Gestational choriocarcinoma, chorioadenoma destruens; hydatidiform mole; acute lymphocytic leukemia; meningeal leukemia; breast cancer; epidermoid cancers of the head and neck; advanced mycosis fungoides; lung cancer, particularly squamous cell and small cell types; non-Hodgkin's lymphomas; non-metastatic osteosarcoma; severe, recalcitrant, disabling psoriasis; severe, active, classical or definite rheumatoid arthritis unresponsive to conventional therapy.
Orally or IM, 15-30 mg daily x 5/7. This is repeated for 3-5 times with rest periods of at least one week interjected between courses, until any manifesting toxic symptoms subside.
Consult specialist literature for further information.
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It reversibly inhibits dihydro-folate reductase – an enzyme that reduces folic acid to tetrahydrofolic acid. Inhibition of tetrahy-drofolate formation limits the accessibility of one-carbon fragments necessary for synthesis of purines and the conversion of deoxyuridylate to thymidylate in the synthesis of DNA and cell reproduction
Should be used in the treatment of neoplastic diseases in pregnancy only when the potential benefit outweighs the risk to the fetus; pregnancy should be avoided if either partner is on the drug.
Pregnant patients with psoriasis or rheumatoid arthritis; nursing mothers; hypersensitivity to it
Activity of warfarin may be decreased; due to its immunosuppressant effect, it may re-activate live attenuated vaccines and / or reduce immune response; immunosuppressants like cyclophosphamide; chlorambucil and corticosteroids accentuate its positive effects as well as its side effects; angiotensin-converting enzyme inhibitors increase the risk of anemia and leukopenia.