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Inilah Alasan Mengapa Poker Online Lebih Baik

heheBelakangan ini beberapa situs internet taruhan olahraga sudah menggerakkan diri mereka sendiri langkah untuk membuahkan uang banyak. Saat ini, ada dua fakta penting kenapa perjudian olahraga bisa menjadi pilihan yang jelek untuk membuahkan uang dibanding pokergame internet.

Gamble

Dalam judi olahraga, cuma ada sejumlah besar spekulasi yang terjebak, sebab untuk sejumlah besar Anda harus memercayakan kebanyakan variabel yang datang dari Anda di tebakan. Untuk contoh, garis (atau, ketidaksamaan arah) ditata oleh rumah. Garis ini diputuskan demikian hingga kontras semua laga dengan jumlahnya yang lebih adil serta imbang, serta dengan begitu membuat dekati kesempatan dalam tentukan kesuksesan sahabatqq

Kebenaran ini saja menolong jadikan judi olahraga lebih untuk judi, sebab benar-benar susah untuk memercayakan nilai-nilai tiap staf. Disamping itu, beberapa hal lain, termasuk juga disposisi crew, cuaca, atau serta bahaya yang lain pada seorang sepanjang laga, mengakibatkan taruhan olahraga untuk taruhan atau peruntungan.

Satu dari aspek ini mempunyai potensi memunculkan kerugian yang mengagumkan untuk keperluan Anda dengan cara pribadi, karena hanya Anda tidak mempunyai keterkaitan atau kendali dari permainan ini. Tanpa ada komponen yang menyerahkan hasil, laga apa saja seperti taruhan olahraga dan lotre bisa menjadi permainan video relatif peruntungan.

Get a Grip on

Di internet poker, karena itu Anda masih memperoleh
Bagus

banyak kontrol berdasar hasil permainan sebab Anda langsung terjebak dalam tiap atraksi. Walau kartu sewenang-wenang serta ada feature peluang untuk tingkat khusus, masih ditetapkan membuat potensi untuk melipat atau mainkan tangan poker Anda.

Bersamaan dengan pilih untuk bermain dengan tangan atau lipatan poker Anda, Anda dapat juga memperoleh pegangan pada kesibukan di laga holdem Texas dengan taruhan yang Anda bikin. Anda mempunyai potensi untuk memaksakan seorang untuk melipat untuk menjebaknya memberi chip-nya saat Anda mempunyai tangan poker yang hebat.

Texas Hold em adalah langkah prima untuk membuat deposit serta tingkatkan pendapatan Anda dibanding bertaruh pada taruhan olahraga. Poker bisa jadi permainan ketrampilan kasino, serta permainan peruntungan atau peruntungan sebab beberapa pemain pendatang baru memperhitungkan.

Yang benar ialah jika sebagian orang pakar poker yang terpopuler (seperti Howard Lederer) pada akhirnya pakar judi olahraga awalnya. Bekas penjudi ini saat ini bermain poker dan membuat jumlahnya dolar yang semakin lebih besar di Texas Hold em.

Dengan mengajarkan diri kita beberapa kemampuan di Texas Hold Em, Anda bisa dengan gampang tingkatkan drama Anda dengan kekuatan Anda untuk memperoleh banyak dana yang fenomenal. Pilih waktu untuk mengetahui banyak ketrampilan dalam poker serta Anda akan selekasnya yakin jika semakin lebih gampang untuk memperoleh uang dalam poker dibanding di judi olahraga.

