Self-injecting methotrexate
Question:
that is a myth. mtx can be injected using insulin needles. injecting in the muscle is not necessary. jeff – Hide quoted text — Show quoted text -> Greetings, Amy…I just read this thread from Google and thought > that I’d jump in with my opinion, as I’ve been on MTX for almost > 10 years, and have had to learn a lot about it, Remicade, and > many other drugs I take. > I’d recheck with your doctor about how you’re administering your > MTX, as this is the info I have…MTX is available as pills or as > an injectable. I couldn’t continue on the pills, due to > unacceptable side effects…many people report this and change > over to the injections. I’m taken care of by the VA Hospital in > Houston, which is now part of the Texas Medical Center and has > what are considered the finest Rheumatologists in the nation. As > you might imagine, with the large patient population of older > veterans, there is a huge and well-experienced Rheumatology > department. I’m also seen by private doctors and specialists > under Medicare. > To make a very long story shorter, when I first went on MTX, I > went down to the VA every Friday morning for routine labs, which > are mandatory when on MTX. Went to lunch, and if labs were okay, > then Pharmacy mixed MTX to order and delivered filled syringe to > nurses who then injected the MTX IM, (Intra-muscular) into a > buttock. We changed "cheeks" each week. They didn’t take any > special handling precautions with the MTX, other than the normal > stuff for injections. They do about a hundred of these a day. We > went through this routine for 2 years while establishing a > response and side-effect profile. > I then signed-up for home self-injecting, and they now send me > the standard manufacturer’s vials of MTX, 3ml BD syringes, and > needles. I went through a long series of discussions with the VA > Rheumatologists, nurses who specialize in injections, the Head of > Pharmacy at the Hospital, and my private doctors, along with > consulting the Monograph, (complete directions) that come with > the drug, and the manufacturer’s web site. > All of these sources advise that using a insulin needle and > injecting sub-q, ( just under the skin ), IS NOT CORRECT, and the > medication will either not be effective, or be overly reactive. > MTX is designed to be injected deep into a muscle, either a > buttock, or upper thigh. As I’m alone, I use the top of an upper > thigh, alternating each week. I inject 15mg with a 3ml BD > syringe, and a 27GA 1 1/4" needle. The needle must be at least 1 > 1/4" to get into the muscle. If you check the PDR, the > manufacturer’s web site, and the monograph enclosed with each > vial, you’ll see that IM injection is the only recommended route, > and sub-q is not mentioned. I’ve seen references to sub-q use of > MTX on several newsgroups, and have again asked the doctors and > nurses who KNOW about this, and they still advise that sub-q use > of MTX is wrong…it must be injected intra-muscularly. > As for the rest of your message, MTX is not dangerous, nor does > it require special handling or refrigeration. I get the standard > vial, syringe and needles from the VA shipped to me and I simply > keep the MTX vials beside the bed. Each week I take one needle > and pull the correct amount of MTX, then change to a new > needle…swab the site with alcohol wipe, let dry, jab straight > down, pull back slightly to make sure I’m not in a vein, then > inject slowly into the muscle. Wait for a few seconds, pull > needle out, then swab again. Check for bleeding at site, go on > about my business. Toss used syringe and needle, MTX vial goes > back on bedstand for next week. The bottle is sealed with a > rubber stopper and they recommend you swab the top of it with the > alcohol wipe after use, but that’s it. They simply do pre-mixes > at the Hospital because they do so many every day and want to > eliminate nurse error or liability in drawing the right dose for > each patient. I do get blood work done each month to monitor CBC, > Differential, Platelets, Liver and Kidney function. > Again, I’d check with my doctor or get another opinion. I’d be > happy to answer any questions that I can. > — > Regards, Jim > ALL POSTS SENT HAVE BEEN SCANNED! > I found out something interesting today – the way I have been > preparing > and injecting myself with methotrexate is considered dangerous! > Apparently the safe way is to have the pharmacy prepare the mtx > by > preloading the correct dose in syringes which you then keep in > the > fridge. They use a fume cupboard etc. But I was taught to just > get the > 50mg vials from the chemist, fill the syringe myself using the > appropriate amount (20mg in my case), then place the leftovers > in the > sharps container. But apparently because it is cytotoxic, this > can be > dangerous to myself and others if spillage occurs or if it is > breathed > in. I wasn’t even told to use gloves. > Am I the only one to be using these so-called unsafe practices, > or is it > standard procedure? > Take care, > Amy.
