Xatmep
Xatmep (methotrexate) is a medication that’s used to treat children with acute lymphoblastic leukemia (ALL). It’s also sometimes used to treat children with non-cancer conditions such as polyarticular juvenile idiopathic arthritis (pJIA) when other medications haven’t worked well enough. Xatmep (methotrexate) is an oral solution that you take by mouth once a week, though the specific dose depends on whether you’re taking it for cancer or a non-cancer condition. This medication can cause side effects such as nausea and low blood cell counts.
What is Xatmep (methotrexate)?
What is Xatmep (methotrexate) used for?
Acute lymphoblastic leukemia (ALL) in children; given with other chemotherapy
Polyarticular juvenile idiopathic arthritis (pJIA) in children; after previous treatment with an NSAID
How Xatmep (methotrexate) works
Xatmep (methotrexate) is an antimetabolite medication that helps treat acute lymphoblastic leukemia (ALL) and non-cancer conditions like arthritis.
For leukemia: Xatmep (methotrexate) works by blocking dihydrofolate reductase, a protein in your body that’s important for making DNA in cells and for cell growth. Since cancer cells grow much more quickly than healthy cells, the medication helps slow down cancer growth so the cancer can’t spread as well.
For non-cancer conditions like arthritis: We don’t know exactly how this medication works to treat non-cancer conditions like arthritis. But research suggests that, at lower doses, methotrexate helps lower the activity of the immune system to lessen inflammation.
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What are the side effects of Xatmep (methotrexate)?
Common Side Effects
- Mouth sores
- Nausea or vomiting
- Diarrhea
- Other stomach discomfort
- Tiredness
- Dizziness
- Chills
- Fever
- Low white blood cell count
- Infections
- High liver enzyme levels
Serious Side Effects
- Serious infections (from having low white blood cell counts): temperature of 100.4 degrees Fahrenheit, with or without other symptoms, such as chills, cough, muscle aches, very fast heartbeat, confusion
- Low platelets: blood in urine or stool, nosebleeds, unexplained bruising or bleeding, bruising or bleeding that doesn’t go away
- Serious lung problems: sudden cough, fever, and trouble breathing
- Serious gut problems: sudden stomach pain, blood in stool
- Serious liver problems: nausea, vomiting, tiredness, stomach pain or swelling, pale-colored stool, dark-colored urine, yellowing of the whites of the eyes or skin
- Serious skin reaction: painful blisters, skin wounds, peeling skin, fever, sore throat, body aches
- Allergic reaction: rash, trouble breathing, swelling of the mouth or around the eyes
Source: DailyMed
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The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Dry cough, shortness of breath or trouble breathing
- Infection—fever, chills, cough, sore throat, wounds that don't heal, pain or trouble when passing urine, general feeling of discomfort or being unwell
- Kidney injury—decrease in the amount of urine, swelling of the ankles, hands, or feet
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
- Low red blood cell level—unusual weakness or fatigue, dizziness, headache, trouble breathing
- Pain, tingling, or numbness in the hands or feet, muscle weakness, change in vision, confusion or trouble speaking, loss of balance or coordination, trouble walking, seizures
- Redness, blistering, peeling, or loosening of the skin, including inside the mouth
- Stomach bleeding—bloody or black, tar-like stools, vomiting blood or brown material that looks like coffee grounds
- Stomach pain that is severe, does not go away, or gets worse
- Unusual bruising or bleeding
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
Pros and cons of Xatmep (methotrexate)
Pros
Taken by mouth once a week
Available as an oral solution for children who can’t swallow pills
Doesn’t typically cause hair loss
Cons
Might raise your risk for infection
Often causes nausea and mouth sores
Requires frequent lab tests to check for side effects
Pharmacist tips for Xatmep (methotrexate)
Take Xatmep (methotrexate) once a week. Choose a day of the week that’s easy to remember or use a reminder app on your phone to help. This medication isn’t meant to be taken every day; otherwise, it could lead to serious side effects.
Make sure to get any lab tests that your provider orders. These tests help your provider check that the medication is safe for you. Some tests include those that check your blood cell counts and kidney, liver, and lung function.
Don’t start or stop any new medications without first talking to your provider or pharmacist. There are several medications you shouldn’t take with Xatmep (methotrexate) because they can raise your risk for side effects. Your provider or pharmacist can make sure all of your medications are safe to take.
Before you get any vaccines, tell your provider or pharmacist that you’re taking Xatmep (methotrexate). Some vaccines might not work as well for you during treatment. In particular, you should avoid getting live vaccines because of the risk of infection from the vaccine itself. Your providers can make sure you can get the vaccine.
Tips on how to take Xatmep (methotrexate):
Be sure you know what your dose is and how to measure it out properly. Xatmep (methotrexate) doses are different for people who are taking it for cancer and for non-cancer conditions. Ask your provider or pharmacist if you’re not sure what dose you should take or how to measure the dose.
Always use the measuring device (such as an oral syringe or dosing spoon) that came with your medication. This helps make sure you take the correct dose of Xatmep (methotrexate). Using a teaspoon or other measuring spoon from home won’t be exact.