Tips – Tips Untuk Pemain Rookie di Judi Online

heeheSebelum Anda lakukan sama seperti yang dilaksanakan oleh tiap pemain online baru, yang saya kenali cara “The Newbie Circle of Death, ” Saya mempunyai 5 pertimbangan fundamen yang mengagumkan yang cuma Anda pertimbangkan. (Tutorial ini tidak cocok untuk pemain level yang tambah tinggi atau mereka yang ingin mengganti permainan mereka. Tutorial ini dibikin cuma untuk menolong orang baru hindari kekeliruan yang saya meninggalkan. Saya sebetulnya tidak ambil credit untuk semuanya pemikiran, saya sudah pelajarinya waktu saya bergerak ; tetapi saya memvisualisasikan apa yang dalam makna yang paling logis bila Anda menanyakan pada saya. )

1) jika Anda betul-betul tidak paham apa yang tidak Anda pahami. Itu permasalahan penting saya, saya cuma tidak pahami. Jika tidak, Anda kemungkinan tidak ada dalam tempat yang sama juga dengan saya, tapi pada intinya harus menerka, saya pikir Anda betul-betul. Anda barangkali sempat melihat tv poker serta berpikir, “wow, meskipun mereka berada di tv saya dapat juga! ” Atau “Saya mengalahkan laga kandang saya tiap minggu, saya ingin hentikan pekerjaan saya serta bermain dengan” Ini ialah sikap saya semenjak saya mulai dan saya kembali lagi untuk mengerti jika itu ialah pencegah paling besar saya.

Benar-benar bagus untuk mempunyai keyakinan pada laga situs poker paling dipercaya Anda dan untuk yakin jika Anda ialah pemain yang sukses. Tetapi, keyakinan serta bukti ialah dua hal yang tidak sama. Silahkan kita melihat kondisi pribadi saya. Saya mulai bermain dengan poker demikian saya lihat jika World Collection of Poker 2003 di ESPN. Saya lihat jika ketukan mengerikan, tebing besar, jelas, uang. Saya membutuhkannya. Saya tidak paham apa-apa mengenai laga itu, tapi terdapat beberapa penghasilan di telephone. Tetapi silahkan kita melihat sedikit lebih dekat.

Apa Anda sadar poker yang ditayangkan tv betul-betul memberikan keuntungan? Saat mereka pilih apa yang Anda saksikan. Apa yang banyak orang tidak ketahui, ialah jika satu jam aplikasi poker yang Anda saksikan hanya pertempuran meja final 10 jam. Sebelum meja final yang panjangnya 10 jam itu, itu ialah acara tiga hari dari beberapa ratus (terkadang beberapa ribu) orang yang ikut sepanjang 10 12 jam tiap hari.

Saat ini, sesudah menjelaskan itu, yakinlah. Ingat saya sebutkan mereka pilih apa yang Anda melihat? Dengan cara efisien, mereka pilih untuk memperlihatkan pada Anda konfrontasi yang sangat menarik. Tebing-tebing besar itu, panggilan yang mengagumkan kembali dengan barisan pangkalan, satu-outers mengenai danau ; percaya mereka ialah sisi dari permainan, tapi serta bukan yang lumayan besar. Tetapi, bila Anda benar-benar seperti saya, ” Saya ingin lakukan itu! Saya ingin yakin jika saya menggerakkan beberapa badan, jadi saya memperoleh pot. Rasa-rasanya mengagumkan buat saya dengan cara pribadi, apabila berperan, saya ialah yang baik. Tapi saat itu gagal, “Bagaimana ia dapat mengontak saya dengan adanya ini? ! ? ”

, silahkan kita melihat di laga kandang Anda. Sudah pernahkah Anda stop memandang kaliber rekan serta keluarga? Pria serta wanita yang bermain dengan Anda kemungkinan benar-benar jelek dalam ide dimana Anda kemungkinan yakin jika Anda hebat. Di penjelajahan saya, saya sudah bermain dengan sebagian orang yang tidak berhasil untuk tahu apakah itu blinds, bermain di tiap bagian, tapi tidak paham jika itu dapat tingkatkan preflop, dan lain-lain. unggul dibanding yang terjelek. Jangan ijinkan ini ke arah pemikiran yang berpikir Anda ialah Dewa Poker.