Response:
Thanks Dwight, I tend to agree – I do use a vial with a rubber stopper, clean the site, use a new syringe etc, so I think it sounds safe enough. I went and got my first pharmacist-prepared mtx, which is sealed in a syringe which I attach a needle too and inject. It doesn’t seem to be much different to what I do already. Plus it costs $25.80 for 3 weeks, versus $3.80 for 5 weeks using the vials – may not sound like a lot but when you are not working every little bit makes a difference. And it costs $2 for parking to pick up the mtx from the hospital. So I think next time I will bypass the whole strict hospital rules and just get my GP to write me a prescription I can get myself as I have been doing since December. Thanks for your response too Jeff. Take care, Amy. – Hide quoted text — Show quoted text – > Let me state that I’m not a doctor and not that familiar with mtx, but I > do have experience with self-injections. If you’re using a vial and not > having to mix it yourself, I can’t imagine it being dangerous. You’re > using a vial on a one-time basis, using a new syringe everytime, and > cleaning the injection site, there shouldn’t be anything to worry about. > The vial should be sealed and spill-proof with the rubber stopper in it > and it shouldn’t allow any fumes to escape. I’m a diabetic and I’ve > also got hep-c which I’m currently going through treatment for. I give > myself four injections a day of insulin, two shots a week of Neupogen, > one shot of Procrit a week, and one shot of interferon a week. I can’t > imagine going to the doctor for any of my injections anymore. I used to > be one of the biggest babies in the world when it came to injections, it > was so bad I had trouble not passing out when the nurse had to give me a > shot. Now I would rather do it myself. > Dwight
(The Human Pin Cushion) – Hide quoted text — Show quoted text –
Response:
I did interferon too, 5 million units daily for 56 weeks (I HBV besided cronh’s). Hope your INF is showing progress with your HCV. brian
– Hide quoted text — Show quoted text -> Thanks Dwight, I tend to agree – I do use a vial with a rubber stopper, > clean the site, use a new syringe etc, so I think it sounds safe enough. I > went and got my first pharmacist-prepared mtx, which is sealed in a > syringe which I attach a needle too and inject. It doesn’t seem to be much > different to what I do already. Plus it costs $25.80 for 3 weeks, versus > $3.80 for 5 weeks using the vials – may not sound like a lot but when you > are not working every little bit makes a difference. And it costs $2 for > parking to pick up the mtx from the hospital. > So I think next time I will bypass the whole strict hospital rules and > just get my GP to write me a prescription I can get myself as I have been > doing since December. > Thanks for your response too Jeff. > Take care, > Amy. > Let me state that I’m not a doctor and not that familiar with mtx, but I > do have experience with self-injections. If you’re using a vial and not > having to mix it yourself, I can’t imagine it being dangerous. You’re > using a vial on a one-time basis, using a new syringe everytime, and > cleaning the injection site, there shouldn’t be anything to worry about. > The vial should be sealed and spill-proof with the rubber stopper in it > and it shouldn’t allow any fumes to escape. I’m a diabetic and I’ve also > got hep-c which I’m currently going through treatment for. I give myself > four injections a day of insulin, two shots a week of Neupogen, one shot > of Procrit a week, and one shot of interferon a week. I can’t imagine > going to the doctor for any of my injections anymore. I used to be one > of the biggest babies in the world when it came to injections, it was so > bad I had trouble not passing out when the nurse had to give me a shot. > Now I would rather do it myself. > Dwight > (The Human Pin Cushion)
Response:
For the difference in price, I would get the vials too. Dwight – Hide quoted text — Show quoted text – > Thanks Dwight, I tend to agree – I do use a vial with a rubber stopper, > clean the site, use a new syringe etc, so I think it sounds safe enough. > I went and got my first pharmacist-prepared mtx, which is sealed in a > syringe which I attach a needle too and inject. It doesn’t seem to be > much different to what I do already. Plus it costs $25.80 for 3 weeks, > versus $3.80 for 5 weeks using the vials – may not sound like a lot but > when you are not working every little bit makes a difference. And it > costs $2 for parking to pick up the mtx from the hospital. > So I think next time I will bypass the whole strict hospital rules and > just get my GP to write me a prescription I can get myself as I have > been doing since December. > Thanks for your response too Jeff. > Take care, > Amy. > Let me state that I’m not a doctor and not that familiar with mtx, but > I do have