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Drug Information For:


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Common Uses:

This medicine is an antimetabolite used to treat certain types of cancer, severe psoriasis, or rheumatoid arthritis in certain patients. It may be used alone or with other medicines. It may also be used for other conditions as determined by your doctor.

Before Using This Medicine:

WARNING: THIS MEDICINE MAY CAUSE SEVERE AND SOMETIMES FATAL SIDE EFFECTS, INCLUDING BONE MARROW, BLOOD, LIVER, LUNG, KIDNEY, OR SKIN PROBLEMS. This medicine is only used to treat certain patients who have life-threatening cancer or who have severe psoriasis or rheumatoid arthritis that is not relieved by other treatments. CERTAIN MEDICINES AND CONDITIONS MAY INCREASE YOUR RISK FOR SIDE EFFECTS. Tell your doctor if you have excess fluid in your stomach or around your lungs, or if you have any liver, kidney, lung, blood, bone marrow, stomach, bowel, or immune system problems, or if you develop any new or worsening symptoms. YOUR DOCTOR WILL PERFORM LAB TESTS TO CHECK FOR SIDE EFFECTS while you take this medicine. Keep all doctor and laboratory appointments. Talk with your doctor and be sure to understand the risks and benefits of using this medicine. THIS MEDICINE MAY CAUSE BIRTH DEFECTS OR FETAL DEATH. Do not use this medicine to treat psoriasis or rheumatoid arthritis if you are pregnant. TELL YOUR DOCTOR BEFORE YOU TAKE THIS MEDICINE if you are pregnant or think you may be pregnant. DO NOT BECOME PREGNANT OR FATHER A CHILD WHILE USING THIS MEDICINE. Talk to your doctor about using an effective form of birth control. THIS MEDICINE MAY INCREASE THE RISK of developing a certain type of cancer (lymphoma). It may also cause a serious and possibly fatal condition called tumor lysis syndrome (TLS) in certain patients with cancer. Discuss any questions or concerns with your doctor. Some medicines or medical conditions may interact with this medicine. INFORM YOUR DOCTOR OR PHARMACIST of all prescription and over-the-counter medicine you take. DO NOT TAKE THIS MEDICINE if you also take acitretin, or if you have taken/will be taking palifermin within 24 hours of taking this medicine. ADDITIONAL MONITORING OF YOUR DOSE OR CONDITION may be needed if you are taking oral anticoagulants (eg, warfarin), chloramphenicol, ciprofloxacin, corticosteroids (eg, prednisone), cyclosporine, dantrolene, digoxin, folic acid, hydantoins (eg, phenytoin), hydroxychloroquine, leflunomide, mercaptopurine, nonsteroidal anti-inflammatory drugs (NSAIDs) (eg, ibuprofen, celecoxib), penicillamine, penicillins (eg, amoxicillin), phenylbutazone, pristinamycin, probenecid, proton pump inhibitors (PPIs) (eg, omeprazole), salicylates (eg, aspirin), sulfonamides (eg, sulfamethoxazole, sulfasalazine), tetracyclines (eg, doxycycline), theophylline, trimethoprim, vancomycin, or medicine that may harm the kidney (eg, amphotericin B; tacrolimus; aminoglycosides, such as gentamicin) or liver (eg, azathioprine; retinoids, such as isotretinoin; acetaminophen; ketoconazole; isoniazid; certain HIV medicines). Ask your doctor if you are unsure if any of your medicines may harm the kidney or liver. DO NOT START OR STOP any medicine without doctor orpharmacist approval. Inform your doctor of any other medical conditions, including a history of lung problems, immune system problems, nervous system problems (eg, seizures), liver problems (eg, hepatitis), kidney problems, diabetes, blood problems (eg, anemia, low white blood cells, low blood platelets), alcohol abuse, allergies, pregnancy, or breast-feeding. Tell your doctor if you have an active infection, severe vomiting or diarrhea, dehydration, mouth sores, excess fluid in your stomach or around your lungs, stomach or bowel problems (eg, ulcers, inflammation, blockage), folic acid deficiency, or very poor health. Tell your doctor if you are receiving chemotherapy or radiation, or if you are very overweight. USE OF THIS MEDICINE IS NOT RECOMMENDED TO TREAT psoriasis or rheumatoid arthritis if you are pregnant; if you have alcoholism, liver problems caused by alcohol, or chronic liver problems; or if you have a weakened immune system or certain blood problems (eg, anemia, bone marrow depression, low white blood cell count, low platelet count). Contact your doctor or pharmacist if you have any questions about taking this medicine.