Khususnya, saat orang mulai bermain poker online di luar mereka mulai lebih kecil. Semua kamar poker online mempunyai permainan kas serendah $. 05 – $. 10 gorden, serta kompetisi yang bisa Anda mainkan untuk memperoleh cuma $ 1 saja). Biarlah saya bicara dengan Anda sedikit rahasia ; Anda tak perlu eksklusif bila berperan serta dalam taruhan rendah. Saya sudah menaklukkan pegangan rendah serta menengah tanpa ada batas sepanjang beberapa dekade, serta saya bahkan bisa saja tidak memandang diri saya untuk peserta tingkat tinggi. Anda perlu mempunyai ABC bermakna segala hal yang perlu dilaksanakan. Dapatkan taktik pre-flop fundamen, dapatkan taktik post-flop fundamen, serta dalami tempat. Ini ialah 3 prinsip yang benar-benar fundamental serta saya pribadi bisa menjadi fundamen untuk pertandingan-pertandingan poker yang baik. Saya samar-samar akan sentuh basis bersama-sama mereka, tetapi kemungkinan tidak dengan cara detil, jadi itu untuk laporan yang tidak sama. Setelah itu, pada intinya pergi ke tiap kondisi atau tangan yang kemungkinan, ini bisa menjadi bacaan yang luas.

Dua) Gagasan Mendasar. Dapatkan Langkah melipat. Melipat itu demikian monoton, kan? Saya mengiris jika 45 dengan ketidakberhasilan hadir A 23, serta saya cuma tahu jika pemula dengan A-J dapat memberikan saya tumpukannya. Ini hari saya harus gampang diingat. Saya lihat ke bawah ke T4 itu serta saya ketahui itu betul-betul bukan tangan yang bagus, tetapi itu pas. Saya dapat tidak berhasil 2 pasang atau perjalanan, serta pria itu cuma terbagi dalam orang buta. Dua orang telah menelepon serta saya sudah dengar mengenai suatu hal yang disebutkan kesempatan ganja, kemungkinan saya harus meramalkan? Saya meramalkan. Oh man, ini hari tombolnya makin bertambah 3x bertambah banyak. Wow, tiap orang memprediksikan, ada juga kesempatan ganjil walau saya tidak betul-betul tahu benar apa yang akan berlangsung, saya anggap saya akan menelepon serta cuma menempatkan bertambah banyak chip bila saya melonjak besar. Oh wow ini hari persis apa, ketidakberhasilan hadir T 3 2. Saya mempunyai pasangan paling atas tapi terdapat beberapa kenaikan preflop.

Methotrexate (Anti-Rheumatic) Tablet

Uses

Methotrexate is used to treat certain types of cancer or to control severe psoriasis or rheumatoid arthritis that has not responded to other treatments. It may also be used to control juvenile rheumatoid arthritisMethotrexate belongs to a class of drugs known as antimetabolites. It works by slowing or stopping the growth of cancer cells and suppressing the immune system.

Early treatment of rheumatoid arthritis with more aggressive therapy such as methotrexate helps to reduce further joint damage and to preserve joint function.

How to use Methotrexate (Anti-Rheumatic) Tablet

Read the Patient Information Leaflet if available from your pharmacist before you start taking methotrexate and each time you get a refill. If you have any questions, ask your doctor or pharmacist.

Methotrexate is a strong medication. The dosage and how often you take this medication are based on your medical condition and response to treatment. There are many different dosing schedules for this medication (especially for cancer treatment). Taking this medication the wrong way may cause serious side effects, including death. Therefore, it is very important that you follow your doctor’s instructions carefully. Take this medication by mouth as directed by your doctor.

For the treatment of psoriasis or rheumatoid arthritis, take this medication by mouth as directed by your doctor, usually once a week. It may take up to several months before you get the full benefit of this drug.

If you are using the liquid form of this medication, carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose.