experience with self-injections. If you’re using a vial and > not having to mix it yourself, I can’t imagine it being dangerous. > You’re using a vial on a one-time basis, using a new syringe > everytime, and cleaning the injection site, there shouldn’t be > anything to worry about. The vial should be sealed and spill-proof > with the rubber stopper in it and it shouldn’t allow any fumes to > escape. I’m a diabetic and I’ve also got hep-c which I’m currently > going through treatment for. I give myself four injections a day of > insulin, two shots a week of Neupogen, one shot of Procrit a week, and > one shot of interferon a week. I can’t imagine going to the doctor > for any of my injections anymore. I used to be one of the biggest > babies in the world when it came to injections, it was so bad I had > trouble not passing out when the nurse had to give me a shot. Now I > would rather do it myself. > Dwight > (The Human Pin Cushion)
–
Response:
Greetings, Amy…I just read this thread from Google and thought that I’d jump in with my opinion, as I’ve been on MTX for almost 10 years, and have had to learn a lot about it, Remicade, and many other drugs I take. I’d recheck with your doctor about how you’re administering your MTX, as this is the info I have…MTX is available as pills or as an injectable. I couldn’t continue on the pills, due to unacceptable side effects…many people report this and change over to the injections. I’m taken care of by the VA Hospital in Houston, which is now part of the Texas Medical Center and has what are considered the finest Rheumatologists in the nation. As you might imagine, with the large patient population of older veterans, there is a huge and well-experienced Rheumatology department. I’m also seen by private doctors and specialists under Medicare. To make a very long story shorter, when I first went on MTX, I went down to the VA every Friday morning for routine labs, which are mandatory when on MTX. Went to lunch, and if labs were okay, then Pharmacy mixed MTX to order and delivered filled syringe to nurses who then injected the MTX IM, (Intra-muscular) into a buttock. We changed "cheeks" each week. They didn’t take any special handling precautions with the MTX, other than the normal stuff for injections. They do about a hundred of these a day. We went through this routine for 2 years while establishing a response and side-effect profile. I then signed-up for home self-injecting, and they now send me the standard manufacturer’s vials of MTX, 3ml BD syringes, and needles. I went through a long series of discussions with the VA Rheumatologists, nurses who specialize in injections, the Head of Pharmacy at the Hospital, and my private doctors, along with consulting the Monograph, (complete directions) that come with the drug, and the manufacturer’s web site. All of these sources advise that using a insulin needle and injecting sub-q, ( just under the skin ), IS NOT CORRECT, and the medication will either not be effective, or be overly reactive. MTX is designed to be injected deep into a muscle, either a buttock, or upper thigh. As I’m alone, I use the top of an upper thigh, alternating each week. I inject 15mg with a 3ml BD syringe, and a 27GA 1 1/4" needle. The needle must be at least 1 1/4" to get into the muscle. If you check the PDR, the manufacturer’s web site, and the monograph enclosed with each vial, you’ll see that IM injection is the only recommended route, and sub-q is not mentioned. I’ve seen references to sub-q use of MTX on several newsgroups, and have again asked the doctors and nurses who KNOW about this, and they still advise that sub-q use of MTX is wrong…it must be injected intra-muscularly. As for the rest of your message, MTX is not dangerous, nor does it require special handling or refrigeration. I get the standard vial, syringe and needles from the VA shipped to me and I simply keep the MTX vials beside the bed. Each week I take one needle and pull the correct amount of MTX, then change to a new needle…swab the site with alcohol wipe, let dry, jab straight down, pull back slightly to make sure I’m not in a vein, then inject slowly into the muscle. Wait for a few seconds, pull needle out, then swab again. Check for bleeding at site, go on about my business. Toss used syringe and needle, MTX vial goes back on bedstand for next week. The bottle is sealed with a rubber stopper and they recommend you swab the top of it with the alcohol wipe after use, but that’s it. They simply do pre-mixes at the Hospital because they do so many every day and want to eliminate nurse error or liability in drawing the right dose for each patient. I do get blood work done each month to monitor CBC, Differential, Platelets, Liver and Kidney function. Again, I’d check with my doctor or get another opinion. I’d be happy to answer any questions that I can. — Regards, Jim ALL POSTS SENT HAVE BEEN SCANNED!
