"Methotrexate" for rheumatoid arthritis: reviews. Instructions for use, description of the preparation

Rheumatoid arthritis, if translated literally from Greek, indicates a state of inflammation. The question of what factors provoke the development of this disease is still unclear. Indirect information that the number of leukocytes in the blood increases and the erythrocyte sedimentation rate (ESR) increases , makes it possible to conclude that the process of the development of the disease is of an infectious nature. There is an opinion that the impetus for the development of the disease is an infection that provokes irregularities in the functioning of the immune system. However, not all are affected, but only those with hereditary predisposition. The result of the introduction of this infection in the human body is the formation of immune complexes (from viruses, antibodies, etc.), which accumulate in the tissues and lead to joint damage.

In most cases, treatment of this formidable disease consists in alleviating pain, slowing the course of the disease and repairing the lesions (as far as possible in each case) with the help of surgical methods.

There are a lot of drugs for treatment at present. One such is Methotrexate. With rheumatoid arthritis (reviews of health workers and patients confirm this information), this medication is quite effective, the results of its influence will be felt for a long time.

Composition and principle of action

The main active ingredient of the drug is methotrexate. It is a nitostatic, a folic acid antagonist . Currently, to slow the development of rheumatoid arthritis, treatment with Methotrexate is used more often than other methods. In essence, this drug is an antitumor, cytostatic agent, inhibits mitosis (indirect cell division), slows the growth of actively proliferating tissues, inhibits the development of tumors.

According to statistics, the effectiveness of the medication is observed in 80% of patients, the positive dynamics become noticeable in 2-6 weeks after the start of the course of therapy. After a long treatment time (up to 5 years), Methotraxatom is significantly less effective than any other medication used to slow the development of rheumatoid arthritis.

Forms of the preparation

The medication itself is a Russian analogue of the Austrian Methotrexate Ebove. The original drug manufacturer offers its customers in several forms of release. Tablets are available in three dosages: 2.5 mg, 5 mg and 10 mg of the main active ingredient. All of them are packed in polypropylene bottles of 50 pieces each. In addition, Methotrexate (Austria - the manufacturer), can be purchased as a solution for injection at a dosage of 50 mg / 5 ml. Ampoules are made of dark glass and packed in a cardboard box.

It is also possible to buy a medication in the form of a concentrate for the preparation of infusions (droppers). Dosage - 100 mg / 1 ml. In this form, "Methotrexate" is sold in vials of 5, 10, 50 ml. One bottle is packed in a cardboard box.

Indications for taking "Methotrexate"

The indications for the use of the medication are quite specific, since its main purpose is to fight against neoplasms. It is recommended to take "Methotrexate" in cases where the patient suffers from acute lymphoblastic leukemia and non-Hodgkin's lymphomas. It is also prescribed for trophoblastic tumors, mushroom mycosis and psoriasis (in severe stages).

Also, if other treatments and medications do not have a significant effect, use Methotrexate in rheumatoid arthritis. Comments of experts-rheumatologists about the medicine are quite positive.

Indications for taking "Methotrexate Ebewe" are somewhat more extensive. Specialists prescribe it in the presence of malignant neoplasms of a variety of systems and organs: lung and breast cancer, osteosarcoma and soft tissue sarcomas, ovarian and testicular tumors, Jung's sarcoma, retinoblastoma and autoimmune diseases.

Who should not take the medicine?

It is inadmissible to take the drug to people with increased sensitivity to the main active ingredient. Contraindicated in taking "Methotrexate" pregnant women and nursing mothers. Do not prescribe the drug with existing abnormalities in the liver and kidneys, with hematologic disorders (anemia, thrombocytopenia, leukopenia). You can not begin treatment with medication for patients in the acute stage of any infectious diseases suffering from immunodeficiency syndrome. Both the Russian analogue and the original "Methotrexate" (Austria) are inadmissible to give children up to three years.

With a number of diseases, the drug is administered with great care. Such problems include stomach ulcers and duodenal ulcer, ulcerative colitis, dehydration of the body. When viral, fungal and bacterial infections also act very carefully. To the same group of problems carry previously conducted radiation or chemotherapy.

Possible side effects

"Methotrexate" in ampoules, in tablets, with infusions can cause a number of side effects. Quite serious problems can arise from the hemopoietic system (leukopenia, thrombocytopenia, etc.) and the gastrointestinal tract (dyspepsia, anorexia, hepatotoxicity, pancreatitis). The nervous system can respond with headaches, drowsiness, paresis, seizures. High doses of medication can trigger the development of encephalopathy. There may be deviations from the organs of vision and the cardiovascular system (hypotension, pericarditis, thromboembolism).

May develop respiratory failure, chronic obstructive pulmonary disease, dyspnea, dry, unproductive cough, fever. On the part of the genitourinary system, there is a possibility of severe forms of nephropathy or kidney failure. Possible a violation of spermatogenesis and oogenesis, a decrease in libido, the development of infertility, impotence.

If a woman is pregnant, Methotrexate (injections, pills, droppers) can cause miscarriage, developmental defects, or fetal death.

