Otrexup

Be fully experienced in the use of antimetabolite therapy. Increased risk of severe toxic reactions. Discontinue if malignant lymphomas occur. Obtain baseline and monitor CBCs with differential, platelet counts, chest X-ray, and hepatic, renal and pulmonary function. During therapy monitor hematology monthly, renal and hepatic function, every 1–2 months, more often if increasing dose or predisposed to toxicity (eg, dehydration). Discontinue immediately if blood counts drop significantly. Obtain liver biopsy prior to treatment if history of alcoholism, persistently abnormal LFTs, or chronic HBV/HCV infection; discontinue if persistently abnormal LFTs develop or liver biopsy shows moderate to severe changes. Interrupt therapy if vomiting, diarrhea, stomatitis, or pulmonary symptoms occur. Peptic ulcer. Ulcerative colitis. Active infection. Obesity. Diabetes. Hepatic fibrosis. Steatohepatitis. Renal impairment, ascites, pleural effusions: monitor for toxicity and reduce dose or discontinue if needed. Maintain adequate hydration. Elderly. Debilitated. Embryo-fetal toxicity. Exclude pregnancy status prior to initiation. Advise use of effective contraception during and for 6 months (females of reproductive potential) and for ≥3 months (males w. female partners) after the last dose. Nursing mothers: not recommended (during and for 1 week after the last dose).

Be fully experienced in the use of antimetabolite therapy. Increased risk of severe toxic reactions. Discontinue if malignant lymphomas occur. Obtain baseline and monitor CBCs with differential, platelet counts, chest X-ray, and hepatic, renal and pulmonary function. During therapy monitor hematology monthly, renal and hepatic function, every 1–2 months, more often if increasing dose or predisposed to toxicity (eg, dehydration). Discontinue immediately if blood counts drop significantly. Obtain liver biopsy prior to treatment if history of alcoholism, persistently abnormal LFTs, or chronic HBV/HCV infection; discontinue if persistently abnormal LFTs develop or liver biopsy shows moderate to severe changes. Interrupt therapy if vomiting, diarrhea, stomatitis, or pulmonary symptoms occur. Peptic ulcer. Ulcerative colitis. Active infection. Obesity. Diabetes. Hepatic fibrosis. Steatohepatitis. Renal impairment, ascites, pleural effusions: monitor for toxicity and reduce dose or discontinue if needed. Maintain adequate hydration. Elderly. Debilitated. Embryo-fetal toxicity. Exclude pregnancy status prior to initiation. Advise use of effective contraception during and for 6 months (females of reproductive potential) and for ≥3 months (males w. female partners) after the last dose. Nursing mothers: not recommended (during and for 1 week after the last dose).