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 not clarified. Indirect information that the number of leukocytes in the blood is increasing and the erythrocyte sedimentation rate (ESR) is increasing , makes it possible to conclude that the process of the development of the disease has an infectious nature. It is believed that the impetus for the development of the disease is an infection that provokes disturbances in the functioning of the immune system. However, not everyone is exposed to this, but only those with a hereditary predisposition. The result of the introduction of this infection into the human body is the formation of immune complexes (from viruses, antibodies, etc.) that accumulate in the tissues and lead to joint damage.
In most cases, the treatment of this formidable disease consists in alleviating pain, slowing down the course of the disease and in restoring injuries (as far as possible in each case) using surgical methods.
There are a great many drugs for treatment . One of these is Methotrexate. With rheumatoid arthritis (reviews of health workers and patients confirm this information), the mentioned medication is quite effective, the results of its effect will be felt for a long time.
Composition and principle of action
The main active component of the drug is methotrexate. It is a nitostatic, folic acid antagonist . Currently, to slow the development of rheumatoid arthritis, treatment with Methotrexate is used more often than other methods. In essence, this medication is an antitumor, cytostatic agent, inhibits mitosis (indirect cell division), slows the growth of actively proliferating tissues, and inhibits the development of tumors.
According to statistics, the effectiveness of the drug is observed in 80% of patients, positive dynamics becomes noticeable 2-6 weeks after the start of the course of therapy. After a long treatment time (up to 5 years), Methotraxat therapy is canceled much less often than any other medicines used to slow the development of rheumatoid arthritis.
Forms of drug release
The medication itself is the Russian analogue of the Austrian Methotrexat Ebeve. The manufacturer offers the original drug to its customers in several forms of release. The tablets go on sale 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 - manufacturer), can be purchased as an injection solution in a dosage of 50 mg / 5 ml. Ampoules are made of dark glass and packaged in a cardboard box.
It is also possible to buy 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 bottles of 5, 10, 50 ml. One bottle is packed in a cardboard box.
Indications for Methotrexate
Indications for the use of the medication are quite specific, since its main purpose is the 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, fungal mycosis and psoriasis (in severe stages).
Also, if other methods of treatment and drugs do not have a noticeable effect, Methotrexate is used for rheumatoid arthritis. Reviews of rheumatologists about the medication are quite positive.
Indications for taking "Methotrexate Ebeve" are somewhat more extensive. Specialists prescribe it if the patient has malignant neoplasms of a wide variety of systems and organs: lung and breast cancer, osteosarcoma and soft tissue sarcoma, ovarian and testicular tumors, Jung's sarcoma, retinoblastoma and autoimmune diseases.
Who should not take the medicine?
It is unacceptable to take the drug for people with hypersensitivity to the main active ingredient. Methotrexate is contraindicated for pregnant women and nursing mothers. Do not prescribe the drug with existing abnormalities in the liver and kidneys, with hematological disorders (anemia, thrombocytopenia, leukopenia). Do not start treatment with medication for patients in the acute stage of any infectious disease suffering from immunodeficiency syndrome. Both the Russian counterpart and the original Methotrexate (Austria) are not allowed to be given to children under three years of age.
With a number of diseases, the drug is prescribed with great care. Such problems include ulcers of the stomach and duodenum, ulcerative colitis, dehydration. With viral, fungal and bacterial infections, one must also act very carefully. The same group of problems includes previous radiation or chemotherapy.
Feasible side effects
"Methotrexate" in ampoules, tablets, with infusions can cause a number of side effects. 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, convulsions. High doses of the drug can trigger the development of encephalopathy. Deviations from the organs of vision and the cardiovascular system (hypotension, pericarditis, thromboembolism) are possible.
Respiratory failure, chronic obstructive pulmonary disease, shortness of breath, dry nonproductive cough, and fever may develop. From the genitourinary system, there is a likelihood of severe forms of nephropathy or renal failure. Perhaps a violation of spermatogenesis and ovogenesis, 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.