Do not increase your dose or use this drug more often or for longer than prescribed. Your condition will not improve any faster, and your risk of side effects will increase.

Since this drug can be absorbed through the skin and lungs and may harm an unborn baby, women who are pregnant or who may become pregnant should not handle this medication or breathe the dust from the tablets.

Drink plenty of fluids while taking this medication unless your doctor tells you otherwise. Doing so helps your kidneys to remove the drug from your body and avoid some of the side effects.

Product(s) containing methotrexate:

methotrexate systemic

Brand names: RasuvoTrexall, Methotrexate LPF Sodium, Otrexup
Drug class(es): antimetabolitesantipsoriaticsantirheumaticsother immunosuppressants
Methotrexate systemic is used in the treatment of:

What should I avoid while taking methotrexate?

Avoid drinking alcohol. It may increase your risk of liver damage.

Do not receive a “live” vaccine while using methotrexate, or you could develop a serious infection. Live vaccines include measles, mumps, rubella (MMR), polio, rotavirus, typhoid, yellow fever, varicella (chickenpox), and zoster (shingles).

This medicine can pass into body fluids (urine, feces, vomit). Caregivers should wear rubber gloves while cleaning up a patient’s body fluids, handling contaminated trash or laundry or changing diapers. Wash hands before and after removing gloves. Wash soiled clothing and linens separately from other laundry.

Avoid exposure to sunlight or artificial UV rays (sunlamps or tanning beds), especially if you are being treated for psoriasis. Methotrexate can make your skin more sensitive to sunlight and your psoriasis may worsen.

Methotrexate side effects

Get emergency medical help if you have signs of an allergic reaction to methotrexate (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning in your eyes, skin pain, red or purple skin rash that spreads and causes blistering and peeling).

Call your doctor at once if you have:

  • fever, chills, swollen lymph glands, night sweatsweight loss;
  • vomiting, white patches or sores inside your mouth or on your lips;
  • diarrhea, blood in your urine or stools;
  • dry cough, cough with mucus, stabbing chest pain, wheezing, feeling short of breath;
  • seizure (convulsions);
  • kidney problems – little or no urination, swelling in your feet or ankles;
  • liver problems – stomach pain (upper right side), dark urine, jaundice (yellowing of the skin or eyes);
  • nerve problems – confusion, weakness, drowsiness, coordination problems, feeling irritable, headache, neck stiffness, vision problems, loss of movement in any part of your body; or
  • signs of tumor cell breakdown – confusion, tiredness, numbness or tingling, muscle cramps, muscle weakness, vomiting, diarrhea, fast or slow heart rate, seizure.

Side effects may be more likely in older adults.

Common methotrexate side effects may include:

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect methotrexate?

Methotrexate can harm your liver, especially if you also use certain other medicines for infections, tuberculosisdepression, birth control, hormone replacement, high cholesterol, heart problems, high blood pressureseizures, or pain or arthritis medicines (including acetaminophenTylenolAdvilMotrin, and Aleve).

Many drugs can interact with methotrexate. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed here. Tell your doctor and pharmacist about all your current medicines and any medicine you start or stop using.

What is methotrexate?

Methotrexate interferes with the growth of certain cells of the body, especially cells that reproduce quickly, such as cancer cells, bone marrow cells, and skin cells.

Methotrexate is used to treat certain types of cancer of the breast, skin, head and neck, or lung. It is also used to treat severe psoriasis and and certain forms of rheumatoid arthritis.

Methotrexate is usually given after other medications have been tried without successful treatment of symptoms.

Methotrexate made also be used for purposes not listed in this medication guide.

Important Information

Methotrexate is usually not taken every day. You must use the correct dose for your condition. Some people have died after taking methotrexate every day by accident.

Do not use methotrexate to treat psoriasis or rheumatoid arthritis if you have low blood cell counts, a bone marrow disorder, weak immune system, liver disease (especially if caused by alcoholism), or if you are pregnant or breast-feeding.

