Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Methotrexate is classified as an antimetabolite
drug which means it is capable of blocking the metabolism of cells. (Metabolism
consists of the production and destruction of important components of the cell
as well as the production of energy for use by the cell.) As a result of this
effect, it has been found helpful in treating certain diseases associated with
abnormally rapid cell growth, such as cancer of the
breast and psoriasis.
Recently, methotrexate has been shown to be effective in inducing miscarriage,
for example in patients with ectopic pregnancy. This effect of methotrexate is
attributed to its action of killing the rapidly growing cells of the placenta.
It has also been found very helpful in treating rheumatoid arthritis, although
its mechanism of action in this illness is not known. It seems to work, in part,
by altering immunity, which may play a role in causing rheumatoid arthritis.
PRESCRIPTION: Yes
GENERIC AVAILABLE: Yes
PREPARATIONS: Injectable: 25mg/ml; powder for injection 1 g. Tablet: 2.5, 5,
7.5, 10, and 15 mg
STORAGE: Store at room temperature 15° to 30°C (59° to 86°F), avoid light.
PRESCRIBED FOR: Methotrexate is used for cancer treatment generally in higher
doses than for other uses and is often administered intravenously or
intramuscularly. Methotrexate is used to treat psoriasis, an inflammatory skin
disease, as well as the arthritis that occurs in 10 percent of these patients
(psoriatic arthritis). It is also used to treat active rheumatoid arthritis in
adults and children and other rheumatic diseases, including polymyositis and
systemic lupus erythematosus. Methotrexate has been used to induce miscarriage
in patients with ectopic pregnancies.
DOSING: Methotrexate may be taken with or without food.
For rheumatoid
arthritis and psoriasis, the dose of methotrexate is given WEEKLY, by injection
or orally.
For psoriasis, the starting oral dose is a single 7.5 mg dose weekly
or 2.5 mg every 12 hours for three doses, once weekly.
DRUG INTERACTIONS: Using
nonsteroidal anti-inflammatory drugs (NSAIDs) before
or during methotrexate treatment may result in serious adverse events because
NSAIDS may increase the blood concentrations of methotrexate. Combining
methotrexate with drugs that adversely affect the liver or kidneys may result in
additional liver or kidney toxicity.
PREGNANCY: Methotrexate should not be used in
pregnancy, as it can be toxic
to the embryo and can cause fetal defects and spontaneous abortion
(miscarriage). It should be discontinued prior to conception if used in either
partner. Male patients should stop taking methotrexate at least 3 months prior
to a planned conception and females should discontinue use for at least one
ovulatory cycle before conception.
NURSING MOTHERS: Methotrexate is excreted in
breast milk and should not be
used by nursing mothers.
SIDE EFFECTS: Methotrexate can be well tolerated, but also can cause severe
toxicity which is usually related to the dose taken. The most frequent reactions
include mouth sores, stomach upset, and low white blood counts. Methotrexate can
cause severe toxicity of the liver, kidneys and bone marrow, which require
regular monitoring with blood tests. It can cause headache and drowsiness which
may resolve if the dose is lowered. Methotrexate can cause
itching, skin rash,
dizziness, and hair loss. A dry, non-productive cough can be a result of rare
lung toxicity.
Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease.
Crohn's disease is a chronic inflammatory disease,
primarily involving the small and large intestine, but which can
affect other parts of the digestive system as well. Abdominal pain, diarrhea, vomiting, fever, and weight loss are
common symptoms.
Psoriasis is a long-term skin condition that may cause large plaques of red, raised skin, flakes of dry skin, and skin scales. There are several types of psoriasis, including psoriasis vulgaris, guttate psoriasis, inverse psoriasis, and pustular psoriasis. Symptoms vary depending on the type of psoriasis the patient has. Treatment of psoriasis may include creams, lotions, oral medications, injections and infusions of biologics, and light therapy. There is no cure for psoriasis.
Liver disease can be cause by a variety of things including infection (hepatitis), diseases such as gallstones, high cholesterol or triglycerides, blood flow obstruction to the liver, and toxins (medications and chemicals). Symptoms of liver disease depends upon the cause; however, common symptoms may include nausea, vomiting, upper right abdominal pain, and jaundice. Treatment depends upon the cause of the liver disease.
Systemic lupus erythematosus is a condition characterized by chronic inflammation of body tissues caused by autoimmune disease. Lupus can cause disease of the skin, heart, lungs, kidneys, joints, and nervous
system. When only the skin is involved, the condition is called discoid lupus.
When internal organs are involved, the condition is called systemic lupus
erythematosus (SLE).
Sarcoidosis, a disease resulting from chronic inflammation, causes small lumps (granulomas) to develop in a great range of body tissues and can appear in almost any body organ. However, sarcoidosis most often starts in the lungs or lymph nodes.
Ankylosing spondylitis is a type of arthritis that causes chronic inflammation of the spine. The tendency to develop ankylosing spondylitis is genetically inherited.
Psoriatic arthritis is a disease that causes skin and joint inflammation. Symptoms include painful, stiff, and swollen joints, tendinitis, and organ inflammation. Treatment involves antiinflammatory medications and exercise.
Scleroderma is an autoimmune disease of the connective tissue. It is characterized by the formation of scar tissue (fibrosis) in the skin and organs of the body, leading to thickness and firmness of involved areas. Scleroderma is also referred to as systemic sclerosis, and the cause is unknown. Treatment of scleroderma is directed toward the individual features that are most troubling to the patient.
