Intramuscular methotrexate administration should be considered when rheumatoid arthritis remains active in spite of high dose oral methotrexate. Methods: 143 patients were switched from intramuscular to oral methotrexate. warnings. for intrathecal and high-dose therapy, use the preservative-free formulation of methotrexate. do not use the preserved formulation for intrathecal or high-dose therapy because it contains benzyl alcohol. receiving low-dose methotrexate and, thus, may not require cytotoxic treatment. Discontinue Otrexup first and, if Discontinue Otrexup first and, if the lymphoma does not regress, appropriate treatment should be instituted [see Warnings and Precautions (5.8)]. • Spontaneous abortions have been reported in 42.5% of pregnant women exposed to low-dose methotrexate treatment (less than 30 mg/week), compared to a reported rate of 22.5% in disease-matched patients treated with drugs other than methotrexate. Dose adjustments are easier if you absorb all of the medication Can I inject the Methotrexate by Myself? Yes, methotrexate can easily be injected by you or your family members. Efficacy of Intramuscular (IM) Methotrexate in the Treatment of RA. Methotrexate, either as monotherapy or in combination, remains the gold standard therapy for RA. Two RCT were found that evaluated parenteral methotrexate.11 12 longstanding RA patients who had failed on 15–20 mg/week oral methotrexate and were switched to 15 mg/week intramuscular methotrexate for 6 weeks, without achieving a DAS28 response, Lambert et al11 evaluated subsequent intramuscular placebo versus intramuscular methotrexate escalation up to 45 mg/week. methotrexate injection, usp rx only warnings methotrexate should be used only by physicians whose knowledge and experience include the use of antimetabolite therapy. Objective: To compare the clinical efficacy of methotrexate and tolerance to the drug in patients with rheumatoid arthritis who were switched from intramuscular to oral administration because of a shortage of the intramuscular preparation. Detailed Methotrexate dosage information for adults and children. Includes dosages for Rheumatoid Arthritis, Psoriasis, Juvenile Rheumatoid Arthritis and more; plus renal, liver and dialysis adjustments.