– Hide quoted text — Show quoted text -> I found out something interesting today – the way I have been preparing > and injecting myself with methotrexate is considered dangerous! > Apparently the safe way is to have the pharmacy prepare the mtx by > preloading the correct dose in syringes which you then keep in the > fridge. They use a fume cupboard etc. But I was taught to just get the > 50mg vials from the chemist, fill the syringe myself using the > appropriate amount (20mg in my case), then place the leftovers in the > sharps container. But apparently because it is cytotoxic, this can be > dangerous to myself and others if spillage occurs or if it is breathed > in. I wasn’t even told to use gloves. > Am I the only one to be using these so-called unsafe practices, or is it > standard procedure? > Take care, > Amy.
Response:
right on!!!!! jeff
– Hide quoted text — Show quoted text -> Let me state that I’m not a doctor and not that familiar with mtx, but I > do have experience with self-injections. If you’re using a vial and not > having to mix it yourself, I can’t imagine it being dangerous. You’re > using a vial on a one-time basis, using a new syringe everytime, and > cleaning the injection site, there shouldn’t be anything to worry about. > The vial should be sealed and spill-proof with the rubber stopper in > it and it shouldn’t allow any fumes to escape. I’m a diabetic and I’ve > also got hep-c which I’m currently going through treatment for. I give > myself four injections a day of insulin, two shots a week of Neupogen, > one shot of Procrit a week, and one shot of interferon a week. I can’t > imagine going to the doctor for any of my injections anymore. I used to > be one of the biggest babies in the world when it came to injections, it > was so bad I had trouble not passing out when the nurse had to give me a > shot. Now I would rather do it myself. > Dwight > (The Human Pin Cushion) > I found out something interesting today – the way I have been preparing > and injecting myself with methotrexate is considered dangerous! > Apparently the safe way is to have the pharmacy prepare the mtx by > preloading the correct dose in syringes which you then keep in the > fridge. They use a fume cupboard etc. But I was taught to just get the > 50mg vials from the chemist, fill the syringe myself using the > appropriate amount (20mg in my case), then place the leftovers in the > sharps container. But apparently because it is cytotoxic, this can be > dangerous to myself and others if spillage occurs or if it is breathed > in. I wasn’t even told to use gloves. > Am I the only one to be using these so-called unsafe practices, or is it > standard procedure? > Take care, > Amy. > —
Response:
Hi amy, Thanks for the information. It was very helpful. Wow! I am amazed at all the meds that you are on. You must have been pretty sick. All the best to you, and Thanks Nyse
Response:
i think that is overkill. but to each their own. i know a healthy person should not have skin contact, but for cripes sake, we are injecting the dang stuff!!! i guess some people could have an inverse reaction to the stuff. mtx is wicked, but i doubt that a few molecules we are talking about that get air borne will hurt anyone any worse than second hand smoke. not a chemist or pharmacist here, but i do know what a molecule is.
– Hide quoted text — Show quoted text -> I found out something interesting today – the way I have been preparing > and injecting myself with methotrexate is considered dangerous! > Apparently the safe way is to have the pharmacy prepare the mtx by > preloading the correct dose in syringes which you then keep in the > fridge. They use a fume cupboard etc. But I was taught to just get the > 50mg vials from the chemist, fill the syringe myself using the > appropriate amount (20mg in my case), then place the leftovers in the > sharps container. But apparently because it is cytotoxic, this can be > dangerous to myself and others if spillage occurs or if it is breathed > in. I wasn’t even told to use gloves. > Am I the only one to be using these so-called unsafe practices, or is it > standard procedure? > Take care, > Amy.
