Rheumatrex/Methotrexate IS USED FOR:

Treating certain types of cancer, severe psoriasis, or rheumatoid arthritis in certain patients. It may be used alone or with other medicines. It may also be used for other conditions as determined by your doctor.

Rheumatrex/Methotrexate is an antimetabolite. It works to treat cancer and psoriasis by blocking an enzyme needed for cell growth. This helps to slow the growth of cancer cells and abnormal skin cells. Exactly how Rheumatrex/Methotrexate works to treat rheumatoid arthritis is unknown. It reduces symptoms of inflammation (eg, pain, swelling, stiffness) caused by rheumatoid arthritis.

More recently it has come into use as a treatment for some autoimmune diseases, including ankylosing spondylitis, Crohn's disease, psoriasis, psoriatic arthritis, and rheumatoid arthritis

DO NOT USE Rheumatrex/Methotrexate IF:

• you have moderate or severe kidney problems
• you are treating psoriasis or rheumatoid arthritis and abuse alcohol or have liver problems, an immunodeficiency syndrome (eg, AIDS), bone marrow problems, or blood problems (eg, anemia, low white blood cell count, low platelet count)
• you are treating psoriasis or rheumatoid arthritis and you are pregnant or breast-feeding
• you are allergic to any ingredient in Rheumatrex/Methotrexate
• you are taking acitretin

Contact your doctor or health care provider right away if any of these apply to you.

POSSIBLE SIDE EFFECTS OF Rheumatrex/Methotrexate:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Dizziness; headache; loss of appetite; mild hair loss; nausea; stomach pain or upset; tiredness; vomiting.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); black, tarry stools; blood in the urine; calf or leg pain or swelling; change in the amount of urine; chest pain; coma; confusion; coughing up blood; dark urine; diarrhea; difficult or painful urination; dry cough; fever, chills, or sore throat; menstrual changes; mental or mood changes; mouth sores; one-sided weakness; red, swollen, peeling, or blistered skin; seizures; severe or persistent nausea or vomiting; shortness of breath; speech changes; unusual bleeding or bruising; unusual pain and discoloration of the skin; unusual tiredness or weakness; vision changes or vision loss; yellowing of skin or eyes.

IMPORTANT SAFETY INFORMATION:

• Use Rheumatrex/Methotrexate with caution in the ELDERLY; they may be more sensitive to its effects.
• PREGNANCY and BREAST-FEEDING: Rheumatrex/Methotrexate may cause birth defects and fetal and newborn death if you take it while you are pregnant. Do not become pregnant while you are using it. Use an effective form of birth control while you take Rheumatrex/Methotrexate and for at least 1 ovulatory cycle after you stop taking it. If you think you may be pregnant, contact your doctor right away. Rheumatrex/Methotrexate is found in breast milk. Do not breast-feed while taking Rheumatrex/Methotrexate.
• Lab tests, including albumin levels, complete blood counts, and liver, lung, and kidney function, may be performed while you use Rheumatrex/Methotrexate. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.
• Nausea, vomiting, and loss of appetite are common with Rheumatrex/Methotrexate. Ask your doctor or pharmacist for ways to decrease these effects if they occur.
• Rheumatrex/Methotrexate may lower the ability of your body to fight infection. Avoid contact with people who have colds or infections. Tell your doctor if you notice signs of infection like fever, sore throat, rash, or chills.
• Do not receive a live vaccine (eg, measles, mumps) while you are taking Rheumatrex/Methotrexate. Talk with your doctor before you receive any vaccine.
• Check with your doctor before you drink alcohol while you are taking Rheumatrex/Methotrexate.
• If vomiting or diarrhea occurs, you will need to take care not to become dehydrated. Contact your doctor for instructions.
• Rheumatrex/Methotrexate may cause drowsiness, dizziness, or blurred vision. These effects may be worse if you take it with alcohol or certain medicines. Use Rheumatrex/Methotrexate with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.
• Men who take Rheumatrex/Methotrexate should always use a condom when having sex with a woman who may become pregnant. Do this for as long as you take Rheumatrex/Methotrexate and for 3 months after you stop taking it.
• Rheumatrex/Methotrexate may cause you to become sunburned more easily. Avoid the sun, sunlamps, or tanning booths until you know how you react to Rheumatrex/Methotrexate. Use a sunscreen or wear protective clothing if you must be outside for more than a short time.
• Rheumatrex/Methotrexate may reduce the number of clot-forming cells (platelets) in your blood. Avoid activities that may cause bruising or injury. Tell your doctor if you have unusual bruising or bleeding. Tell your doctor if you have dark, tarry, or bloody stools.
• Do NOT take more than the recommended dose or use for longer than prescribed without checking with your doctor.
• Rheumatrex/Methotrexate should be used with extreme caution in CHILDREN younger than 2 years old; safety and effectiveness in these children have not been confirmed.

