Methotrexate is a medication used to manage several serious health conditions. It belongs to a class of drugs called antimetabolites and is commonly prescribed for autoimmune conditions such as rheumatoid arthritis and psoriasis. This medication also serves as a chemotherapy agent for various cancers, including certain leukemias and lymphomas.
Understanding Methotrexate’s Effects
Methotrexate primarily works by suppressing the immune system. It interferes with cell division, controlling rapid cell growth in cancers and overactive immune responses in autoimmune diseases. It also reduces immune activity by influencing adenosine levels and T-cells. While this immunosuppression is beneficial for managing disease, it inherently increases a person’s vulnerability to infections.
Identifying Illnesses That May Warrant Skipping a Dose
Given its effect on the immune system, certain illnesses may require a temporary pause in methotrexate treatment. Common signs of infection that often prompt consideration of skipping a dose include fever, chills, or a severe sore throat. Significant gastrointestinal symptoms such as severe vomiting or diarrhea also warrant attention. Fever is a key indicator.
If an infection is severe enough to require antibiotic treatment, healthcare providers typically advise stopping methotrexate for the duration of the antibiotic course. However, minor infections might not necessitate skipping the dose.
Potential Outcomes of Your Decision
Deciding whether to skip a methotrexate dose involves balancing potential risks. Continuing methotrexate while significantly ill, particularly with an active infection, can worsen the infection. This is because the medication further suppresses the immune system, potentially hindering the body’s ability to fight off the illness.
Conversely, skipping a dose of methotrexate carries its own set of risks. Missing a dose might lead to a flare-up of the underlying autoimmune condition.
For individuals on stable therapy, a single missed dose typically does not cause a loss of the medication’s therapeutic effect. However, missing three or more consecutive doses can result in the loss of therapeutic benefit and an increased risk of disease flare, with some studies indicating a 20.5% flare rate after a four-week discontinuation. It is important to never take a double dose to compensate for a missed one.
Navigating Dose Resumption and Medical Consultation
The decision to skip a methotrexate dose and, when and how to resume it, should always be made in consultation with a healthcare provider. It is important to contact your healthcare team promptly if you develop symptoms such as fever, chills, or a sore throat. This allows for timely assessment and guidance.
Generally, methotrexate can be resumed once symptoms have significantly improved or fully resolved. After a break due to illness or surgery, it is usually possible to restart at your usual dose, though additional blood tests might be necessary to ensure safety. If a dose is missed and it is only one or two days late, it can be taken, but if it is three or more days late, it is usually advised to skip that dose entirely and take the next as scheduled. Resumption should also be avoided if blood test results show abnormalities.