NHS Grampian Nationally Enhanced Service
Shared Care Policy and Prescribing Information for General Practitioners for
METHOTREXATE
PATIENT NAME
UNIT NUMBER
CHI NUMBER

HOSPITAL
WARD
TELEPHONE NO
CONSULTANT
ADDRESS
DATE OF BIRTH

Insert patient sticker here
THERAPEUTIC INDICATION FOR THIS PATIENT:

SIGNATURE
DATE
(to be completed by consultant)
DOSAGE/PREPARATION/ROUTE/FREQUENCY OF ADMINISTRATION:
Starting dose of 7.5mg as a single oral dose ONCE WEEKLY
Concurrent Folic Acid Y / N *
Dose = 5mg (oral) ONCE WEEKLY (72 hours after Methotrexate)
*Delete where appropriate.
CARE WHICH IS THE RESPONSIBILITY OF
THE HOSPITAL CONSULTANT
Baseline: Chest X-ray, FBC, U & E, and LFTs.
Copy of results to be sent to GP.
CARE WHICH IS THE RESPONSIBILITY OF THE
GENERAL PRACTITIONER
1. Prescribing of medication.
2. The General Practitioner has primary responsibility for
monitoring therapy according to the schedule below:
PIIINP test (dermatology only) – twice prior to
treatment then repeated at 4 monthly intervals.
 FBC, U&E and LFT (incl. ALT and Alk Phos) fortnightly
until 6 weeks after the last dose increase
Initiation of therapy and recommendations for
dose increments. Decision on final dose  FBC, U&E and LFT monthly while on stable dose
required.
 Increase monitoring to 2 weekly after any change in
dose.
Monitoring clinical response to treatment.
 Patients should be asked about the development of
any new or increasing fever, dyspnoea or cough or the
(If agreed by both Consultant and GP blood
presence of rash or oral ulceration at each visit.
request forms may be endorsed (by the GP) so
that a copy is sent to the Consultant who will
When writing laboratory request
make a secondary check on the results.)
forms always include details of
However normal practice is that the clinician
the patient’s medication
who orders the test must act on the result.
NOTE: in addition to absolute values for haematological
indices a rapid fall or a consistent downward trend in
any value should prompt caution and extra vigilance.
What to do if something unexpected occurs
Contact consultant
ADDITIONAL INFORMATION:
(to be completed by consultant where necessary)
Please keep this document in the patients notes
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NHS Grampian Nationally Enhanced Service
Shared Care Policy and Prescribing Information for General Practitioners for
METHOTREXATE
MONITORING: - Action to be taken if:



WBC <4.0x109/L
Neutrophils <2x109/L
Platelets <150x109/L
>2 fold rise in ALT or Alk. Phos (from upper limit of reference range)

Unexplained fall in albumin:

Rash or oral ulceration:

New or increasing dyspnoea or cough:

Unexplained fever:

withhold until discussed with consultant
Withhold until discussed with consultant

MCV>105fl
investigate and if B12 or folate low start appropriate
supplementation

Significant deterioration in renal function:
discuss with consultant

Abnormal bruising or sore throat
withhold until FBC result available
OTHER INFORMATION




Low dose aspirin and standard doses of NSAIDs may be continued
Co-trimoxazole or trimethoprim must be avoided in patients taking methotrexate
Live vaccines should be avoided in patients taking methotrexate - annual influenza vaccine should
be given
Methotrexate is available in strengths of 2.5mg and 10mg - ensure that the patient is aware of
which strength(s) have been prescribed
Responsibilities of GPs undertaking monitoring
A GP agreeing to monitor methotrexate should:
 Ensure that the necessary blood tests are normal
 Ensure that the relevant blood monitoring requirements are undertaken, and at the correct
frequency
 Ensure that the blood test results are checked for any abnormality at the same frequency as the
tests are being undertaken
 Only continue to prescribe methotrexate if it is being satisfactorily monitored
 Contact a consultant in the event of a drug reaction or monitoring abnormality
 Be alert for any of the known adverse reactions.
The patient should be encouraged to ensure blood tests are taken at the correct intervals.
FOR SPECIFIC PRODUCT INFORMATION PLEASE CONSULT THE CURRENT SUMMARY
OF PRODUCT CHARACTERISTICS
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