This fact sheet has been written for parents and carers about how to use this medicine in children. This information sometimes differs from that provided by the manufacturers, because their information is usually aimed at adult patients. Please read this information carefully and keep it somewhere safe so that you can read it again.
Methotrexate is used to treat a wide range of cancers. High dose methotrexate is given in hospital as an intravenous infusion and this information sheet is NOT referring to intermediate dose methotrexate (capizzi), intrathecal methotrexate or methotrexate tablets administered at home.
Interactions with other medications
Methotrexate can interact with other medications, especially when given in high doses. For example, the following medications may affect the levels of methotrexate in the body:
- Some antibiotics including penicillins (e.g. Amoxycillin, Flucloxacillin), trimethoprim with sulfamethoxazole (also called Septrin, Resprim and Bactrim) and ciprofloxacin.
- Proton pump inhibitors given to protect the stomach (e.g. Omeprazole, Esomeprazole, Pantoprazole).
- Some medicines used to treat pain and inflammation (Non-Steroidal Anti-inflammatory Drugs NSAIDs) such as Ibuprofen – Nurofen/Brufen/Advil , and Diclofenac – Voltaren.
- Other medicines including Levetiracetam (Keppra) and other medicines used to prevent seizures. It is important NOT to stop medicines like Levetiracetam abruptly. Please discuss a plan for your child with your consultant.
These medications can reduce the body’s ability to excrete/remove methotrexate from the blood which may result in a higher chance of side effects/toxicity.
When to withhold certain medications and for how long?
- Proton pump inhibitors (e.g. Omeprazole, Esomeprazole, Pantoprazole) should be with-held the day your child is admitted to hospital and restart on discharge or sooner if directed by the treating team.
- Trimethoprim with sulfamethoxazole (Septrin, Resprim and Bactrim) should be with-held for at least 48 hours prior to admission and restart on discharge or sooner if directed by the treating team.
- Penicillin based antibiotics (e.g. Amoxycillin, Amoxycillin with clavulanic acid, Flucloxacillin and Phenoxymethylpenicillin), should be with-held from the day of admission for high dose methotrexate and should only be restarted on discharge or sooner on direction by the treating team.
- Ciprofloxacin should be with-held from the day before admission for high dose methotrexate and should only be restarted on discharge or sooner on direction by the treating team.
- A certain group of pain relieving medicines called Non-steroidal Anti-inflammatory Drugs- NSAIDs (including Ibuprofen – Nurofen/Brufen/Advil, and Diclofenac – Voltaren) should be AVOIDED throughout the entire chemotherapy treatment. These medications can increase the toxicity of many chemotherapy medications including methotrexate and should NOT be used unless prescribed by the oncology consultant.
Who to contact for more information
Your consultant at clinic visits or the Oncology team at the Queensland Children’s Hospital.
Contact us
Oncology pharmacy
Level 5, Queensland Children’s Hospital
501 Stanley Street, South Brisbane, QLD 4101
t: 07 3068 1989
Oncology day unit
Level 5 (5c), Queensland Children’s Hospital
501 Stanley Street, South Brisbane, QLD 4101
t: 07 3068 2060
In an emergency, always call 000.
Queensland Poisons Information Centre 13 11 26.