Xatmep (methotrexate) oral solution is a clear yellow or orange liquid. Contact your provider or pharmacist about what to do if the color looks different.
For non-cancer conditions like arthritis: Make sure you take only the dose that your provider recommends. Taking the medication at too high of a dose can lead to serious side effects. Your provider might recommend that you take folic acid supplements with Xatmep (methotrexate) to help manage side effects.
Tips on how to handle and store Xatmep (methotrexate):
Ask your provider about the best way to handle Xatmep (methotrexate) safely. Since this medication is sometimes used for treating cancer, it can be harmful to people who handle or come in contact with it. Keep it in a safe place away from children and pets.
Store Xatmep (methotrexate) oral solution in the refrigerator until its expiration date. You can also keep the medication at room temperature, but you can’t use it after 60 days at this temperature.
If your medication expires or if you have leftover medication, ask your provider about how to throw it away. You might be able to bring it to the provider’s office or clinic for proper disposal.
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What are the risks and warnings for Xatmep (methotrexate)?
Xatmep (methotrexate) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Low blood cell counts
Xatmep (methotrexate) can cause low blood cell counts, particularly in people taking the medication at doses for cancer treatment. When your red blood cells are low, you might feel more tired. And when your platelets are low, you’re at risk for bleeding. In addition, low white blood cells put you at risk for serious and life-threatening infections.
Your provider will check your blood cell counts before you start Xatmep (methotrexate) and every so often during treatment. Your provider will pay close attention to your white blood cell counts. If your counts are too low, your provider might make adjustments to your treatment to give your body time to make new blood cells.
It’s important to lower your risk of getting sick by washing your hands often and avoiding crowds. Check your temperature regularly, and call your provider right away if your temperature is 100.4 degrees Fahrenheit or higher.
Serious infections
People who take Xatmep (methotrexate) have a higher risk of getting sick, particularly from opportunistic infections (infections that usually only happen when the immune system is weak). Sometimes, providers prescribe additional medications, such as antibiotics and antiviral medications, to prevent infections. Contact your provider right away if you feel sick, such as having a fever, muscle aches, night sweats, severe tiredness, cough, or trouble breathing. You might need to start taking a lower dose or stop Xatmep (methotrexate) altogether if you develop a serious infection during treatment.
Kidney damage and higher risk for side effects
Xatmep (methotrexate) can harm the kidneys, sometimes causing kidney failure. Your risk for side effects might also be higher if you have kidney problems. Your provider will order blood tests often to check your kidney health, typically before you start Xatmep (methotrexate) and periodically during treatment. Your provider will examine your kidneys closely if your blood test results are abnormal.
Damage to the digestive tract
Risk factors: Peptic ulcer disease | Ulcerative colitis | Also taking NSAIDs
Sometimes, Xatmep (methotrexate) causes vomiting, diarrhea, mouth sores, stomach bleeding, or tears in the gut. People taking this medication for arthritis who are also using NSAIDs are at even higher risk for serious gut problems; be careful using NSAIDs if they’re part of your treatment plan. Seek medical help right away if you have sudden stomach pain or bloody stool.
Liver damage
Risk factors: Heavy alcohol use | Personal or family history of liver problems | Diabetes | High cholesterol | Considered obese | Older age
Some people taking Xatmep (methotrexate) have developed liver problems, including cirrhosis or liver failure. These liver problems can be severe, permanent, and even life-threatening. Talk to your provider about the benefits and risks of taking this medication if you have liver problems.
Your provider will order blood tests to check your liver health before you start Xatmep (methotrexate) and periodically during treatment; high liver enzyme levels on your results can suggest liver damage. Let your provider know if you have symptoms of liver damage, such as nausea, tiredness, stomach pain, or yellowing of the whites of the eyes or skin. You might need to pause Xatmep (methotrexate) while your provider examines your liver health.
Lung problems
Some people who’ve taken Xatmep (methotrexate) have experienced a serious lung problem called interstitial lung disease (ILD). These lung problems can sometimes be permanent or life-threatening. Call your provider right away if you have a sudden or worsening cough, trouble breathing, or fever. You’ll probably need to do pulmonary function tests and scans to check how healthy your lungs are.
Allergic reactions and skin problems (including skin burns)
Risk factors: Previous radiation
Some people who take Xatmep (methotrexate) can have allergic reactions to the medication, including anaphylaxis. Sometimes, the medication can also cause severe and potentially life-threatening skin reactions that happen with or without infection, such as Stevens-Johnson syndrome or toxic epidermal necrolysis (TEN).
Tell your provider right away if you develop painful blisters, skin wounds, peeling skin, trouble breathing, or swelling of the mouth or around the eyes. These can be signs of a serious reaction to the medication that needs immediate medical attention.
Xatmep (methotrexate) can also make your skin more sensitive to the sun, raise your risk for sunburns, and even make previous sunburns or skin burns from radiation come back. Try to avoid sun exposure when possible. If you’re going outdoors, wear sunscreen with an SPF of at least 30 and clothes that protect your skin. Let your provider know if you get a sunburn or have painful skin while you’re taking this medication.
