Weekly subcutaneous methotrexate injections

Information for patients / carers

Please note this leaflet is additional to information supplied in the patient-held methotrexate book.

Use of subcutaneous methotrexate

Methotrexate is a cytotoxic drug that slows down the body’s ability to make certain cells. This includes those that are involved in inflammation. This means it may be particularly useful in the treatment of conditions where there is inflammation that causes swelling and stiffness of the joints, thickened skin or damage to the bowel – which is responsible for the problems you experience with your condition. Usually, patients take the drug in tablet form. However, some patients need to inject the drug, as it can lead to better absorption with fewer side effects.

General information

• Methotrexate must only be given once a week, on the same day of each week.
• Methotrexate can harm the development of a baby. It must not be given by or to anyone who is pregnant or breastfeeding. Patients who are planning to get pregnant must stop methotrexate for three to six months first. Men must not father a baby while taking methotrexate.
• Occasionally, methotrexate can cause serious side effects (as highlighted in the patient-held record book).
• It is important that you attend for regular blood tests as directed by your hospital doctor or specialist nurse.
• If you have an infection that does not seem to be getting better, or if you suffer from unusual bleeding or bruising, have a dry tickly cough and / or shortness of breath, please contact your specialist nurse (see contact details below) for advice before having the injections.

Where do I obtain supplies from?

Most patients will obtain methotrexate injections (Metoject®) from their GP. You can either collect a prescription from your surgery and take it to a pharmacy, or sometimes your GP / hospital specialist nurse may arrange for supplies to be delivered to your home. Your specialist nurse(s) will explain how to obtain supplies before you start treatment.

Metoject® is the only licensed form of injectable methotrexate. It is easy to use because the needle is already attached.

Will I need any other equipment?

You will be given a cytotoxic sharps bin (with a purple lid) when your start treatment. When the sharps bin is two-thirds full seal it and either return it to your hospital clinic or to your GP surgery (some community pharmacies will also accept sharps bins for disposal). You should be given a replacement cytotoxic sharps bin. You will also be given a spillage kit, although it is unlikely that you will need this.

How to give the injections

You will be given training on how to administer the injections. If a carer is giving the methotrexate to you, they will be given appropriate training.

Refer to the patient information leaflet supplied with the injections for instructions on how to store methotrexate and how to inject yourself.

Remember: used methotrexate syringes and needles must not be put into the normal household rubbish.

If you are a carer administering methotrexate to someone else, it is advisable to wear gloves during preparation and administration of the injection.

Accidental spillages of methotrexate

This is very unlikely when pre-filled syringes are used and if the procedures are followed correctly. However, make sure you and your family, or carer, know where the spillage kit is kept. After dealing with a spillage, contact your hospital specialist nurse(s) to inform them of the spillage.

Any waste from cleaning up a spillage should not be placed in your household rubbish bin (see sections below for further details)

Spillage onto skin

Wash the affected area with plenty of soap and water. Do not scrub as unbroken skin provides protection. Contact your hospital specialist nurse if you have a skin reaction.

Spillage into eyes

Wash the eye with plenty of water for at least five minutes. Contact your GP for further advice; out of normal working hours go to your local accident and emergency department.

Spillage onto work surface or floors

Wear the plastic gloves and apron from the spillage kit. Mop up the spillage with kitchen roll. Wash the area with plenty of soap and water.

Discard the used gloves, apron and kitchen roll into your cytotoxic sharps bin, seal it and take the waste to your GP surgery or hospital clinic for disposal.

Spillage onto clothing

Wearing plastic gloves, remove the affected clothes immediately. These should be washed twice and separately from other clothes. Dispose of the gloves in your cytotoxic sharps bin and take the waste to your GP surgery or hospital clinic for disposal.

Contacts and further information

For further information during normal working hours contact your specialist nurse(s) using the numbers below; outside of normal working hours please contact your out of hours GP who can advise you on any immediate action.

Dermatology specialist sisters – 01223 217391

Rheumatology practitioners – 01223 254933

Inflammatory bowel disease specialist nurses – 01223 257212

Specialist vasculitis sister – 01223 586796