How to Use This Medicine:

Follow the directions for using this medicine exactly as provided by your doctor. Take this medicine by mouth with or without food. However, you should take it the same way each time in relation to food. It is important to use each dose at the scheduled time. THE DOSE OF THIS MEDICINE and how often you use it are based on your medical condition and response to treatment. It is very important that you follow your doctor's instructions carefully. Taking too much of this medicine may cause serious and sometimes fatal side effects. Be sure you understand exactly how much of this medicine to take and how often you should take it. Ask your doctor or pharmacist if you have any questions. DRINKING EXTRA FLUIDS while you are taking this medicine is recommended. Check with your doctor or nurse for instructions. IF NAUSEA, VOMITING, OR LOSS OF APPETITE OCCURS, ask your doctor, nurse, or pharmacist for ways to lessen these effects. If vomiting or diarrhea occurs, you will need to take care not to become dehydrated. Contact your doctor for instructions. STORE THIS MEDICINE at room temperature between 68 and 77 degrees F (20 and 25 degrees C) in a tightly-closed container, away from heat, moisture, and light. KEEP THIS MEDICINE out of the reach of children and away from pets. IT MAY TAKE SEVERAL WEEKS for the full benefit of this medicine to be seen in the management of psoriasis or rheumatoid arthritis. Do not stop taking this medicine without checking with your doctor. CONTINUE TO TAKE THIS MEDICINE as directed even if you feel well. Do not miss any doses. IF YOU MISS A DOSE OF THIS MEDICINE, contact your doctor or pharmacist. Do not take 2 doses at once.


DO NOT TAKE THIS MEDICINE if you have had an allergic reaction to it or are allergic to any ingredient in this product. DO NOT EXCEED THE RECOMMENDED DOSE or take this medicine for longer than prescribed without checking with your doctor. Laboratory and/or medical tests, including complete blood counts and liver and kidney function, may be performed to monitor your progress or to check for side effects. KEEP ALL DOCTOR AND LABORATORY APPOINTMENTS while you are using this medicine. BEFORE YOU HAVE ANY MEDICAL OR DENTAL TREATMENTS, EMERGENCY CARE, OR SURGERY, tell the doctor or dentist that you are using this medicine. THIS MEDICINE MAY CAUSE DIZZINESS, DROWSINESS, OR BLURRED VISION. DO NOT DRIVE, OPERATE MACHINERY, OR DO ANYTHING ELSE THAT COULD BE DANGEROUS until you know how you react to this medicine. Using this medicine alone, with other medicines, or with alcohol may lessen your ability to drive or to perform other potentially dangerous tasks. Check with your doctor before you drink alcohol while you are taking this medicine. THIS MEDICINE MAY CAUSE you to become sunburned more easily. Avoid exposure to the sun, sunlamps, or tanning booths until you know how you react to this medicine. Use a sunscreen or protective clothing if you must be outside for a prolonged period. THIS MEDICINE MAY REDUCE THE NUMBER OF BLOOD CELLS WHICH ARE NEEDED FOR CLOTTING. Avoid activities that may cause bruising or injury. Tell your doctor if you have unusual bruising or bleeding or if you notice dark, tarry, or bloody stools. THIS MEDICINE MAY LOWER YOUR RESISTANCE to infection. Wash your hands well to prevent the spread of infections. Tell your doctor if you notice signs of infection like fever, sore throat, rash, or chills. DO NOT RECEIVE A LIVE VACCINE (eg, measles, mumps) while you are taking this medicine. Talk with your doctor before you receive any vaccine. BEFORE YOU BEGIN TAKING ANY NEW MEDICINE, either prescription or over-the-counter, check with your doctor or pharmacist. This includes any medicines that contain ibuprofen, naproxen, aspirin, salicylates, or any other medicine used to treat pain, fever, swelling, or arthritis. THIS MEDICINE MAY AFFECT YOUR ABILITY to become pregnant or father a child. Discuss any questions or concerns with your doctor. MEN WHO TAKE THIS MEDICINE SHOULD ALWAYS USE A CONDOM when having sex with a woman who may become pregnant. Do this for as long as you take this medicine and for 3 months after you stop taking it. CAUTION IS ADVISED WHEN USING THIS MEDICINE IN THE ELDERLY because they may be more sensitive to the effects of the medicine. FOR WOMEN: This medicine may cause birth defects and fetal or newborn death if you take it while you are pregnant. Do not become pregnant while you are using it. Use an effective form of birth control while you are taking this medicine and for at least 1 ovulatory cycle after you stop taking it. IF YOU SUSPECT THAT YOU COULDBE PREGNANT, contact your doctor immediately. THIS MEDICINE IS EXCRETED IN BREAST MILK. DO NOT BREAST-FEED while taking this medicine.

