Care of a patient after methotrexate infusion is very crucial. This medication suppresses the whole bone marrow besides treating the disease. Any negligence during or after this medication could lead to serious complications.
What is injection methotrexate?
Methotrexate belongs to a class of drugs called antimetabolites. The main action of the drug is to interfere with the cell metabolism in fast-growing cells, such as cancer cells, immune cells, skin cells, or other fast-growing cells in the body related to cancer in different body parts, such as bones, etc.
In which diseases is chemotherapy with methotrexate used?
Diseases in which methotrexate is used are as follows:
- Bone tumors such as osteosarcomas
- In certain types of Breast cancers
- Used to treat blood cancers such as leukemia’s
- To prevent graft versus host disease in an allogeneic bone marrow transplant
Other than cancers, methotrexate is used to suppress the immune system of a patient having autoimmune disease, such as rheumatoid arthritis and psoriasis (A skin condition)
What care is required during the methotrexate infusion?
As long as the patient is undergoing /receiving the injection, healthcare providers should be careful and vigilant regarding the following points.
- Burn at the infusion site.
- Nausea and vomiting
- IV hydration, especially with sodium bicarbonate to make the urine pH alkaline, because alkaline urine increases the solubility of MTX and prevents kidney damage by crystal formation in an acidic environment.
What kind of food should the patient use during MTX infusion?
During the MTX infusion, the patient should take food that is easily digested, avoid drinking alcohol and caffeine, which would stress the liver and kidneys. The patient should take plenty of fluids and should avoid greasy and spicy food to keep the stomach healthy.
Does methotrexate causes burn at the site of injection?
Yes, methotrexate can infiltrate into the skin, leading to a burn at the injection site. To prevent this effect, healthcare providers should keep an eye on the infusion site for redness or itching and should immediately manage it by removing the line and follow extravasation protocol as per hospital policy. Furthermore, methotrexate should be administered under proper expert supervision.
However, to prevent this side effect, the priority should be a central line, and the peripheral line should be avoided.
How many routes for methotrexate? Care of a patient after Methotrexate infusion
Methotrexate is given by the following routes.
Intravenous route: (in vein directly into blood stream)
Oral route: Care of the patient after Methotrexate infusion:
Methotrexatcomesme in oral pill form as well. This medication is usually given in conditions such as rheumatoid arthritis and psoriasis.
Subcutaneous route: Care of the patient after Methotrexate infusion:
Methotrexate also comes in a prefilled syringe, and it is given subcutaneously in conditions where the oral MTX side effects are worsened, and it’s usually more effective in absorption than oral pills.
Methotrexate comes in oral form as well. By giving the medication orally, the pills should not come into contact with the skin; this could lead to skin irritation. The medication should be kept in a medication cup and administered to the patient.
Care after infusion: Care of the patient after Methotrexate infusion:
After the infusion finishes, the patient may go home with proper instructions from the healthcare provider. The patient may have the following side effects between 7 and 14 days after finishingthef infusion.
What are the expected main side effects of methotrexate?
Expected Side effects of inmethotrexate are as follows
- Brain toxicity
- Mouth ulcers
- Gastrointestinal upset: the patient may feel nausea and vomiting
- Burning at the line site
- Alters blood PH levels
- Bone marrow suppression: due to its effect on fast-growing cells in the body, the patient may experience the following side effects.
- Low WBC counts:
Low white blood count can increase the risk of infection, such as blood, chest, or urinary infections.
- Low platelet count: Care of the patient after Methotrexate infusion:
Due to a low number of platelets, patient many experience bleeding, orare at high risk of bleeding
- Decrease in hemoglobin levels: Care of a patient after Methotrexate infusion
A lower number of hemoglobin may result in weakness and fatigue.
What precautions should healthcare providers take to decrease the side effects of MTX?
The healthcare provider should instruct the patient to take plenty of fluids to keep a good hydration level.
- During methotrexate infusion, the patient should be given ice chips or ice cream to keep the mucosa cool. This may prevent the risk of microsites or oral ulcers. The therapy is known as cryotherapy.
- The urine PH should be alkaline when starting the infusion of sodium bicarbonate.
- Medication for nausea and vomiting should be initiatedbeforeo the therapy.
- Gastroprotective medication should also be started to avoid gastric mucosal damage.
What precautions should be taken before starting the treatment with chemotherapy methotrexate?
Following measures should be taken before starting the medicine
- Tell your healthcare provider if you are consuming alcohol
- Your immunity should be fit enough to tolerate the dose, as the methotrexate medicine causes severe bone marrow suppression.
- You should have proper birth control precautions before starting the treatment.
- Avoidbreastfeedingg if you start the treatment, the medication should harm the child.
- Your healthcare provider will advise complete blood count, liver function tests, and urine PH before initiating the treatment.
When to check the methotrexate levels in the blood?
Your health care provider will prescribe the medication dose on the basis of your BSA (Body surface area; besides that, it is necessary to monitor its levels to prevent complications.
When to check the blood levels of MTX?
The MTX levels are usually monitored 24 hours after finishing the infusion. Within 24 hours, the drug does its work, and after 24 hours, the drug levels should be within the range. If the levels are still high, it causes complications such as neurotoxicity, effects on the brain, and other effects on the liver and kidneys.
How to manage if the levels are too high?
High levels can cause severe complications, so it’s necessary to normalize the level of MTX in the body. Your treating practitioners will manage and prescribe a drug called leucovorin (calcium folinate), which works by rescuing cells from the effects of MTX.
Why is urine PH monitoring necessary during MTX infusion?
Monitoring urine PH is very crucial during high doses of MTX infusion because, if the urine pH is acidic, the methotrexate and its metabolites start precipitating in the renal tubules, which are at high risk for kidney damage.
Why is sodium bicarbonate infusion recommended with MTX infusion?
To prevent kidney damage, the urine PH is made alkaline, above 7-7.5 or above,, by administering sodium bicarbonate infusion.
So, care should be taken to prevent the complications associatedwith intravenous methotrexate. Patient education plays a vital role in preventing and managing side effects. Patients with pregnancy or breastfeeding should discuss the risks and benefits with their healthcare provider
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