No.

Whatever information sheet you have, if it doesn't warn against alcohol, it
isn't complete.  Injectable has the same precautions as the tablets.

However, more than a few of us are wondering how you were able to get ahold
of the injectable.

I'm a few weeks from running out myself.  A few more weeks if I really want
to stretch the unpreserved stuff.

Jo

Nope. An occasional glass of wine or so is okay. But MTX in any form *can*
increase liver enzymes, as can alcohol. So it is better not to drink. I did tell
my RD I was having a glass of wine for Christmas and all he said was not to do
it often. Funnily enough Christmas came and went without wine and I certainly
didn't miss it. If I went out to a fancy restaurant for dinner I might have one.
But regular drinking is not advisable.
---
Joan

Not normally, but talk to your RD.  If your labs are fine, many say a drink
now and then is OK.  But don't imbibe without clearance from your RD.   It's
more about your physiologic state than anything else.

Walt

Nooooo,  After you have been on it for awhile and all your bloodtests are
great,,,, talk to your RD about how much you can drink.
Harv

Karen wrote and asked:

When I have a question like that, I ask my RD or pharmacist.
They are they only people who can give you a genuine, bona
fide, honest answer.

When I did ask re: another prescription, I was asked, "How
much do you drink?"  I replied, "A half glass of wine once
or twice a week."  (Really more than I do in fact drink.)

The RD and pharmacist both stated, in effect, "No problem.
The drug companies, doctors and pharmacists use that "no
alcohol" warning for the 6-pak a night alcoholic or wino."

A drug and alcohol combination can make a driver or heavy
machinery operator twice as drowsy also.  That is a worry,
plus the organ damage that can occur with the combo.

In the next messages, I'm going to post two methotrexate
findings I located today.  Most, if not all, should be in an info
folder you received with the prescription.

Shame, shame on your pharmacist if you did not.

... Multitasking environment:  A bathroom with reading material.

Karen wrote and asked:

Trexall Side Effects, and Drug Interactions - Methotrexate

Methotrexate

SIDE EFFECTS:
IN GENERAL, THE INCIDENCE AND SEVERITY OF ACUTE
SIDE EFFECTS ARE RELATED TO DOSE AND FREQUENCY
OF ADMINISTRATION.

The most frequently reported adverse reactions include
ulcerative stomatitis, leukopenia, nausea, and abdominal
distress. Other frequently reported adverse effects are
malaise, undue fatigue, chills and fever, dizziness and
decreased resistance to infection.

Other adverse reactions that have been reported with
methotrexate arelisted below by organ system. In the
oncology setting, concomitant treatment and the underlying
disease make specific attribution of a reaction to
methotrexate difficult.

Alimentary System: gingivitis, pharyngitis, stomatitis,
anorexia, nausea,vomiting, diarrhea, hematemesis, melena,
gastrointestinal ulceration and bleeding, enteritis,
pancreatitis.

Blood and Lymphatic System Disorders: Suppressed
hematopoiesis causing anemia, aplastic anemia, leukopenia
and/or thrombocytopenia.

Hypogammaglobulinemia has been reported rarely.

Cardiovascular: pericarditis, pericardial effusion,
hypotension, and thromboembolic events (including arterial
thrombosis, cerebral thrombosis, deep vein thrombosis,
retinal vein thrombosis, thrombophlebitis, and pulmonary
embolus).

Central Nervous System: headaches, drowsiness, blurred
vision. Aphasia, hemiparesis, paresis and convulsions have
also occurred following administration of methotrexate.
Following low doses, there have been occasional reports of
transient subtle cognitive dysfunction, mood alteration,
unusual cranial sensations, leukoencephalopathy, or
encephalopathy.

Infection: There have been case reports of sometimes fatal
opportunistic infections in patients receiving methotrexate
therapy for neoplastic and non-neoplastic diseases.
Pneumocystis carinii pneumonia was the most common
infection.  Other reported infections included nocardiosis;
histoplasmosis, cryptococcosis, Herpes zoster, H. simplex
hepatitis, and disseminated H. simplex.

Ophthalmic: conjunctivitis, serious visual changes of
unknown etiology.

Pulmonary System: interstitial pneumonitis deaths have been
reported, and chronic interstitial obstructive pulmonary
disease has occasionally occurred.

Skin: erythematous rashes, pruritus, urticaria,
photosensitivity, pigmentary changes, alopecia, ecchymosis,
telangiectasia, acne, furunculosis, erythema multiforme,
toxic epidermal necrolysis, Stevens-Johnson syndrome, skin
necrosis, and exfoliative dermatitis.

