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methotrexate PO

methotrexate PO

Drug Name	Form	Strength	Non-Formulary	Restricted	TX Sub	Notes
Trexall	TABLET, ORAL	2.5 mg

Display Antineoplastic Agents, Immunomodulatory Agents, Disease-Modifying Antirheumatic Drugs Class : 100000, 922000, 923600

High Alert Drug : Policy

Medication comments:

High Alert Drug: Chemotherapeutic Agents - Oral
• Designated stored location in pharmacy. • Drugs are transported in plastic bags labeled with sticker indicating CHEMOTHERAPY DRUG.

High Alert Drug: Oral methotrexate
• The only frequency option for oral dosing in order entry system is weekly • Verification by pharmacist of appropriate oncologic indication for any daily oral orders • Continuous monitoring of all methotrexate oral orders for appropriateness

Per policy, these hazardous drugs have special waste requirements.
Generic (Brand)	Waste Requirements
methotrexate (Trexall)	If > 3% by weight of drug remains ⇒ BLACK BUCKET Trace amounts/uncontaminated PPE ⇒ YELLOW BUCKET

USP <800> Hazardous Drug Assessment of Risk (AOR)
Per policy, these drugs are exempt from USP <800> handling requirements under normal circumstances. The following outlines must be followed.
generic (Brand) Route [Packaging: Manufacturer ⇒ Dispense]	Activities
methotrexate (Otrexup, Rasuvo, Rheumatrex, Trexall, Xatmep) PO [UD ⇒ UD]	2.5 mg tablet	Stock @ IDBH? Y NIOSH Table 1^↑
Pharmacy: Receiving / Storage / Preparation Exposure Risk: minimal	• Handling/preparation PPE Requirements: n/a
	• Receiving from Distributor: Designated area/ CX gloves
	• Pharmacy Storage Area: Hazardous
	• Packaging/Reconstitution Location: n/a
	• Compounding (Non-Sterile/Sterile) Location: n/a
	• Omnicell Load: No
Transport	• Transport (dose is placed inside a plastic sealable bag): Standard
Nursing: Storage / Administration Exposure Risk: low	• Handling/administration PPE Requirements: Single pair of CX approved gloves. Wash hands after handling
	• Storage of Finished dose in Nursing Area/Procedural Area: Patient Med Drawer
	• Signage on Patient Door Required: Yes
	• Manipulation of Dosage Form: n/a
	• Special Manipulation for Administration: do not crush tablet
Disposal / Spills	• Disposal of Drug Waste: Full- black bin Trace- yellow bin
	• Disposol of Used PPE: yellow bin
	• Spill management: n/a
Reason for exemption of USP<800> Containment Requirements: Purchased in final dosage form; packaged as unit dose. Does not require additional manipulation for dispensing.

Last updated: May. 4, 2026

Hazard.Drug Handling(USP 800) USP<800> Hazardous Drug / Assessment of Risk
Hazardous Waste BLACK BUCKET/YELLOW BUCKET
Chemotherapy
Black Box Warnings Bone marrow, liver, lung and kidney toxicity risk
Look-Alike/Sound-Alike methotrexate confused with metOLazone, MTX Patch (lidocaine and menthol)

UpToDate Lexidrug

Pharmacy Contact Info:

Main Inpatient Pharmacy: ext 4599, 3503
Fax: 704-878-7283

Director of Pharmacy - Randi Raynor, PharmD: ext 4501
Clinical Coordinator - Laura Rollings, PharmD: ext 4597
Pharmacy Informaticist - Stephen Pringle, PharmD: ext 7645
Pharmacy Technician Supervisor - Amy Wingler, CPhT: ext 7385
Pharmacy Automation Coordinator (Omnicell) - Melissa Fulford, CPhT: ext 3556

This site is intended for the staff of Iredell Health System. While others may view accessible pages, Iredell Health System makes no warranty, express or implied, as to the use of this information outside of Iredell Health System. The content of this policy and procedure document serves as guidance to the delivery of quality patient care. Care providers are expected to exercise critical thinking and situational awareness skills, and in specific situations to take such action as is necessary for the delivery of quality patient care.