BEFORE USING Rheumatrex/Methotrexate:

Some medical conditions may interact with Rheumatrex/Methotrexate. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

• if you are receiving chemotherapy or radiation
• if you are pregnant, planning to become pregnant, or are breastfeeding
• if you have mouth sores, excess fluid in your stomach or around your lungs, stomach or intestinal ulcers, bowel inflammation (eg, ulcerative colitis), or a blockage of your stomach or bowel
• if you have a history of lung problems, immune system problems, nervous system problems (eg, seizures), liver problems (eg, hepatitis), or blood problems (eg, anemia, low white blood cells, low blood platelets)
• if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
• if you have a folic acid deficiency, are in very poor health, or have a history of alcohol abuse
• if you have allergies to medicines, foods, or other substances
• if you have an active infection, severe vomiting or diarrhea, or dehydration

Some MEDICINES MAY INTERACT with Rheumatrex/Methotrexate. Tell your health care provider if you are taking any other medicines, especially any of the following:

• Acitretin, Imuran/azathioprine, etretinate, Arava/leflunomide, retinoids, or Azulfidine/sulfasalazine because the risk of liver problems may be increased
• Lanoxin/Digoxin because its effectiveness may be decreased by Rheumatrex/Methotrexate
• Folic acid or leucovorin because they may decrease Rheumatrex/Methotrexate's effectiveness
• Anticoagulants (eg, Coumadin/warfarin), Sandimmune/cyclosporine, or Theo-24 tr/theophylline because the risk of their side effects may be increased by Rheumatrex/Methotrexate
• Chloromycetin/Chloramphenicol, corticosteroids (eg, Meticorten/prednisone), Sandimmune/cyclosporine, dantrolene, hydantoins (eg, Dilantin/phenytoin), nonsteroidal anti-inflammatory drugs (NSAIDs) (eg, Motrin/ibuprofen, Celebrex/celecoxib), Veetids/penicillin antibiotics, phenylbutazone, pristinamycin, Probalan/probenecid, quinolone antibiotics (eg, Cipro/ciprofloxacin), salicylates (eg, aspirin), sulfonamides (eg, sulfamethoxazole), Sumycin/tetracycline, or trimethoprim because they may increase the risk of Rheumatrex/Methotrexate's side effects

This may not be a complete list of all interactions that may occur. Ask your health care provider if Rheumatrex/Methotrexate may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

HOW TO USE Rheumatrex/Methotrexate:

Use Rheumatrex/Methotrexate as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• If you miss a dose of Rheumatrex/Methotrexate, contact your doctor right away. Do not take 2 doses at once.
• Be sure you understand exactly how much of Rheumatrex/Methotrexate to take and how often you should take it. Ask your doctor or pharmacist if you have any questions.
• Rheumatrex/Methotrexate works best if each dose is taken at the scheduled time.
• It may take several weeks for your symptoms to improve. Do not stop taking Rheumatrex/Methotrexate without checking with your doctor.
• Take Rheumatrex/Methotrexate by mouth with or without food. However, you should take it the same way each time in relation to food.
• Drinking extra fluids while you are taking Rheumatrex/Methotrexate is recommended. Check with your doctor for instructions.
• Continue to take Rheumatrex/Methotrexate even if you feel well. Do not miss any doses.

Ask your health care provider any questions you may have about how to use Rheumatrex/Methotrexate.

What is the shelf life of the pills?

• The expiry date is mentioned on each blister. It is different for different batches. The shelf life is 2 years from the date of manufacture and would differ from batch to batch depending on when they were manufactured.