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Mnemonics, Simplified Concepts & Thoughts

Methotrexate : Mnemonic

Epomedicine, Feb 21, 2023Feb 21, 2023

Last updated on February 21, 2023

Methotrexate is a dihydrofolate reductase (DHFRase) inhibitor which inhibits DNA repair, synthesis and cellular replication. Actively proliferating tissues such as malignant cells, bone marrow, fetal cells, buccal and intestinal mucosa, and cells of the urinary bladder are in general more sensitive to its effect.

A convenient regimen for Low Dose Methotrexate (LDMTX) in adults (used in RA, psoriasis, sarcoidosis, Crohn’s disease) is to start therapy with intermittent oral administration of 5–10 mg once a week. If, after 6–8 weeks, the response is not adequate and no adverse effects are present, the weekly dose can be gradually increased to 25 mg.

“Methotrexate” by neofedex is licensed under CC BY-NC-ND 2.0.

Clinical uses of Methotrexate

Mnemonic: CANCER

  1. Choriocarcinoma
  2. Abortion
  3. Non-hodgkin lymphoma
  4. Chron’s disease
  5. Ectopic pregnancy
  6. Rheumatoid Arthritis

Adverse effects of Methotrexate

Mnemonic: MTX

  1. Mucositis/Myelosuppression
  2. Transaminase increase (i.e., hepatotoxicity)
  3. X-rays warranted (chest x-ray for varicella pneumonia or pneumonitis)

Once weekly dosing with folate

  1. Methotrexate for “Monday“.
  2. Folic acid for “Friday“.

Monitoring on Methotrexate

Mnemonic: 0, 1, 2, 3

  • 0 (baseline): CBC, LFT, RFT, Chest X-ray, Pregnancy test (young females)
  • 1-2 weeks: CBC and LFT after initial dose or every dose escalation
  • 3 months: CBC, LFT, RFT on stable/maintenance dose

References:

  1. Methotrexate: Update on Pharmacology, Clinical Applications and Warnings – Nova Science Publishers
  2. Examination Pediatrics by Wayne Harris
  3. Safer prescribing of high-risk medicines – Methotrexate: potentially fatal in overdose, BPAC NZ
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PGMEE, MRCS, USMLE, MBBS, MD/MS Pharmacology

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Epomedicine. Methotrexate : Mnemonic [Internet]. Epomedicine; 2023 Feb 21 [cited 2025 May 30]. Available from: https://epomedicine.com/medical-students/methotrexate-mnemonic/.

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