Possible Side Effects:

SIDE EFFECTS that may occur while taking this medicine include dizziness, drowsiness, general body discomfort, headache, loss of appetite, mild hair loss, mild stomach pain, nausea, or tiredness. If they continue or are bothersome, check with your doctor promptly. CONTACT YOUR DOCTOR IMMEDIATELY if you experience black, tarry stools; blood in the urine; bone pain; calf or leg pain, redness, swelling, or tenderness; change in the amount of urine produced; chest pain; confusion; coughing up blood; diarrhea or vomiting; difficult or painful urination; dry cough; enlargement of the breasts (in males); fainting; fast or irregular heartbeat; fever, chills, or persistent sore throat; menstrual changes; mental or mood changes; mouth or tongue sores or swelling; muscle weakness or cramps; night sweats; one-sided weakness; red, swollen, peeling, or blistered skin; seizures; severe or persistent dizziness or light-headedness; shortness of breath; sluggishness; speech changes; swollen glands; symptoms of liver problems (eg, dark urine, pale stools, persistent loss of appetite, severe stomach pain, yellowing of the skin or eyes); symptoms of pancreas inflammation (eg, severe stomach pain with or without nausea or vomiting); unexplained weight loss; unusual bleeding or bruising; unusual pain and discoloration of the skin; unusual tiredness or weakness; vaginal discharge; vision loss or other vision changes (eg, blurred vision); vomit that looks like coffee grounds. AN ALLERGIC REACTION to this medicine is unlikely, but seek immediate medical attention if it occurs. Symptoms of an allergic reaction include rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue. If you notice other effects not listed above, contact your doctor, nurse, or pharmacist. This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your healthcare provider. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.


If overdose is suspected, contact your local poison control center or emergency room immediately. Symptoms of overdose may include black or bloody stools; change in the amount of urine produced; seizures; severe headache, nausea, vomiting, or stomach pain; swelling or soreness of the mouth or tongue; unusual bruising or bleeding; unusual tiredness or weakness; vomit that looks like coffee grounds.

Additional Information:

Carry an identification card at all times that says you are taking this medicine. DO NOT SHARE THIS MEDICINE with others for whom it was not prescribed. DO NOT USE THIS MEDICINE for other health conditions. IF USING THIS MEDICINE FOR AN EXTENDED PERIOD OF TIME, obtain refills before your supply runs out. CHECK WITH YOUR PHARMACIST about how to dispose of unused medicine.

Copyright 2015 Wolters Kluwer Health, Inc.


- This information is not intended to substitute for professional medical advice. Be sure to contact your physician, pharmacist or other health care provider for more information about this medication. By searching these web site pages, you agree to our terms and conditions of use.