Urogenital System: severe nephropathy or renal failure,
azotemia,cystitis, hematuria; defective oogenesis or
spermatogenesis, transient oligospermia, menstrual
dysfunction, vaginal discharge and gynecomestia;
infertility, abortion, fetal defects.

Other rarer reactions related to or attributed to the use of
methotrexatesuch as nodulosis, vasculitis, opportunistic
infection, arthralgia/myalgia, loss of libido/impotence,
diabetes, osteoporosis, sudden death, and reversible
lymphomas. Anaphylactoid reactions have been reported.

Adverse Reactions in Double-Blind Rheumatoid Arthritis
Studies:  The approximate incidences of methotrexate
attributed (ie, placebo rate subtracted) adverse reactions
in 12 to 18 week double-blind studies of patients (n=128)
with rheumatoid arthritis treated with low-dose oral (7.5 to
15 mg/week) pulse methotrexate, are listed below. Virtually
all of these patients were on concomitant nonsteroidal anti-
inflammatory drugs and some were also taking low dosages of
corticosteroids.

Incidence greater than 10%: Elevated liver function tests
15%, nausea/vomiting 10%.

Incidence 3% to 10%: Stomatitis, thrombocytopenia, (platelet
count less than 100,000/mm3).

Incidence 1% to 3%: Rash/pruritus/dermatitis, diarrhea,
alopecia, leukopenia (WBC less than 3000/mm3), pancytopenia,
dizziness.

No pulmonary toxicity was seen in these two trials. Thus,
the incidence is probably less than 2.5% (95% C.L.). Hepatic
histology was not examined in these short-term studies. (See
PRECAUTIONS.)

Other less common reactions included decreased hematocrit,
headache, upperrespiratory infection, anorexia, arthralgias,
chest pain, coughing, dysuria, eye discomfort, epistaxis,
fever, infection, sweating, tinnitus, and vaginal
discharge.

Adverse Reactions in Psoriasis
There are no recent placebo-controlled trials in patients
with psoriasis. There are two literature reports (Roenigk,
1969 and Nyfors, 1978) describing large series (n=204, 248)
of psoriasis patients treated with methotrexate. Dosages
ranged up to 25 mg per week and treatment was administered
for up to four years. With the exception of alopecia,
photosensitivity, and "burning of skin lesions" (each 3% to
10%), the adverse reaction rates in these reports were very
similar to those in the rheumatoid arthritis studies.

Adverse Reactions in JRA Studies
The approximate incidences of adverse reactions reported in
pediatric patients with JRA treated with oral, weekly doses
of methotrexate (5 to 20 mg/m2/wk or 0.1 to 0.65 mg/kg/wk)
were as follows (virtually all patients were receiving
concomitant nonsteroidal anti-inflammatory drugs, and some
also were taking low doses of corticosteroids); elevated
liver function tests, 14%; gastrointestinal reactions (e.g.,
nausea, vomiting, diarrhea), 11%; stomatitis, 2%;
leukopenia, 2%; headache, 1.2%; alopecia, 0.5%, dizziness,
0.2%; and rash, 0.2%. Although there is experience with
dosing up to 30 mg/m2/wk in JRA, the published data for
doses above 20 mg/m2/wk are too limited to provide reliable
estimates of adverse reaction rates.

DRUG INTERACTIONS
Concomitant administration of some NSAIDs with high dose
methotrexate therapy has been reported to elevate and
prolong serum methotrexate levels, resulting in deaths from
severe hematologic and gastrointestinal toxicity.

Caution should be used when NSAIDs and salicylates are
administered concomitantly with lower doses of methotrexate.
These drugs have been reported to reduce the tubular
secretion of methotrexate in an animal model and may enhance
its toxicity.

Despite the potential interactions, studies of methotrexate
in patients with rheumatoid arthritis have usually included
concurrent use of constant dosage regimens of NSAIDs,
without apparent problems. It should be appreciated,
however, that the doses used in rheumatoid arthritis (7.5 to
15 mg/week) are somewhat lower than those used in psoriasis
and that larger doses could lead to unexpected toxicity.

Methotrexate is partially bound to serum albumin, and
toxicity may beincreased because of displacement by certain
drugs, such as salicylates, phenylbutazone, phenytoin, and
sulfonamides. Renal tubular transport is also diminished by
probenecid; use of methotrexate with this drug should be
carefully monitored.

