Medicines

Methotrexate for skin conditions

This leaflet is for parents and carers about how to use this medicine in children. Our information may differ from that provided by the manufacturers, because their information usually relates to adults. Read this leaflet carefully. Keep it somewhere safe so that you can read it again.

Name of medicine

Methotrexate

Brand name: Maxtrex®

This leaflet is about the use of methotrexate for the skin conditions psoriasis and scleroderma (also called morphea).

Why is it important for my child to take methotrexate?

Methotrexate is used to treat severe psoriasis and scleroderma when other medicines have not helped. It helps by slowing down the rate at which the skin grows.

Methotrexate does not cure the condition but may help to keep it under control.

What is methotrexate available as?

Liquid medicine can be ordered specially from your pharmacist.

Tablets: 2.5 mg, 10 mg

Your child should only ever have the 2.5 mg tablets. The two strengths of tablet are similar in colour but have different shapes. Check you have the right ones each time you collect a new prescription. If you are not sure, contact your pharmacist before giving the tablets to your child.

When should I give methotrexate

Methotrexate is given once a week. Methotrexate should be given in the evening, at least 1 hour after food. Give it on the same day each week. 

Choose a day when your child has a regular activity or a favourite TV programme, to help you remember.

If your doctor has recommended that your child also takes folic acid, it is important that the methotrexate and folic acid are given on different days. Otherwise, methotrexate will not work properly.

How much should I give?

Your doctor will work out the amount of methotrexate (the dose) that is right for your child. The dose will be shown on the medicine label.

It is important that you follow your doctor’s instructions about how much to give.

How should I give methotrexate?

Tablets

Tablets should be swallowed with a glass of water, milk or juice. Your child should not chew the tablet. Do not crush these tablets. Handle the tablets as little as possible and wash your hands thoroughly after touching them.

Liquid medicine

  • Shake the medicine well. Measure out the right amount using an oral syringe or a medicine spoon. You can get these from your pharmacist. Do not use a kitchen teaspoon as it will not give the right amount.

When should the medicine start working?

It may take 1–3 months before you see a difference in your child’s skin. It is important that you continue to give methotrexate once a week during this time.

What if my child is sick (vomits)?

  • If your child is sick less than 30 minutes after having a dose of methotrexate, give them the same dose again.
  • If your child is sick more than 30 minutes after having a dose of methotrexate, do not give them another dose. Wait until the next normal dose.

If your child is sick again, seek advice from your family doctor, nurse, pharmacist, or hospital. They will decide what to do based on your child’s condition and the specific medicine involved.

What if I forget to give it?

If you remember any time over the next 2 days, give the missed dose. For example, if you usually give it on Monday, you can give it on the Tuesday or Wednesday. If you remember after this, do not give the missed dose.

If your child is also taking folic acid, it is important that the methotrexate and folic acid are given on different days.

Never give a double dose of methotrexate.

What if I give too much?

If you think you may have given your child too much methotrexate, contact your doctor or local NHS services (111 in England and Scotland; 111 or 0845 4647 in parts of Wales) or take your child to hospital. Take the medicine container or packet with you, even if it is empty. This will be useful to the doctor. Have the packet with you if you telephone for advice.

It can be dangerous to give too much methotrexate.

Are there any possible side effects?

We use medicines to make our children better, but sometimes they have other effects that we don’t want (side-effects).

Most children who take methotrexate once a week for psoriasis have very few or no side-effects. However, it can occasionally cause more serious side-effects that need urgent treatment. If your child gets any new symptoms after starting methotrexate, contact your doctor.

Side effects you must do something about

If your child has any of the following, tell your doctor straight away:

  • Infections, including fever (temperature above 38°C), chills or sore throat.
  • Skin rash, changes in nail of skin colour, ulcers or soreness.
  • Yellowing of the skin or whites of the eyes and widespread itching.
  • Bleeding gums, unexpected bruising or bleeding that doesn’t stop as quickly as normal.
  • Black ‘tarry’ stools (poo).
  • Chest pain, difficulty breathing or a dry cough that doesn’t go away.
  • Severe and continuing diarrhoea, vomiting or stomach pains.
  • Inflammation (swelling and soreness) or ulcers of the vagina.

Other side-effects you need to know about

Your child may may feel sick, get diarrhoea, or feel lightheaded for 1–2 days after each dose of methotrexate. If these side-effects are severe or carry on for longer than this, contact your doctor for advice.

