Maxtrex

How does it work?

Maxtrex tablets contain the active ingredient methotrexate, which is a type of medicine called a cytotoxic antimetabolite. (NB. Methotrexate is also available without a brand name, ie as the generic medicine.) Methotrexate is used to treat three different conditions: rheumatoid arthritis, psoriasis and cancer of various types. Cancers form when cells within the body multiply uncontrollably and abnormally. These cells then spread and destroy nearby tissues. Methotrexate works by preventing the cancer cells from dividing and multiplying. It does this by inhibiting the action of an enzyme called dihydrofolate reductase. This enzyme normally converts folic acid into a substance called tetrahydrofolic acid, which is essential for the synthesis of new genetic material (DNA) within cells. Cells are unable to divide, multiply and repair themselves without tetrahydrofolic acid to make new DNA. As methotrexate deprives cells of this nutrient it kills cancer cells and stops the cancer growing. Unfortunately, methotrexate also affects the division of normal, healthy cells, particularly those that divide rapidly such as the cells lining the mouth and gut and cells in the bone marrow. For this reason, cancer chemotherapy using high doses of methotrexate is usually followed by a treatment called folinic acid rescue therapy. This involves giving tetrahydrofolic acid, in the form of folinic acid (also called calcium folinate or calcium leucovorin), usually 24 hours after the methotrexate. This bypasses the action of the methotrexate and allows normal cell division to recover. Normal healthy cells recover faster than cancer cells and this helps to prevent side effects. The aim is to progressively shrink the cancer over several cycles of chemotherapy, allowing normal cells to recover in between. Methotrexate is used to treat a wide variety of cancers, including acute leukaemias, non-Hodgkin's lymphoma, soft tissue and bone cancers, and solid tumours, particularly breast, lung, head and neck, bladder, cervical, ovarian, and testicular cancers. It may be given by mouth or injection, depending on the dose, and is most commonly used in combination with other chemotherapy medicines. Methotrexate is used in lower doses taken by mouth to treat severe rheumatoid arthritis and severe psoriasis that have not responded to other treatments. In rheumatoid arthritis methotrexate is thought to work by suppressing the excessive activity of the immune system that causes the inflammation in this condition, though the exact mechanism of action is not fully understood. It is used when the arthritis does not improve sufficiently with conventional treatment, or for people who cannot tolerate conventional treatments. In arthritis methotrexate is sometimes referred to as a disease-modifying antirheumatic drug (DMARD), because it suppresses the disease process. In psoriasis, methotrexate works by preventing the excessive division and multiplication of skin cells that causes the skin scaling and raised plaques in this condition. It is used when the condition is severe and unresponsive to conventional treatments. In low doses methotrexate can also affect the division of normal, healthy cells, and it has the potential to produce serious side effects. For this reason, treatment with methotrexate is usually only initiated by hospital specialists, and regular blood tests are needed to monitor for potential side effects.

What is it used for?

Cancer

Inflammatory disease of the joints

Severe psoriasis

Warning!

It is recommended that you avoid drinking alcohol while taking this medicine.

It is important that you pay close attention to the dose of methotrexate your doctor has prescribed, and how often you should take this dose. You should check the strength of the tablets you have been given, how many you need to take and how often. Methotrexate tablets for treating rheumatoid arthritis or psoriasis are usually taken once a week. Exceeding the prescribed dose can greatly increase the chance of serious side effects. Talk to your doctor or pharmacist if you are unsure what dose you should be taking.

Before starting treatment with this medicine you should have a chest x-ray and blood tests to monitor your kidney function, liver function and levels of blood cells in your blood. These should be repeated before starting treatment again after a rest period.

People receiving low-dose methotrexate, ie for psoriasis or rheumatoid arthritis, should have blood tests to monitor the levels of blood cells in the blood (full blood count), kidney function and liver function before starting treatment with this medicine. These tests should be repeated weekly until therapy is stabilised, and then every two to three months throughout treatment. It is important that you do not miss a blood test.

This medicine may rarely cause a decrease in the normal amounts of blood cells in the blood. For this reason you should consult your doctor immediately if you experience any of the following symptoms: unexplained bruising or bleeding, purple spots, sore throat, mouth ulcers, high temperature (fever), feeling tired or general illness. Your doctor may want to take a blood test to check your blood cells.

Consult your doctor if you experience swollen lymph nodes (glands in the neck, armpits or groin), a sore inflamed mouth or mouth ulcers while receiving treatment with this medicine.

This medicine may sometimes have side effects on the lungs, and you should consult your doctor immediately if you experience a cough, shortness of breath, difficulty breathing or a fever while receiving treatment with this medicine.

This medicine may be harmful to an unborn baby. For this reason, women taking this medicine should use effective contraception to prevent pregnancy, and men taking this medicine should use effective contraception to prevent fathering a child. You should continue to use contraception to prevent pregnancy for at least three months after stopping this medicine. Women should consult their doctor immediately if they become pregnant.

This medicine is not recommended for children, except as chemotherapy in the treatment of cancer.

Use with caution in

Elderly people

Decreased kidney function

Decreased liver function

Diarrhoea

Fluid collection in abdomen (ascites)

Fluid in the chest cavity around the lungs (pleural effusion)

Inflammation of the bowel and back passage

Life long inherited blood diseases which can cause a variety of symptoms, including mental health problems (porphyrias)

Low blood cell counts

Peptic ulcer

Psychiatric disorders

Not to be used in

Acute infectious illness

People with decreased defences against disease or infection (impaired immune response) due to disease or treatment

Liver disease

Significantly decreased liver function

Recent or active hepatitis

Severely decreased kidney function

Severe anaemia

Severely decreased number of platelets in the blood

Severely decreased number of white blood cells in the blood (leucopenia)

Pregnancy

Breastfeeding

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and Breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

This medicine must not be used during pregnancy, as it may be harmful to the unborn baby. Effective contraception should be used by women who themselves, or whose male partners, are receiving treatment with this medicine. Contraception should be continued for at least three months after the medicine is stopped. Consult your doctor immediately if you become pregnant.

This medicine may pass into breast milk, therefore mothers taking this medicine must not breastfeed. Discuss with your doctor.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

Headache

Blurred vision

Diarrhoea

Changes in mood

Drowsiness

Fatigue

Lung disorders

Abnormal reaction of the skin to light, usually a rash (photosensitivity)

Hair loss (alopecia)

Nausea and vomiting

Low red blood cell count (anaemia)

Decrease in the number of white blood cells in the blood (leucopenia)

Inflammation of the lining of the mouth (stomatitis)

Shaky movements and unsteady walk (ataxia)

Irritation of the eye

Decrease in the number of platelets in the blood (thrombocytopenia)

Liver disorders

A general feeling of being unwell (malaise)

Ulceration or bleeding of the stomach or intestines

Rash or itching

Kidney disorders

Decrease in fertility (reversible on stopping treatment)

The side effects listed above may not include all of the side effects reported by the drug's manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

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