Pulmonary fibrosis is scarring throughout the lungs. Pulmonary fibrosis can be caused by many conditions including chronic inflammatory processes, infections, environmental agents, exposure to ionizing radiation, chronic conditions, and certain medications. Symptoms include shortness of breath, coughing, and diminished exercise tolerance. Treatment options are dependent on the type of pulmonary fibrosis; lung transplant and/or medications are optons.
Optic neuritis is inflammation of the optic nerve, the structure that connects the eye to the brain. The precise cause of optic neuritis is unknown, but it is thought to be a type of autoimmune disorder. Optic neuritis most commonly develops due to an autoimmune disorder that may be triggered by a viral infection.
Polymyositis is a disease of the muscle featuring inflammation of the muscle fibers. It results in weakness of the muscles which can be severe and when associated with skin rash, is referred to as dermatomyositis. Although the cause of this disease is unknown, diagnosis includes physical examination of muscle strength, blood tests for muscle enzymes, electrical tests of muscle and nerves, and conformation by a muscle biopsy. Treatment of Polymyositis and Dermatomyositis includes high doses of cortisone-related medications, immune suppression, and physical therapy.
Male breast cancer accounts for 1% of all breast cancers, and most cases are found in men between the ages of 60 and 70. A man's risk of developing breast cancer is one in 1,000. Signs and symptoms include a firm mass located below the nipple and skin changes around the nipple, including puckering, redness or scaling, retraction and ulceration of the nipple. Treatment depends upon staging and the health of the patient.
Wegener's granulomatosis, a condition that usually affects young or middle-aged adults, is an inflammation of the arteries supplying blood to the sinuses, lungs, and kidneys. Symptoms of Wegener's granulomatosis include bloody sputum, fatigue, weight loss, joint pain, sinusitis, shortness of breath, and fever. Wegener's granulomatosis may be fatal within months without treatment. Treatment aims to stop inflammation with high doses of prednisone and cyclophosphamide.
Reactive arthritis is a chronic, systemic rheumatic disease characterized by three conditions, including conjunctivitis, joint inflammation, and genital, urinary or gastrointestinal system inflammation. Inflammation leads to pain, swelling, warmth, redness, and stiffness of the affected joints. Non-joint areas may experience irritation and pain. Treatment for reactive arthritis depends on which area of the body is affected. Joint inflammation is treated with antiinflammatory medications.
Juvenile arthritis (juvenile rheumatoid arthritis or JRA) annually affects one child in every thousand. There are three types of JRA: pauciarticular (less than four joints affected), polyarticular (more than four joints affected), and systemic-onset (inflamed joints with high fevers and rash). Treatment of juvenile arthritis depends upon the type the child has and should focus on treating the symptoms that manifest.
Relapsing polychondritis is an uncommon, chronic disorder of the cartilage that is characterized by recurrent episodes of inflammation of the cartilage of various tissues of the body. Tissues containing cartilage that can become inflamed include the ears, nose, joints, spine, and windpipe (trachea). Tissues that have a biochemical makeup similar to that of cartilage such as the eyes, heart, and blood vessels, can also be affected. Nonsteroidal antiinflammatory medications (NSAIDs) is used as treatment for mild cases of the disease. Steroid-related medications also are usually required.
Cleft palate and cleft lip are facial and oral defects that occur early in pregnancy. A cleft lip is a split of the two sides of the upper lip, and a cleft palate is a split in the roof of the mouth. Cleft lip the fourth most common birth defect in the U.S. Repair of a cleft palate or cleft lip may require multiple surgeries.
SAPHO syndrome is a chronic disorder that involves the skin, bone, and joints. SAPHO syndrome is an eponym for the combination of synovitis, acne, pustulosis, hyperostosis, and osteitis. SAPHO syndrome is related to arthritic conditions such as ankylosing spondylitis and reactive arthritis. Treatment is directed toward the individual symptoms that are present, and includes medications such as nonsteroidal antiinflammatory drugs (NSAIDs), and cortisone medications.
Eosinophilic fasciitis is a skin disease that causes thickening and inflammation of the skin and fascia. Symptoms include redness, warmth, and hardening of the skin, as well as occasional tissue and joint pain. Treatment for eosinophilic fasciitis aims to eliminate inflammation through the use of aspirin, NSAIDs, and cortisone. Aggressive forms of eosinophilic fasciitis may require the use of immune suppression medications.
Felty's syndrome is a complication of long-term rheumatoid arthritis. Felty's syndrome is defined by the presence of three conditions: rheumatoid arthritis, an enlarged spleen, and an abnormally low white blood count. Treatment of Felty's syndrome is not always required; however, treatment for patients with infections is available.
Cleft lip and cleft palate are
facial and oral malformations that occur very early in pregnancy, while
the baby is developing inside its mother. Clefting results when there is
not enough tissue in the mouth or lip area, and the tissue that is
available does not join together properly.
A cleft lip is a physical split or separation of the two sides of the
upper lip and appears as a narrow opening or gap in the skin of the
upper lip. This separation often extends beyond the base of the nose and
includes the bones of the upper jaw and/or upper gum.
A cleft palate is a split or opening in the roof of the mouth. A
cleft palate can involve the hard palate (the bony front portion of the
roof of the mouth), and/or the soft palate (the soft back portion of the
roof of the mouth).
Cleft lip and cleft palate can occur on one or both sides of the
mouth. Because the lip an...
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