Methotrexate. Cautions Elective surgery - continue, but consider infection risk & drug interactions. Chronic renal failure (stable) - avoid if eGFR< 20 ml/minute. Ascites and pleural effusions – reduced elimination of methotrexate. Avoid dehydration – increased risk of toxicity. Contraindications Active gastrointestinal ulcer disease. Hepatic Impairment Alcohol abuse Acutely unwell older person - acute renal failure likely. Pregnancy: female patients must be advised not to conceive whilst receiving methotrexate. A reliable form of contraception should be used by men and women whilst on methotrexate and for at least 6 months after discontinuing it. Discontinue methotrexate and refer immediately if a patient or partner discovers they are pregnant whilst taking methotrexate. Breast Feeding: Women being treated with methotrexate should not breastfeed. Active infection and immunodeficiency syndromes Avoid in chronic or recurrent infections especially respiratory or urinary tract Bone marrow supression indicated by leucopenia or thrombocytopenia, anaemia. Immunisations - avoid live immunisations. Untreated folate deficiency. Previous interstitial lung disease due to methotrexate. Important adverse effects & management Serious side effects can occur acutely at any time during treatment Nausea, vomiting & acute minor GI upsets or mucosal side effects - can occur at any stage. Advise patient to take methotrexate with food. May resolve with methotrexate dose reduction or increasing dose of folic acid. Withhold treatment if does not resolve or is severe and discuss with specialist. Alopecia, rash & diarrhoea – may be encountered, but if severe withhold treatment and discuss with specialist. Pulmonary symptoms - a small minority of patients develop symptoms of interstitial pneumonitis, often soon after starting treatment, indicated by persistent dry cough, shortness of breath or fever. Withhold treatment and refer urgently to specialist or A&E. Severe sore throat, abnormal bruising - request urgent FBC & withhold treatment until results known. Haematopoetic suppression - may occur abruptly; factors likely to increase toxicity include advanced age, renal impairment and concomitant anti-folate medication. Any profound drop in white cell or platelet count calls for immediate withdrawal of treatment and urgent referral for supportive treatment. Patient develops significant infection or is systemically unwell - withhold treatment & discuss with speciali...
Methotrexate. ESCA: For the treatment of active Crohn’s disease despite repeated attempts to treat with steroids, 5 ASAs and Azathioprine or 6-Mercaptopurine AREAS OF RESPONSIBILITY FOR THE SHARING OF CARE This shared care agreement outlines suggested ways in which the responsibilities for managing the prescribing of methotrexate in active Crohn’s disease despite repeated attempts to treat with steroids, 5 ASAs and azathioprine or 6-mercaptopurine can be shared between the specialist and general practitioner (GP). You are invited to participate however, if you do not feel confident to undertake this role, then you are under no obligation to do so. In such an event, the total clinical responsibility for the patient for the diagnosed condition remains with the specialist. Sharing of care assumes communication between the specialist, GP and patient. The intention to share care will be explained to the patient by the specialist initiating treatment. It is important that patients are consulted about treatment and are in agreement with it. Patients with active Crohn’s disease are usually under regular specialist follow-up, which provides an opportunity to discuss drug therapy. The doctor who prescribes the medication legally assumes clinical responsibility for the drug and the consequences of its use.
Methotrexate. ESCA: For the treatment of severe, uncontrolled psoriasis, which is not responsive to other therapy AREAS OF RESPONSIBILITY FOR THE SHARING OF CARE This shared care agreement outlines suggested ways in which the responsibilities for managing the prescribing of methotrexate for severe, uncontrolled psoriasis, which is not responsive to other therapy can be shared between the specialist and general practitioner (GP). You are invited to participate however, if you do not feel confident to undertake this role, then you are under no obligation to do so. In such an event, the total clinical responsibility for the patient for the diagnosed condition remains with the specialist. Sharing of care assumes communication between the specialist, GP and patient. The intention to share care will be explained to the patient by the specialist initiating treatment. It is important that patients are consulted about treatment and are in agreement with it. Patients with severe, uncontrolled psoriasis are usually under regular specialist follow-up, which provides an opportunity to discuss drug therapy. The doctor who prescribes the medication legally assumes clinical responsibility for the drug and the consequences of its use. RESPONSIBILITIES and ROLES Specialist responsibilities
Methotrexate. For the treatment of severe, uncontrolled psoriasis, which is not responsive to other therapy Trust Contact details Telephone No. Email address: Consultant:- Specialist Nurse Please refer to BSSE APC formulary website for complete document. BACK-UP ADVICE AND SUPPORT (To be completed by Specialist team) Patient’s name Date of birth Sex Home Address Hospital Number NHS Number Hospital Specialist/Consultant Name (please print) Signature Date To be completed by the General Practitioner: I agree to participate in this shared care agreement for the treatment of the below named patient with methotrexate for severe, uncontrolled psoriasis, which is not responsive to other therapy General Practitioner Name (please print) Signature Date Please keep a copy of this agreement for your own records and forward the original to the above named Consultant. In the patient's notes, using the appropriate Read Code listed below, denote that the patient is receiving treatment under a shared care agreement. GP Prescribing System Read Code Description GP Prescribing System Read Code Description
Methotrexate. Produced by 3Ts Formulary Group Further copies can be obtained from: • Pharmacy Department, Great Western Hospital. • Wilts Primary Care Trust. • Swindon Primary Care Trust. Patient‛s Name Consultant Signature Date I agree to your request to prescribe Methotrexate in accordance with the shared care guideline: GP Signature Date Availability: Methotrexate 2.5mg is available through pharmacy wholesalers. Contact details:- Contact Speciality Available Tel No. Out of hours Dr E Price Consultant Rheumatologist Mon Fri 9 – 5 01793 604314 Dr L Xxxxxxxxxx " Mon Fri 9 – 5 01793 604317 Xx X Xxxxxxx " 01793 604318 Rheumatology GWH NHS Mon Fri 01793 Helpline Foundation 9 – 5 604323 Trust Medicines GWH NHS Mon Fri 01793 Information Foundation Trust 9 - 5 605029 The information contained in this agreement is issued on the understanding it is the best available from the resources at our disposal at the time of issue. For full prescribing details please refer to the relevant summary of product characteristics. Aim The aim of Shared Care Agreement is to provide information to general practitioners (GPs) and hospital staff about complex or high cost therapies that their patients may be given following specialist referral. Use of this shared care agreement has been reached following the understanding that shared care is an appropriate option, and includes a statement of Specialist Unit/GP responsibilities. Shared Care Agreements will ensure that all GP‛s have sufficient information to enable them to undertake prescribing responsibility for specialist therapies (if indicated). Supervising Consultants will inform GP's that therapy has been initiated and that a shared care agreement is appropriate. This document will incorporate NICE guidance where applicable To arrange agreement: TWO copies of this agreement must be signed by the referring specialist and forwarded to the General Practioner (GP). The G.P. should indicate if they will take on shared care (see front of agreement) and sign both copies, one of which should be returned to the specialist and the other placed in the patients notes. If the GP is unhappy with prescribing the medication, this should be discussed with the referring specialist verbally or by letter. Drug Information Rationale for use/Licensed Indications: • This guideline covers use as disease modifying therapy in Rheumatoid Arthritis, psoriatic arthritis and other forms of inflammatory arthritis including juvenile arthritis. • If used outside of these indi...
