Methotrexate: In rheumatic diseases

Methotrexate in the treatment of rheumatic diseases Methotrexate is a disease modifying anti rheumatic drug. It is usually started in the dose of 7.5 - 15 mg once a week. An effect is usually seen during the first month of treatment. If there seems to be no response, the dose may be gradually increased up to 25 mg per week. If there is no response in 3 months, the drug should be withdrawn without further waiting and alternative should be considered. The drug should not be used in pregnancy or during breastfeeding. Haemoglobin, WBCs and platelets, serum ALT (AST) are checked every second week during the first 2 - 3 months. After that, laboratory tests are performed at 2 - 3 -month intervals. Small changes in values for serum ALT (and AST) are common. There is no need to stop the drug, if enzyme values do not exceed 150 U/L. When the values increase to 100 - 150 U/L, the dose has to be reduced.


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