Harm to unborn baby
Xatmep (methotrexate) can cause harm to an unborn baby and pregnancy loss (miscarriage) when it’s taken during pregnancy. For this reason, you can’t take this medication for non-cancer conditions if you’re pregnant.
In general, it’s best to avoid becoming pregnant while you’re taking Xatmep (methotrexate). If you or your partner can get pregnant, you should use effective birth control during treatment. Continue using birth control for another 6 months after the last dose for females or another 3 months after the last dose for males. Let your provider know right away if you or your partner becomes pregnant while you’re taking Xatmep (methotrexate).
Changes to your ability to have children (infertility)
Taking Xatmep (methotrexate) might affect your fertility, which is your ability to have children in the future. This medication has been linked to low sperm count and menstrual problems, and it’s unclear whether these changes are reversible. Talk to your provider if you have concerns.
Risk for new cancers
Some people who took Xatmep (methotrexate) developed new cancers. Some people reported getting cancers affecting their white blood cells (lymphoproliferative disease) even at low doses of Xatmep (methotrexate); the new cancer improved when they stopped the medication in these cases. During treatment, your provider will routinely check for signs of new cancers from your lab tests and your symptoms. Follow up with your provider for any new, unusual symptoms. You might need to pause your treatment while your provider looks into it.
Higher risk for side effects if you have extra body fluid
Risk factors: Fluid buildup in the stomach area or lungs
Xatmep (methotrexate) can build up in pockets of fluid in the body. The medication can stay in your body longer if you’ve been told that you have extra fluid buildup in your body, such as around your stomach (ascites) or your lungs. This can put you at risk for worse side effects from Xatmep (methotrexate). Your provider will check for any extra fluid in your body and manage or treat it before you start Xatmep (methotrexate).
Risks with radiation therapy
People taking Xatmep (methotrexate) who are also doing radiation treatment are at higher risk for tissue and bone damage. Talk to your provider if you’re concerned about getting radiation with Xatmep (methotrexate).
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Xatmep (methotrexate) dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 2.5mg/ml | 16 ml | $320.56 | $20.04 |
Typical dosing for Xatmep (methotrexate)
Your provider will calculate the dose based on your body size or body surface area (BSA, in m2 units), which takes into account height and weight.
Acute lymphoblastic leukemia (ALL): The typical starting dose is 20 mg/m2 by mouth once a week. The provider will adjust the dose based on your child’s lab test results.
Polyarticular juvenile idiopathic arthritis (pJIA): The typical starting dose is 10 mg/m2 by mouth once a week. Your child’s provider will adjust the dose based on how well the medication is working to relieve symptoms and on any side effects.
How much does Xatmep (methotrexate) cost?
Xatmep (methotrexate) contraindications
Previous severe allergic reaction to methotrexate
Currently pregnant (only if taking for non-cancer conditions)
Xatmep (methotrexate) images
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References
Best studies we foundAl-Quteimat, O. M., et al. (2014). Practical issues with high dose methotrexate therapy. Saudi Pharmaceutical Journal.
American Cancer Society. (2019). How chemotherapy drugs work.
American Cancer Society. (2019). Targeted therapy safety.
American Cancer Society. (2019). Chemotherapy safety.
American Cancer Society. (2024). Anemia (low red blood cell counts).
American Cancer Society. (2024). Neutropenia (low white blood cell counts).
American Cancer Society. (2024). Thrombocytopenia (low platelet count).
Arthritis Foundation. (n.d.). Juvenile idiopathic arthritis (JIA).
Azurity Pharmaceuticals, Inc. (2022). Xatmep- methotrexate solution [package insert]. DailyMed.
Benjamin, O., et al. (2023). Disease-modifying antirheumatic drugs (DMARD). StatPearls.
Burris, H. A., 3rd, et al. (2010). Radiation recall with anticancer agents. The Oncologist.
Centers for Disease Control and Prevention. (n.d.). What you need to know: Neutropenia and risk for infection.
Czarnecka-Operacz, M., et al. (2014). The possibilities and principles of methotrexate treatment of psoriasis - The updated knowledge. Advances in Dermatology and Allergology.
Hafner, J., et al. (2023). Intestinal perforation. StatPearls.
Hanoodi, M., et al. (2023). Methotrexate. StatPearls.
Justiz Vaillant, A. A., et al. (2023). Lymphoproliferative disorders. StatPearls.
Leukemia & Lymphoma Society. (n.d.). Acute lymphoblastic leukemia.
National Human Genome Research Institute. (2024). DNA replication.
Rahman, N. M., et al. (2023). Pleural effusion. Merck Manual Consumer Version.
Sepkowitz, K. A. (2002). Opportunistic infections in patients with and patients without acquired immunodeficiency syndrome. Clinical Infectious Diseases.
Shah, N. J., et al. (2023). Acute liver failure. StatPearls.
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