Key Considerations for Patients with Rheumatic Diseases

Healthcare professionals must ensure that patients receiving methotrexate (MTX) for rheumatic conditions fully understand their treatment regimen. Methotrexate, recognized as the leading therapy for rheumatological disorders, is typically initiated with a dosage of 15 mg per week, which may be increased to 25 mg based on clinical response.

It is crucial for pharmacists to confirm that patients comprehend the importance of adhering to a once-weekly dosing schedule. Misinterpretations can arise, particularly if dosing instructions in the nationwide medication plan (BMP) are not accurately documented. Pharmacists are advised against entering doses in a daily schedule format, as this can lead to confusion when utilizing QR codes for medication verification.

Moreover, methotrexate should be taken on an empty stomach and avoided with dairy products to ensure optimal absorption. Patients can expect a therapeutic effect within six to eight weeks. Caution is also advised regarding potential drug interactions; for instance, combining MTX with cotrimoxazole can result in significant blood abnormalities. Due to the formation of polyglutamate within cells, staggered administration of these medications is ineffective.

Conversely, the interaction concerns associated with non-steroidal anti-inflammatory drugs (NSAIDs) or COX-2 inhibitors can generally be disregarded when administering less than 30 mg of MTX weekly. However, it is recommended that patients do not take NSAIDs on the same day as their MTX dose.

To alleviate side effects commonly associated with methotrexate, such as nausea, a standard practice is to supplement with 5 to 10 mg of folic acid 24 to 48 hours after administering MTX. Taking the medication in the evening may help patients sleep through any nausea experienced. Additionally, maintaining adequate hydration is essential, as dehydration can exacerbate side effects.