Dosing regimen of tablets

When treating malignant neoplasms, the pill regimen is developed individually and depends on the chemotherapy schedule. If we are talking about the use of the drug "Methotrexate" in rheumatoid arthritis (reviews of patients are positive), then the initial dose, as a rule, is 7.5 mg once a week. You can take the entire dose at once, but you can divide it into 3 doses with a 12-hour interval.

In some cases (achieving the optimal effect), a weekly dose can be increased. However, it should not exceed 20 mg. When the necessary clinical effect is achieved, the dosage should be gradually reduced to a minimum. The optimal period of the course of therapy was not clinically detected.

Injections of Methotrexate

And how do injections with the drug "Methotrexate"? Injections with rheumatoid arthritis start to do with a dosage of 7.5 mg per week. This can be done subcutaneously, intramuscularly or intravenously. If the drug is well tolerated by the patient, the dose can be gradually increased weekly by 2.5 mg, but not more than 25 mg. When the therapeutic effect is achieved (usually 1-2 months after the start of treatment), the dose should be gradually reduced to the minimum required. For any patient with rheumatoid arthritis, dosage can be gradually adjusted to maintain the optimal effect of treatment. Clinical studies have shown that "Methotrexate" is better absorbed and gives a minimal number of adverse reactions if injections are done subcutaneously or intramuscularly.

With the continuous admission of Methotrexate, the initial positive therapeutic effect persists for two years. With the withdrawal of medication, rheumatoid arthritis manifests itself in 3-6 weeks.

Exceeding the permissible dose

Exceeding the permissible dose of a Russian medication or a medicine "Methotrexate Ebove" (tablets, injections, infusions) does not manifest itself with any specific symptoms. The fact of overdose can be established by the level of methotrexate concentration in the blood plasma.

Treatment consists in immediate (optimally in the first hour) application of the antidote, which is calcium folinate. The amount of the injected substance should be equal to or greater than the dose of "Methotrexate". In addition, doses of calcium folinate can be prescribed by a doctor as needed. Before each next dose, and then every 6 hours throughout the process of eliminating overdose symptoms with an antidote, the urine pH should be determined. Such measures will minimize the likelihood of developing nephropathy.

Also in the necessary set of measures to eliminate the effects of an overdose of medicines include hydration of the body and alkalinization of urine. These procedures will accelerate the excretion of methotrexate.

Interaction with other substances and preparations

If the patient has gout and the appointment of medicines "Methotrexate" or "Methotrexate Ebove", the dose of antidiagnostic drugs should be adjusted. The parallel use of salicylates, phenylbutazone, phenytoion, sulfonamides, a number of certain antibiotics (tetracycline, penicillin, chloramphenicol), anticoagulants of indirect influence and lipid-lowering medication can lead to severe intoxication, even to death.

Large amounts of "Methotrexate" in parallel with NSAIDs can cause death from severe hematologic and gastrointestinal intoxication. The combination of NSAIDs and low doses of the drug under consideration can reduce the excretion of the latter by the renal tubules.

Hepatotoxic medicines (based on sulfasalazine, azathioprine, ethanol) increase the risk of hepatotoxicity, hematotoxic - hematotoxicity of Methotrexate. Parallel drug administration and radiotherapy procedures can provoke bone marrow suppression.

Special instructions

Before you start treatment with Methotrexate medication (injections, tablets, if they are used, it is not important), it is necessary to perform a general blood test (to know the platelet count), biochemistry (to determine the values of liver enzymes, albumin, bilirubin), to make a chest x-ray. In addition, it is necessary to investigate the work of the kidneys, in some cases tests for hepatitis and tuberculosis will not be superfluous.

In order not to miss the development of intoxication, it is necessary to control the composition of peripheral blood (the number of platelets and leukocytes), the functioning of the kidneys, the activity of hepatic transaminases, the level of uric acid in the blood serum. Before each use of Methotrexate, the mucosa of the mouth and throat should be checked for ulcers. The process of bone marrow hematopoiesis should be checked at the beginning of therapy, once during the course of treatment and after its termination.

Price range

The form of the release (tablets, injections) and dosage are the main factors influencing the cost of the drug "Methotrexate".

The price of packing tablets (50 pcs.) With a dosage of 2.5 mg can range from 240 to 250 rubles. The same number of tablets with a dose of 5 mg can be purchased for a sum of 390 to 420 rubles. Packaging of the drug with the highest dosage (10 mg) will cost the buyer 530-550 rubles.

The solution for injections costs much more expensively, and the dispersion of the prices is much wider. For example, 5 ampoules of a drug with a dosage of 50 mg / 5 ml in some pharmacies can cost about 1200-1300 rubles, in others - 4,900 rubles.

Consumer opinion

There are both positive and negative opinions of patients about the drug "Methotrexate". With rheumatoid arthritis, the reviews were mostly fixed in a positive direction (about 80% of patients experienced efficacy in the first 1-1.5 months from the start of treatment). However, it is often possible to hear about the negative effect of the medication on the patient's body, on the development of side effects of varying severity and on the part of different systems and organs.

To minimize the negative impact, Methotrexate should be prescribed exclusively by the attending physician, and he must develop a treatment regimen and choose an effective dose.