Nordimet (Methotrexate) Injection
Nordimet contains the active substance methotrexate which works by:
- reducing inflammation or swelling, and
- reducing the activity of the immune system (the body’s own defense mechanism). An overactive immune system has been linked to inflammatory diseases.
Pharmacist - M.B.A. (Public Health) D.I.C.
Nordimet (Methotrexate) Injection
Why have I been prescribed Nordimet?…
Why have I been prescribed Nordimet?
- Methotrexate is used in the management of active rheumatoid arthritis in adult patients and severe forms of psoriasis vulgaris, particularly of the plaque type.
- It is also used in the treatment of some cancers such as acute leukaemia and carcinoma.
How does it work?
- Methotrexate suppresses the immune system which attacks the body in rheumatoid arthritis, thereby reducing inflammation.
- It also destroys cells that grow too quickly, which is important in treating cancer and psoriasis.
When and how do I take it?
It it very important that methotrexate is only taken ONCE A WEEK.
What’s the dose?
The usual dose is:
Dose in patients with rheumatoid arthritis
- The recommended starting dose is 7.5 mg methotrexate once a week.
- The doctor may increase the dose if the used dose is not effective but tolerated well. The average weekly dose is 15-20 mg. Generally, a weekly dose of 25 mg should not be exceeded. Once Nordimet starts working, the doctor may reduce the dose gradually to the lowest possible effective maintenance dose.
- Generally, improvement of symptoms can be expected after 4-8 weeks of treatment. Symptoms may return if treatment with Nordimet is stopped.
Dose in children and adolescents below 16 years with polyarthritic forms of juvenile idiopathic arthritis 2
- The doctor will calculate the dose required from the child’s body surface area (m ), and the dose is expressed as mg/m2.
- Use in children under
- Use in adults with severe forms of psoriasis vulgaris or psoriatic arthritis
- Your doctor will give you a single test dose of 5-10 mg, in order to assess possible side effects. If the test dose is well tolerated, treatment will be continued after a week with a dose of approximately 7.5 mg.
- Response to treatment can generally be expected after 2-6 weeks. Depending on the effects of treatment and results of blood and urine tests, the therapy is then continued or stopped.
Method and duration of administration
- Nordimet is given as injection under the skin (subcutaneously). It must be injected once weekly and it is recommended to always inject Nordimet on the same day of the week.
- At the start of your treatment, Nordimet may be injected by medical staff. However, your doctor may decide that you can learn how to inject Nordimet yourself. You will receive appropriate training for you to do this. Under no circumstances should you attempt to inject yourself unless you have been trained to do so.
- The duration of treatment is determined by the treating physician. Treatment of rheumatoid arthritis, juvenile idiopathic arthritis, psoriasis vulgaris and psoriatic arthritis with Nordimet is a long-term treatment.
How to give yourself an injection of Nordimet
If you have difficulty handling the pen, ask your doctor or pharmacist. Do not try to inject yourself if you have not been trained on how to do so. If you are not sure what to do, talk to your doctor or nurse immediately.
Before injecting yourself with Nordimet
- Check the expiry date on the medicine. Do not use if the date has passed.
- Check the pen is not damaged and the medicine in it is a clear, yellow solution. If not, use another pen.
- Check your last injection site to see if the last injection caused any redness, change in skin colour, swelling, oozing or is still painful, if so talk to your doctor or nurse.
- Decide where you are going to inject the medicine. Change the place where you inject each time.
Instructions on injecting yourself with Nordimet
- Wash your hands thoroughly with soap and water.
- Sit or lie in a relaxed, comfortable position. Make sure you can see the skin area you are going to inject.
- The pen is pre-filled and ready to use. Remove the pen from the box and ensure that the tamper-evident seal between the white body of the pen and the green cap is intact. If the tamper-evident seal is broken, return the pen and box to the pharmacist who supplied it and use another pen for the injection.
Visually inspect the pen. You should see a yellow fluid through the viewing window. You may see a small air bubble, this does not affect the injection and will not harm you. A droplet may appear at the tip of the needle. This is normal.
- Wipe the area that you will inject with the alcohol swab provided.
- While holding the body of the pen, pull the cap off. Once you have taken the cap off, keep the pen in your hand. Do not allow the pen to touch anything else. This is to make sure that the pen is not accidentally activated and that the needle stays clean.
- Make a fold in the skin by gently pinching the skin of the injection place with your forefinger and thumb. Make sure you hold the skin fold throughout the injection.
- Move the pen towards the skin fold (site of injection) with the needle shield pointing directly at the site of injection. Place the yellow needle shield against the area of injection so that the entire rim of the needle shield is touching the skin.
- Apply downward pressure on the pen on to your skin until you hear and feel a “click”. This activates the pen and the solution will inject automatically into the skin.
- The injection lasts for a maximum of 10 seconds. You will feel and hear a second “click” once the injection is completed.
- Wait another 2-3 seconds before removing the pen from your skin. The safety shield on the pen is now locked to prevent any needle stick injuries. You can now let go of the skin fold.
- Visually inspect the pen through the viewing window. You should see green plastic. This means that all the fluid has been injected. Discard the used pen into the sharps bin provided. Close the container lid tightly and place the container out of reach of children. If you accidently get methotrexate on the surface of the skin or soft tissues you must rinse with plenty of water.
If you use more Nordimet than you should
- Follow the dose recommendations of your treating doctor. Do not change the dose without your doctor’s recommendation.
- If you suspect that you have used too much Nordimet, tell your doctor or contact the nearest hospital immediately. Take your medicine package and this leaflet with you if you go to a doctor or hospital.
- An overdose of methotrexate can lead to severe toxic reactions. Overdose symptoms may include easy bruising or bleeding, unusual weakness, mouth sores, nausea, vomiting, black or bloody stools, coughing up blood or vomit that looks like coffee grounds, and decreased urinating.
If you forget to use Nordimet
- Do not take a double dose to make up for a forgotten dose, but continue taking the prescribed dose as normal. Ask your doctor for advice.
If you stop taking Nordimet
- You should not interrupt or discontinue Nordimet treatment before discussing with your doctor. If you suspect that you are experiencing side effects, contact your doctor immediately for advice.
- If you have any further questions on the use of this medicine, ask your doctor or pharmacist.
Could they interact with other tablets?
The following medicines may interact with Methotrexate:
- folic acid
- nitrous oxide
- para-aminobenzoic acid
The following types of medicine may interact with Methotrexate:
- acidic anti-inflammatory agents
- folic acid antagonists
- live vaccines
- medicines that are damaging to the kidney
- medicines that are damaging to the liver
- non-steroidal anti-inflammatories
- oral hypoglycaemics
- thiazide diuretics
If you are taking Methotrexate and one of the above medicines or types of medicines, make sure your prescriber knows about it.Herbal supplements should be used with caution and only after informing your doctor first.
What are the possible risks or side-effects?
Common side effects include:
- mouth ulcers
- low white cell count
- weight loss
- skin rash
- hair loss
Can I drink alcohol while taking it?
You cannot drink alcohol while taking methotrexate.
What if I’m pregnant/breastfeeding?
Methotrexate cannot be taken while pregnant or breast feeding.
If you have any more questions please ask your Pharmacist.
Remember to keep all medicines out of reach of children
Please Note: We have made every effort to ensure that the content of this information sheet is correct at time of publish, but remember that information about drugs may change. This sheet does not list all the uses and side-effects associated with this drug. For full details please see the drug information leaflet which comes with your medicine. Your doctor will assess your medical circumstances and draw your attention to any information or side-effects which may be relevant in your particular case.