Oral antibiotics such as tetracycline, chloramphenicol, and
nonabsorbable broad spectrum antibiotics, may decrease
intestinal absorption of methotrexate or interfere with the
enterohepatic circulation by inhibiting bowel flora and
suppressing metabolism of the drug by bacteria.

Penicillins may reduce the renal clearance of methotrexate;
increased serum concentrations of methotrexate with
concomitant hematologic and gastrointestinal toxicity have
been observed with high and low dose methotrexate. Use of
methotrexate with penicillins should be carefully
monitored.

The potential for increased hepatotoxicity when methotrexate
is administered with other hepatotoxic agents has not been
evaluated.

However, hepatotoxicity has been reported in such cases.
Therefore,patients receiving concomitant therapy with
methotrexate and otherpotential hepatotoxins (e.g.,
azathioprine, retinoids, sulfasalazine)should be closely
monitored for possible increased risk of
hepatotoxicity.

Methotrexate may decrease the clearance of theophylline;
theophylline levels should be monitored when used
concurrently with methotrexate.

Vitamin preparations containing folic acid or its
derivatives may decreaseresponses to systemically
administered methotrexate. Preliminary animal and human
studies have shown that small quantities of intravenously
administered leucovorin enter the CSF primarily as 5-
methyltetrahydrofolate and in humans, remain 1 - 3 orders of
magnitude lower than the usual methotrexate concentrations
following intrathecal administration. However, high doses of
leucovorin may reduce the efficacy of intrathecally
administered methotrexate.

Folate deficiency states may increase methotrexate toxicity.

Trimethoprim/sulfamethoxazole has been reported rarely to
increase bone marrow suppression in patients receiving
methotrexate, probably by an additive antifolate effect.

12/08/2004

... Exaggeration is a billion times worse than understatements.

Karen wrote and asked:

Methotrexate

  Brand name:
  Methotrexate
  Pronounced: meth-oh-TREX-ate
  Brand names: Rheumatrex, Trexall

  Why is this drug prescribed?

  Methotrexate is an anticancer drug used in the treatment
of lymphoma (cancer of the lymph nodes) and certain forms
of leukemia. It is also given to treat some forms of
cancers of the uterus, breast, lung, head, neck, and ovary.

  Methotrexate is also given to treat rheumatoid arthritis
when other treatments have proved ineffective, and is
sometimes used to treat very severe and disabling psoriasis
(a skin disease characterized by thickened patches of red,
  inflamed skin often covered by silver scales).

  Most important fact about this drug

  Be certain to remember that in the treatment of psoriasis
and rheumatoid arthritis, methotrexate is taken once a
week, not once a day. Accidentally taking the recommended
weekly dosage on a daily basis can lead to fatal over-
dosage. Be sure to read the patient instructions that come
with the package.

  How should you take this medication?

  Take methotrexate exactly as prescribed, and promptly
report to your doctor any new symptoms that may develop.

  Methotrexate is given at a higher dosage for cancer than
for psoriasis or rheumatoid arthritis.  After high-dose
methotrexate treatment, a drug called leucovorin may be
given to limit the toxic effects.

  --If you miss a dose...
  Skip it and go back to your regular schedule. Do not take
2 doses at once.

  --Storage instructions...
  Store at room temperature, away from light.

  What side effects may occur?

  Side effects cannot be anticipated. If any develop or
change in intensity, inform your doctor as soon as
possible. Only your doctor can determine whether it is safe
for you to continue taking methotrexate.

    More common side effects may include:
    Abdominal pain and upset, chills and fever, decreased
resistance to infection, dizziness, fatigue, general
feeling of illness, mouth ulcers, nausea

    Less common side effects may include:
    Abortion, acne, anemia, birth defects, black or tarry
stool, boils, bruises, changes in skin coloration,
convulsions, diarrhea, drowsiness, eye or vision problems,
fatigue, hair loss, headaches, hives, inability to speak,
infection of hair follicles, infertility, inflammation of
the gums or mouth, intestinal inflammation, kidney failure,
loss of appetite, lung disease, menstrual problems, partial
or complete paralysis, rash or itching, red patches on
skin, sensitivity to light, skin peeling or flaking, sore
throat, stomach and intestinal ulcers and bleeding, stomach
pain, vaginal discharge, vomiting, vomiting blood

    Rare side effects may include:
    Diabetes, impotence, infection, joint pain, loss of
sexual desire, muscular pain, osteoporosis, ringing in the
ears, severe allergic reaction, shortness of breath,
sleepiness, sudden death, sweating

  If you are taking methotrexate for psoriasis, you may
also experience hair loss and/or sun sensitivity, and your
patches of psoriasis may give a burning sensation.