Tablet dosage regimen
In the treatment of malignant neoplasms, a pill regimen is developed individually and depends on the regimen for conducting chemotherapy sessions. If we are talking about the use of the drug “Methotrexate” for rheumatoid arthritis (patient reviews are positive), then the initial dose, as a rule, is 7.5 mg once a week. You can take the entire dose at once, or you can divide it into 3 doses with a 12-hour interval.
In some cases (achieving the optimal effect), the weekly dose may 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 has not been clinically identified.
Methotrexate Injections
And how do injections with the drug "Methotrexate"? Injections with rheumatoid arthritis begin to be done 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 necessary. For any patient with rheumatoid arthritis, the dosage can be gradually adjusted to maintain the optimal treatment effect. Clinical studies have shown that Methotrexate is better absorbed and gives a minimal number of side responses if injections are given subcutaneously or intramuscularly.
With continuous use of Methotrexate, the initial positive therapeutic effect persists for two years. When the medication is canceled, rheumatoid arthritis makes itself felt after 3-6 weeks.
Excess dose
Exceeding the permissible dose of the Russian medication or Metotrexat Ebeve drug (tablets, injections, infusions) does not manifest any specific symptoms. The fact of an overdose can be established by the concentration level of methotrexate in blood plasma.
Treatment consists in immediate (optimal in the first hour) use of an antidote, which is calcium folinate. The amount of substance administered should be equal to or greater than the dose of Methotrexate taken. Additionally, doses of calcium folinate can be prescribed by a doctor as needed. Before introducing each next dose, and then every 6 hours throughout the entire process of eliminating the symptoms of overdose with an antidote, urine pH should be determined. Such events will minimize the likelihood of nephropathy.
Also, the necessary set of measures to eliminate the consequences of an overdose of a drug includes hydration and alkalization of urine. These procedures will speed up the excretion of methotrexate.
Interaction with other substances and preparations
If the patient has gout and is prescribed Methotrexate or Methotrexate Ebeve medications, the dose of antigout preparations should be adjusted. The parallel use of salicylates, phenylbutazone, phenytoion, sulfonamides, a number of certain antibiotics (tetracycline, penicillin, chloramphenicol), indirect anticoagulants and lipid-lowering medications can lead to severe intoxication, up to death.
Large volumes of "Methotrexate" in parallel with NSAIDs can cause death from severe hematological and gastrointestinal intoxication. The combination of NSAIDs and low doses of the drug we are considering can reduce the excretion of the latter by the renal tubules.
Hepatotoxic drugs (based on sulfasalazine, azathioprine, ethanol) increase the risk of hepatotoxicity, and hematotoxic drugs increase the hematotoxicity of Methotrexate. Concurrent use of the drug and radiotherapy procedures can provoke bone marrow depression.
Special instructions
Before you start treatment with the Methotrexate medication (whether injections or pills are used, it doesn’t matter), you should definitely perform a general blood test (find out the platelet count), biochemistry (determine the values of liver, albumin, bilirubin enzymes), and take a chest x-ray. In addition, it is necessary to study the work of the kidneys, in some cases, tests for hepatitis and tuberculosis will not be superfluous.
In order not to miss the moment of the development of intoxication, it is necessary to control the composition of peripheral blood (platelet and leukocyte counts), the functioning of the kidneys, the activity of hepatic transaminases, and the level of uric acid in blood serum. Before each use of Methotrexate, the oral and pharyngeal mucosa should be checked for ulcers. The process of bone marrow hematopoiesis should be monitored at the beginning of therapy, once during the course of treatment and after its completion.
Price range
The form of release (tablets, injections) and dosage are the main factors affecting the cost of the Methotrexate preparation.
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 an amount from 390 to 420 rubles. Packaging the drug with the largest dosage (10 mg) will cost the buyer 530-550 rubles.
Injection is much more expensive, and the price range 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 - 4900 rubles.
Consumer opinion
There are both positive and negative opinions of patients about the drug "Methotrexate". In rheumatoid arthritis, the reviews were mostly recorded in a positive direction (about 80% of patients felt effective in the first 1-1.5 months from the start of treatment). However, one can often hear about the negative effect of the drug on the patient’s body, about the development of side effects of varying severity from different systems and organs.
To minimize the negative impact, Methotrexate should be prescribed exclusively by the attending physician, and he must also develop a treatment regimen and select an effective dose.