Prescription requirement | Methotrexate

Prescription requirement

All dosages are available only on prescription!

Methotrexate for rheumatism

Methotrexate (MTX for short, trade name Lantarel®) is a drug that is very often used as a so-called anti-inflammatory drug for the treatment of rheumatic inflammation. The terms “rheumatism” or diseases of the rheumatic group of forms summarize hundreds of different diseases caused by inflammation. Since Methotrexate has an immunosuppressive effect, i.e. it suppresses reactions of the body’s own defense system, it is used in diseases where this body’s own defense system is disturbed.

Methotrexate is used especially for rheumatoid joint inflammation (e.g. chronic polyarthritis or psoriatic arthritis). However, methotrexate can also be used to treat rheumatic diseases that lead to inflammation of blood vessels (vasculitis) or internal organs (e.g. lupus erythematosus). Depending on the type of disease, rheumatoid inflammation can cause permanent joint damage such as rheumatic nodules on the elbows or even permanent disorders of internal organs.

Methotrexate is usually used in combination with pain therapy to combat the underlying inflammatory process and counteract the permanent damage. The course of the disease is usually positively influenced by drugs such as methotrexate, which is why these drugs are also called basic drugs or disease-modifying drugs (DMARD, Disease Modifying AntiRheumati Drugs). Since in most cases no exact cause for the rheumatic disease is known, it is usually not possible to cure the disease.

Therapy with methotrexate should always be started only after a thorough weighing up of possible risks and side effects of treatment with the risks of non-treatment (e.g. permanent damage to joints and organs). It has not yet been conclusively clarified what kind of anti-inflammatory effect Methotrexate has. It probably interferes with the activity of the immune system by inhibiting the proliferation of immune cells and the production of inflammatory mediators (endogenous substances that initiate or maintain an inflammatory reaction, e.g. cytokines).

This slows down the inflammatory process that destroys the joint. The use of methotrexate has been shown to reduce inflammatory joint changes such as joint pain and swelling in most cases. Morning stiffness and tiredness decrease and the ability to work under stress increases.Often the signs of inflammation in the blood (e.g. the rate of blood sedimentation) also improve under methotrexate.

Long-term studies also show that methotrexate can halt the progression of inflammatory bone changes. In about 10 to 20 percent of cases, methotrexate therapy is not well tolerated, so that other basic drugs must be used. Major side effects include nausea and vomiting, inflammation of the oral mucosa, cirrhosis of the liver and increased susceptibility to infection.

In some cases, a combination of methotrexate with other basic medicines may also be useful. Methotrexate is usually used in rheumatic diseases in small doses of 5-25 milligrams per week and in this dosage has mainly an anti-inflammatory effect. In much higher doses of up to 10,000 milligrams per day, Methotrexate is also used, for example, to treat malignant cancers (tumors).

At these high doses, the risk of undesirable side effects is much greater than in the treatment of rheumatic diseases, and the tolerability profile is even relatively good. Methotrexate is injected once a week into the vein (intravenously, i.v.) or into the muscles (intramuscularly, i.m.)

or taken in the form of tablets, although complete absorption of the drug is not always guaranteed (e.g. in the case of diarrhoea). Furthermore, Methotrexate injections are better tolerated and the effect is stronger. It is important to make sure that Methotrexate is only taken once a week and never at shorter intervals.

Methotrexate usually works with a delay of 4-10 weeks, as do other basic drugs used to treat rheumatism. Often this delay is bridged by an additional intake of cortisone or cortisone-free anti-inflammatory drugs, which work immediately. The maximum effect is reached after three to four months.

Methotrexate therapy must also be continued if an improvement in the rheumatic symptoms is achieved, as discontinuing it easily leads to a new flare-up in the disease. It is therefore necessary that treatment with Methotrexate is long-term and regular. The use of Methotrexate is not indicated in cases of allergy, pregnancy or desire to have children, liver disease, alcohol abuse, reduced blood formation or severe diabetes (Diabetes mellitus). It is recommended to take at least five milligrams of folic acid per week during Methotrexate therapy to reduce side effects.