  Methotrexate can sometimes cause serious lung damage
that makes it necessary to limit the treatment. If you
experience a dry cough, fever, or breathing difficulties
while taking methotrexate, be sure to tell your doctor
right away.

  During and immediately after treatment with methotrexate,
fertility may be impaired.  Men may have an abnormally low
sperm count; women may have menstrual irregularities.

  People on high doses of methotrexate may develop a brain
condition signaled by confusion, partial paralysis,
seizures, or coma.

  Why should this drug not be prescribed?

  Do not take this medication if you are sensitive to it or
it has given you an allergic reaction.

  Do not take this medication if you are pregnant.

  Methotrexate treatment is not suitable for you if you
suffer from psoriasis or rheumatoid arthritis and also
have one of the following conditions:

  Abnormal blood cell count
  Alcoholic liver disease or other chronic liver disease
  Alcoholism
  Anemia
  Immune-system deficiency

  Special warnings about this medication

  Before you start taking methotrexate, your doctor will do
a chest X-ray plus blood tests to determine your blood cell
counts, liver enzyme levels, and the efficiency of your
kidney function. While you are taking methotrexate, the
blood tests will be repeated at regular intervals; if you
develop a cough or chest pain, the chest X-ray will be
repeated.

  If you are being treated for psoriasis or rheumatoid
arthritis, your doctor will test your liver function at
regular intervals. You should avoid alcoholic beverages
while taking this drug.

  You may develop an opportunistic infection--one that
takes advantage of your altered body chemistry--while you
are taking methotrexate. Before receiving an immunization
or vaccination, be sure to inform health care workers that
you are taking this drug.

  Older or physically debilitated people are particularly
vulnerable to toxic effects from methotrexate. Your doctor
will prescribe methotrexate with great caution if you have
any of the following:

  Active infection
  Liver disease
  Peptic ulcer
  Ulcerative colitis

  Possible food and drug interactions when taking this
medication

  If you are being given methotrexate for the treatment of
cancer or psoriasis, you should not take aspirin or other
nonsteroidal painkillers such as Advil or Naprosyn; this
combination could increase the toxic effects of
methotrexate.
  If you are taking methotrexate for rheumatoid arthritis,
you may be able to continue taking aspirin or a
nonsteroidal painkiller, but your doctor should monitor you
carefully.

  Other drugs that may increase the toxic effects of
methotrexate include:

  Cisplatin (Platinol)
  Penicillins
  Phenylbutazone
  Phenytoin (Dilantin)
  Probenecid
  Retinoid drugs such as Retin-A and Renova
  Sulfa drugs such as Bactrim and Gantrisin

  Sulfa drugs may increase methotrexate's toxic effect on
the bone marrow, where new blood cells are made.

    Certain antibiotics, including tetracycline (Sumycin)
and chloramphenicol (Chloromycetin), may reduce the
effectiveness of metho?trexate. This is also true of
vitamin preparations that contain folic acid.

  In addition, methotrexate can alter the effect of
theophylline (Quibron, Theo-Dur).

  Special information if you are pregnant or breastfeeding

  A woman should not start methotrexate therapy until the
doctor is sure she is not pregnant. Because methotrexate
causes birth defects and miscarriages, it must not be taken
during pregnancy by women with psoriasis or rheumatoid
arthritis. It should be taken by women being treated for
cancer only if the potential benefit outweighs the risk to
the developing baby.  In fact, a couple should avoid
pregnancy if either the man or the woman is taking
methotrexate.  After the end of methotrexate treatment, a
man should wait at least 3 months, and a woman should wait
for the completion of at least one menstrual cycle, before
attempting to conceive a child.

  Methotrexate should not be taken by a woman who is breast-
feeding; it does pass into breast milk and may harm a
nursing baby.

  Recommended dosage

  Treatment with methotrexate is highly individualized.
Your doctor will carefully tailor your dosage of
methotrexate in order to avoid serious side effects and
possible under- or overdosing.

  Overdosage

  Taken in excess, methotrexate can cause serious and even
fatal damage to the liver, kidneys, bone marrow, lungs, or
other parts of the body. Symptoms of overdosage may include
lung or breathing problems, mouth ulcers, or diarrhea.

  Initially, however, serious damage caused by methotrexate
may be apparent only in the results of blood tests. For
this reason, careful, regular monitoring by your doctor is
necessary. If for any reason you suspect symptoms of an
overdose of this drug, seek medical attention immediately.

... Before drawing boards were invented, what did people go back to?