twice weekly. Methotrexate can also be given intravenously (injected into the vein) for specific cancer treatments. It is vital to take methotrexate on schedule and follow all instructions from your doctor to get the best results.

What are the Side effects of Methotrexate?

Common side effects of methotrexate include:

• Nausea and vomiting
• Stomach upset
• Loss of appetite
• Diarrhea
• Headache
• Dizziness
• Hair loss or thinning hair
• Swelling in the hands, feet, or ankles
• Fatigue
• Joint pain or stiffness
• Unusual bruising or bleeding
• Skin rash or itching
• Changes in vision
• Mouth sores or ulcers.

Less commonly, methotrexate can cause serious side effects, including liver damage, lung inflammation, and low white blood cell counts. Therefore it is essential to talk with your doctor about the risks and benefits of taking methotrexate.

Methotrexate Nursing Considerations & Implications

  • Monitor patients for signs and symptoms of toxicity such as nausea, vomiting, diarrhea, fatigue, fever, rash, joint pain, abdominal pain, mouth sores, or vision changes.
  • Encourage patients to take folic acid supplements while taking methotrexate, as it can help reduce the risk of side effects.
  • Monitor for signs and symptoms of infection such as fever, chills, sore throat, cough, body aches, or shortness of breath. Methotrexate suppresses the immune system, making it more vulnerable to infection.
  • Inform patients of the importance of avoiding alcohol while taking methotrexate. Alcohol can increase the risk of liver toxicity and other serious side effects.
  • Advise patients about potential reproductive risks of methotrexate use, such as congenital disabilities or infertility.
  • Educate patients on the importance of having regular check-ups while taking methotrexate. This will help to monitor for any potential side effects and ensure that the patient is getting the most benefit from this medication.
  • Provide support to patients who are struggling with managing their symptoms and encourage them to discuss any challenges they may be facing with their healthcare team.
  • Methotrexate is an essential medication in the treatment of cancer and other conditions. Nurses must be aware of the nursing considerations when administering methotrexate to ensure patients receive the best care possible.

Methotrexate Nursing Interventions

  • Assess patient for signs and symptoms of infection: Methotrexate suppresses the immune system, increasing the risk of infection. Monitor temperature, pulse, respirations, appearance of skin and mucous membranes, breath sounds, intake and output ratios for signs of infection.
  • Monitor complete blood count (CBC): The CBC should be monitored weekly during treatment with methotrexate.
  • Monitor liver function tests: Elevated levels of bilirubin, transaminase, and alkaline phosphatase can indicate hepatotoxicity associated with methotrexate therapy.
  • Educate patient about adverse effects: Teach the patient to recognize symptoms of infection or other adverse effects of methotrexate, such as anorexia, nausea, vomiting, diarrhea, and abdominal pain.
  • Monitor for signs of bone marrow suppression: Bone marrow suppression is a common side effect of methotrexate. Patients should be monitored for signs of anemia including fatigue and pallor.
  • Monitor folate levels: Supplementation with folate can help prevent or reduce the side effects of methotrexate.
  • Monitor for signs of an allergic reaction: Allergic reactions to methotrexate include rash, itching, hives, and difficulty breathing. If any of these symptoms occur, notify the provider immediately.
  • Provide patient education on drug interactions: Educate the patient about potential drug interactions with methotrexate before prescribing other medications.
  • Monitor for signs of tissue necrosis: Tissue necrosis is a rare but severe side effect of methotrexate that can occur in areas where the drug was injected. Patients should be monitored closely for signs of pain, redness, and swelling at the injection site.
  • Monitor for signs of pulmonary toxicity: Pulmonary toxicity is another rare but severe side effect of methotrexate; patients should be monitored for changes in respiratory symptoms, such as shortness of breath, cough, and wheezing.
  • Provide support and reassurance: Reinforce the need to follow the medication regimen and recommend lifestyle modifications to reduce side effects. Provide emotional support and relief throughout the treatment process.
  • Monitor for signs of methotrexate overdose: Overdose can occur due to incorrect dosing or poor patient adherence to the prescribed regimen. Symptoms include confusion, disorientation, fever, anemia, and bone marrow suppression. If any of these symptoms occur, notify the provider immediately.

Drug Dose for rheumatoid arthritis, psoriasis, and Crohn’s disease

Rheumatoid arthritis: The initial dose is typically 7.5 to 20 mg once a week, taken orally or by injection. 20 mg is the maximum dose. [Note
Psoriasis: Low-dose methotrexate (7.5 mg/week) is the typical starting point for adults.
Crohn’s Disease: The usual starting dose of methotrexate for Crohn’s disease is 10 to 25 mg/week.
Note: It is always recommended to consult your doctor for a dosage prescription. This post is just for informational purposes.

Final Words

Methotrexate is an effective treatment for many medical conditions, as described above. Before starting any treatment, it is essential to talk with your doctor or healthcare provider, especially regarding a medication like Methotrexate that can cause serious side effects. Your doctor will help you decide if Methotrexate suits your situation. Taking all necessary precautions and closely monitoring any side effects should ensure that using Methotrexate is safe and effective.


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