Your child may also get the following side-effects:

  • They may have difficulty sleeping. If this is still a problem after 2 weeks, contact your doctor.

  • They may lose some hair.

  • Your child’s skin will be more sensitive to sunlight. Keep them out of strong sun. When outdoors, they should wear a long-sleeved top, trousers and a hat and should use a high-factor sun screen (at least SPF 30).

Your child may sometimes get side-effects that are not listed above. Contact your doctor if you notice anything unusual or are concerned. You can report suspected side-effects to www.mhra.gov.uk/yellowcard.

Can other medicines be given at the same time as methotrexate?

  • You can give your child medicines that contain paracetamol, unless your doctor has told you not to.

methotrexate should not be taken with some medicines that you get on prescription. It is important to tell your doctor and pharmacist about any other medicines your child is taking before starting methotrexate.

  • Check with your doctor or pharmacist before giving any other medicines to your child. This includes herbal and complementary medicines.

You should not give your child ibuprofen while they are being treated with methotrexate.

Is there anything else I need to know about this medicine?

Tell your doctor that your child is taking methotrexate before they are given any vaccines, as there are some vaccines that they should not have.

Every time you collect a new prescription, make sure that you have the right strength of medicine or tablets. Normally your child will have been prescribed the 2.5 mg tablets, which are round.

  • Your doctor may suggest that your child takes folic acid while they are taking methotrexate, which will help reduce the chance of side-effects.
  • Methotrexate may harm an unborn baby. If your daughter or son is sexually active, it is vital that they use adequate contraception to prevent unplanned pregnancy while they are taking methotrexate and for six months after. The oral contraceptive pill can be used safely in women or girls taking methotrexate. If your daughter thinks that she may be pregnant, it is important that she sees your family doctor as early as possible. Your daughter should keep taking her medication until she sees her doctor.
  • Methotrexate is used to treat many conditions, including arthritis and certain types of cancer. For these conditions it may be given at a higher dose and more often than when it is used for skin conditions. Many of the side-effects of methotrexate that you may read about are more likely when it is used for these illnesses. Side-effects are much less likely when methotrexate is given once a week for psoriasis or scleroderma.
  • Your doctor will take blood samples regularly while your child is taking methotrexate, to check that their liver and blood have not been affected.
  • The results of blood tests and doses of methotrexate should be written in your methotrexate handheld record book, which you should take to all medical appointments. 

General advice about medicines

  • Only give this medicine to your child. Never give it to anyone else, even if their condition appears to be the same, as this could do harm.
  • Make sure that you always have enough medicine. Order a new prescription at least 2 weeks before you will run out.
  • Make sure that the medicines you have at home have not reached the ‘best before’ or ‘use by’ date on the packaging. Give old medicines to your pharmacist to dispose of.

If you think someone else may have taken the medicine by accident, contact your doctor straight away.

Where should I keep this medicine?

  • Keep the medicine in a cupboard, away from heat and direct sunlight.
  • It does not need to be kept in the fridge.
  • Make sure that children cannot see or reach the medicine.
  • Keep the medicine in the container it came in.

Who to contact for more information?

Your child’s doctor, pharmacist or nurse will be able to give you more information about methotrexate and about other medicines used to treat skin conditions.

England: NHS 111

Tel 111

www.nhs.uk

Scotland: NHS 24

Northern Ireland: NI Direct

Wales: NHS Direct

Tel 111 (free) or 0845 46 47 (2p per minute)

111.wales.nhs.uk/

Raynaud’s and Scleroderma Association

020 3893 5998

www.sruk.co.uk/

The Psoriasis and Psoriatic Arthritis Alliance

01923 672837

www.papaa.org/

The Psoriasis Association

Copyright disclaimer

Version [2]. © NPPG, RCPCH and WellChild, all rights reserved. Review by July 2017.

The primary source for the information in this leaflet is the British National Formulary for Children. For details on any other sources used for this leaflet, please contact us through our website, www.medicinesforchildren.org.uk.

We take great care to make sure that the information in this leaflet is correct and up-to-date. However, medicines can be used in different ways for different patients. It is important that you ask the advice of your doctor or pharmacist if you are not sure about something. This leaflet is about the use of these medicines in the UK, and may not apply to other countries. The Royal College of Paediatrics and Child Health (RCPCH), the Neonatal and Paediatric Pharmacists Group (NPPG), WellChild and the contributors and editors cannot be held responsible for the accuracy of information, omissions of information, or any actions that may be taken as a consequence of reading this leaflet.