Trexol Caution For Usage

Instructions for Use: Methotrexate may be administered by intramuscular, intravenous or intrathecal routes.
"For Intravenous injection, Methotrexate Injection should be diluted in dextrose 5% solution or sodium chloride 0.9% solution".
METHOTREXATE INJECTION 100 MG/ML SHOULD BE USED INTRAVENOUS INFUSION ONLY. IT SHOULD NOT BE USED INTRATHECALLY AS THE SOLUTION IS HYPERTONIC.
Methotrexate 100 mg/ml solution for injection is a hypertonic presentation and therefore not suitable for intrathecal use, non-isotonic solutions of methotrexate injection should not be administered intrathecally.
For intrathecal injection, Methotrexate Injection should be diluted to a strength of 1 mg/mL with an appropriate preservative-free medium such as 0.9% Sodium Chloride Injection.
For conversion of mg/kg bodyweight to mg/m² of body surface area or the reverse, a ratio of 1:30 is given as a guideline. The conversion factor varies between 1:20 and 1:40 depending on age and body build.
As with all antineoplastic agents, trained personnel should prepare Methotrexate Injection. This should be performed in a designated area (preferably a cytotoxic laminar flow cabinet). Protective gown, mask, gloves and appropriate eye protection should be worn when handling methotrexate.
Where solution accidentally contacts skin or mucosa, the affected area should be immediately washed thoroughly with soap and water. It is recommended that pregnant personnel not handle cytotoxic agents such as methotrexate. Luer-Lock fitting syringes are recommended. Large bore needles are recommended to minimise pressure and possible formation of aerosols. Aerosols may also be reduced by using a venting needle during preparation.
Items used to prepare Methotrexate Injection, or articles associated with body waste, should be disposed of by placing in a double sealed polythene bag and incinerating at 1100°C.
Incompatibilities: Methotrexate has been reported to be incompatible with cytarabine, fluorouracil and prednisolone.
Spills and disposal: If spills occur, restrict access to the affected area. Wear two pairs of gloves (latex rubber), a respirator mask, a protective gown and safety glasses. Limit the spread of the spill by covering with absorbent material such as absorbent towel or adsorbent granules. Collect up the towel of absorbent/adsorbent material and other debris from spill and place in a leak proof plastic container and label accordingly. Cytotoxic waste should be regarded as hazardous or toxic and clearly labelled 'CYTOTOXIC WASTE FOR INCINERATION AT 1100°C'. Waste material should be incinerated at 1100°C for at least 1 second. Cleanse the remaining spill area with copious amounts of water.