Methotrexate is commonly prescribed to treat rheumatoid arthritis, psoriatic arthritis, psoriasis, as well as many other autoimmune diseases. It comes as a pill but in certain situations the medication may be more effective if it’s injected.  That being said, injectable methotrexate comes as a auto-injector pen but due to cost, often times we need to rely on the good old-fashioned method: needle, syringe, and a vial of methotrexate.  First, Dr. Farrell is going to teach us how to inject a vial of methotrexate.  In the second video, she will teach us how to inject with an auto-injector pen.

Preparing for your injection

• Keep your medication stored in the refrigerator until use
  • Before injecting medication, take the vial out of the refrigerator.
  • Allow it to warm up to room temperature.
• Pick a place in your house that is clean and has room for your materials (such as the kitchen table).
• Wash your hands thoroughly with either:
  • Soap & water
  • Hand sanitizer
• Chose an area to inject – Thigh or Stomach.
  • Chose an area that is intact and clear.
  • It should not have any of the following:
    • Cuts
    • Scrapes
    • Bruises
    • Psoriasis patches
    • If you have extensive psoriasis, inject between patches
    • Moles
    • Scars
  • Please rotate area each time you inject (shown in picture below).

• Cleanse chosen area
  • Cleanse chosen area with either of the following:
    • Alcohol swab
    • Alcohol and a cotton ball
  • Use the chosen alcohol material to “swipe” area
    • Can either use a circular motion or wipe in “strips”
    • Allow the area to dry

Injecting a methotrexate vial

Drawing the medication

• If it is your first time using the vial, you will have to remove the plastic cap from the vial
• Clean the top of the vial with an alcohol swab
• Open syringe packaging and take syringe out
  • Be careful while doing this – the needle may come apart, so make sure the needle is securely on the syringe before moving on
• Double check the dosage on your prescription.  Does your doctor want you to inject 0.5 mL? 0.6 mL?
• Pull plunger to get air into the syringe
  • The amount of air should be half the amount of the dose that you are going to draw up (Example: if you need a dose that is 1 mL of methotrexate, draw up 0.5 mL of air)
• Press the needle into the vial
  • Should be right into the center of the top of the vial at a 90-degree angle

• Push the plunger to transfer the air into the vial
• Flip the vial upside down with the needle still in
• Pull back on the plunger to draw liquid into the syringe
  • If an air bubble appears into the syringe, push the plunger back up and try pulling out again
  • This may take a few tries before you get only medication into the syringe
• Once you have withdrawn the dose of the medication that you need, flip the vial and take the needle out

Injecting the medicine

• Pinch cleansed skin
• Insert needle into the chosen area at a 45-degree angle
  • You may keep the skin pinched or let go of the skin
• Push the plunger slowly to inject the medication
• Once you have injected all of the medication, take the needle out of your skin

After the injection

• Properly dispose of the entire syringe
  • NEVER recap the needle
  • Sharps Container
    • Can be purchased at your local pharmacy
    • Disposal

• • • • Hospitals may take full sharps containers, ask first.
      • Pharmacies and Doctors’ offices are not allowed to take used syringes or needles
• Discard remaining materials in the trash (cap, alcohol swabs, etc.)

Injecting methotrexate with an auto-injector pen

Injecting Otrexup®

• There will be a number “1” labeled on the auto-injector
  • Twist cap off
• There will be a number “2” labeled on the auto-injector
  • Press with thumb to flip cap off
• Place tip of the auto-injector on the skin at a 90-degree angle

• Press button to release medication
  • Hold for 10 seconds
  • May feel a slight pinch and tingling as the medication goes in

Injecting Rasuvo®

• There will be a yellow cap at the end that you will pull straight off
• Place tip of the auto-injector on the skin at a 90-degree angle
• Press button to release medication
  • Hold for 10 seconds
  • May feel a slight pinch and tingling as the medication goes in

After the injection

• Properly dispose of the auto-injector.
  • Sharps Container
    • May be provided by the drug company (depending on the medication)
    • Can be purchased at your local pharmacy
    • You may use a coffee can if you are unable to attain a sharps container
    • Disposal
      • Hospitals may take sharps
      • Pharmacies and Doctors’ offices are not allowed to take used syringes or needles
• Discard remaining materials in the trash (cap, alcohol swabs, etc.)

Credits