Common brand names

• Jylamvo
• Trexall
• Various
• Xatmep

How it is administered

Methotrexate is available in several forms, including:

• Oral tablets (commonly 2.5 mg per tablet)
• Oral solution (such as Jylamvo, 2 mg/mL)
• Injectable formulations for intravenous (IV), intramuscular (IM), subcutaneous (SC), or intrathecal (directly into the spinal fluid) administration

The method of administration and dose depend on the specific disease being treated, the patient's age, and other factors. For blood cancers, methotrexate is often part of a combination chemotherapy regimen and may be given orally or by injection.

How it works

Methotrexate works by inhibiting an enzyme called dihydrofolate reductase. This enzyme is necessary for cells to make DNA, which is required for cell growth and division. By blocking this enzyme, methotrexate prevents the formation of new DNA, which particularly affects rapidly dividing cells, such as cancer cells and certain cells in the immune system.

Because blood cancers like leukemia and lymphoma involve the uncontrolled growth of abnormal blood cells, methotrexate helps slow or stop this growth. However, other rapidly dividing healthy cells (such as those in the bone marrow, digestive tract, and hair follicles) can also be affected, which is why side effects can occur.

Methotrexate is used in various dosing regimens and is often combined with other chemotherapy drugs to increase its effectiveness and reduce the risk of cancer cells becoming resistant.

Who should take it

Methotrexate is indicated for adults and children with certain blood cancers, including:

• Acute lymphoblastic leukemia (ALL), as part of a combination chemotherapy maintenance regimen
• Mycosis fungoides (a type of cutaneous T-cell lymphoma)
• Relapsed or refractory non-Hodgkin lymphoma, as part of a metronomic combination regimen

It is also used for other conditions such as rheumatoid arthritis, severe psoriasis, and polyarticular juvenile idiopathic arthritis, but in the context of blood cancers, its main use is as part of multi-drug chemotherapy protocols.

The decision to use methotrexate is made by a cancer specialist (oncologist) based on the type and stage of cancer, previous treatments, and the patient’s overall health.

Who should not take it

Methotrexate should not be taken by:

• Pregnant women when used for non-cancer conditions, due to the risk of severe birth defects and fetal death
• Anyone with a history of severe hypersensitivity reactions (including anaphylaxis) to methotrexate

Caution is also needed in patients with significant liver or kidney disease, active infections, or certain blood disorders, as methotrexate can worsen these conditions. It is important to discuss your full medical history with your doctor before starting methotrexate.

Methotrexate is a powerful medication and should only be used under close medical supervision, with regular monitoring of blood counts and organ function.

Commonly used with

Methotrexate is commonly used in combination with other chemotherapy drugs for blood cancers. The specific drugs used together depend on the cancer type and treatment protocol. For example, in acute lymphoblastic leukemia (ALL), methotrexate may be combined with drugs like vincristine, prednisone, and asparaginase.

Supportive medications, such as leucovorin (a form of folinic acid), may be given to reduce the risk of certain side effects, especially when high doses of methotrexate are used.

Commonly tested with

Methotrexate is often tested in clinical trials with other chemotherapy agents and supportive treatments. For blood cancers, it is frequently studied in combination with:

• Vincristine
• Prednisone
• Asparaginase
• Cytarabine
• Doxorubicin
• Leucovorin (for rescue after high-dose methotrexate)

These combinations are designed to improve treatment effectiveness and manage side effects.