Response:
Let me state that I’m not a doctor and not that familiar with mtx, but I do have experience with self-injections. If you’re using a vial and not having to mix it yourself, I can’t imagine it being dangerous. You’re using a vial on a one-time basis, using a new syringe everytime, and cleaning the injection site, there shouldn’t be anything to worry about. The vial should be sealed and spill-proof with the rubber stopper in it and it shouldn’t allow any fumes to escape. I’m a diabetic and I’ve also got hep-c which I’m currently going through treatment for. I give myself four injections a day of insulin, two shots a week of Neupogen, one shot of Procrit a week, and one shot of interferon a week. I can’t imagine going to the doctor for any of my injections anymore. I used to be one of the biggest babies in the world when it came to injections, it was so bad I had trouble not passing out when the nurse had to give me a shot. Now I would rather do it myself. Dwight (The Human Pin Cushion) – Hide quoted text — Show quoted text – > I found out something interesting today – the way I have been preparing > and injecting myself with methotrexate is considered dangerous! > Apparently the safe way is to have the pharmacy prepare the mtx by > preloading the correct dose in syringes which you then keep in the > fridge. They use a fume cupboard etc. But I was taught to just get the > 50mg vials from the chemist, fill the syringe myself using the > appropriate amount (20mg in my case), then place the leftovers in the > sharps container. But apparently because it is cytotoxic, this can be > dangerous to myself and others if spillage occurs or if it is breathed > in. I wasn’t even told to use gloves. > Am I the only one to be using these so-called unsafe practices, or is it > standard procedure? > Take care, > Amy.
–
Response:
Hi Amy, I was just talking to my Gastro. he is going to put me on Methotrexate, as I had bad reaction to Immuran. I will not be injecting the medication myself, he said my family doctor has to do it. I really can’t believe that you have to inject it yourself. I was also woundering if you could give me some info about methotrexate, does it help you? all I know is that i have to get a weekly injection.
Response:
nyse, The injection is just under the skin (into the stomach or thigh), using an insulin needle which is fine and short, so it is not painful at all. It really isn’t that hard to administer, it’s the same thing that diabetics do every day. It is a bit scary doing it at first though! I would be quite happy to have my doctor do it every week, but I felt I was expected to cope doing it myself, which I am doing but I don’t enjoy it. I noticed that on the night of my injection, my stomach would feel a bit funny, but this has stopped happening now. It could have been the mtx or it could have been the folic acid pill I take on the same day. But that is the only side effect I have noticed, apart from perhaps a bit of extra tiredness on the night of the injection. You need to get your blood tests done regularly, just like you do with Imuran. I have distal UC which is pretty much resistant to most medication, but I do feel as if it has helped a bit (I have been on it since December). It certainly helped my arthritis which seems to have cleared up completely. I also take Salofalk granules, have been on pred since last May (am down to 4mg at the moment), use colifoam twice a day, and had a remicade infusion a few weeks ago. I was on Imuran for more than 2 years and that didn’t seem to help me at all. I hope you get good results with the methotrexate! Take care, Amy. – Hide quoted text — Show quoted text – > Hi Amy, > I was just talking to my Gastro. he is going to put me on Methotrexate, as > I had bad reaction to Immuran. I will not be injecting the medication > myself, he said my family doctor has to do it. I really can’t believe that > you have to inject it yourself. I was also woundering if you could give me > some info about methotrexate, does it help you? all I know is that i have > to get a weekly injection.
Response:
I found out something interesting today – the way I have been preparing and injecting myself with methotrexate is considered dangerous! Apparently the safe way is to have the pharmacy prepare the mtx by preloading the correct dose in syringes which you then keep in the fridge. They use a fume cupboard etc. But I was taught to just get the 50mg vials from the chemist, fill the syringe myself using the appropriate amount (20mg in my case), then place the leftovers in the sharps container. But apparently because it is cytotoxic, this can be dangerous to myself and others if spillage occurs or if it is breathed in. I wasn’t even told to use gloves. Am I the only one to be using these so-called unsafe practices, or is it standard procedure? Take care, Amy.
Response:
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