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methotrexate PO

methotrexate PO
Brand names: Trexall
Form Strength
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
 • Stored separately in pharmacy.
 • Drugs are transported in plastic bags/designated transport containers 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. 22, 2025
  • 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



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