Methotrexate can cause serious or life-threatening side effects. Tell your doctor if you have diarrhea, mouth sores, cough, shortness of breath, upper stomach pain, dark urine, numbness or tingling, muscle weakness, confusion, seizure, or skin rash that spreads and causes blistering and peeling.

Call your doctor if you have unusual bruising or bleeding, or signs of infection (fever, chills, body aches).

Do not use methotrexate if you are pregnant or breast-feeding a baby.

Before taking this medicine

You should not use methotrexate if you are allergic to it. Methotrexate should not be used to treat psoriasis or rheumatoid arthritis if you have:

  • alcoholism, cirrhosis, or chronic liver disease;
  • low blood cell counts;
  • a weak immune system or bone marrow disorder; or
  • if you are pregnant or breast-feeding.

Methotrexate is sometimes used to treat cancer even when patients do have one of the conditions listed above. Your doctor will decide if this treatment is right for you.

Tell your doctor if you have:

  • kidney disease;
  • lung disease;
  • any type of infection; or
  • radiation treatments.

Methotrexate can harm an unborn baby or cause birth defects, whether the mother or father is taking this medicine.

  • If you are a woman, do not use methotrexate to treat psoriasis or rheumatoid arthritis if you are pregnant. You may need to have a negative pregnancy test before starting this treatment. Use an effective form of birth control while you are taking this medicine, and for 6 months after your last dose.
  • If you are a man, use a condom to keep from causing a pregnancy while you are using methotrexate. Continue using condoms for at least 3 months after your last dose.
  • Tell your doctor right away if a pregnancy occurs while either the mother or the father is taking methotrexate.

This medicine may affect fertility (ability to have children) in both men and women. However, it is important to use birth control to prevent pregnancy because methotrexate may harm the baby if a pregnancy does occur.

You should not breast-feed while using this medicine.

Do not give this medicine to a child without the advice of a doctor.

How should I take methotrexate?

Take methotrexate exactly as it was prescribed for you. Follow all directions on your prescription label and read all medication guides or instruction sheets.

Methotrexate is sometimes taken once or twice per week and not every day. You must use the correct dose. Some people have died after taking methotrexate every day by accident. Ask your doctor or pharmacist if you have questions about your dose or how often to take it.

Measure liquid medicine carefully. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon).

Methotrexate can be toxic to your organs, and may lower your blood cell counts. Your blood will need to be tested often, and you may need an occasional liver biopsy. Your cancer treatments may be delayed based on the results.

If you need to be sedated for dental work, tell your dentist you currently use this medicine.

Store tablets at room temperature away from moisture and heat.

Store the liquid medicine in the refrigerator, do not freeze.

You may also store the liquid at room temperature for up to 60 days.

What happens if I miss a dose?

Call your doctor for instructions if you miss a dose of methotrexate.

Get your prescription refilled before you run out of medicine completely.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of methotrexate can be fatal.

Methotrexate

Methotrexate

(meth-oh-TREKS-ayt)

Trade names: Otrexup™, Rasuvo®, Rheumatrex®, TrexallTM
Other names: Amethopterin, Methotrexate Sodium, MTX

Methotrexate is the generic name for the trade drug names Otrexup™, Rasuvo®, Rheumatrex® and Trexall™. MTX, Amethopterin, and Methotrexate Sodium are other names for Methotrexate. In some cases, health care professionals may use the trade names Otrexup™, Rasuvo®, Rheumatrex® and Trexall™ or other names MTX, Amethopterin, and Methotrexate Sodium when referring to the generic drug name Methotrexate.

Drug type: Methotrexate is an anti-cancer (“antineoplastic” or “cytotoxic”) chemotherapy drug. This medication is classified as an “antimetabolite.” (For more detail, see “How this drug works” section below).

What Methotrexate Is Used For:

  • Acute lymphoblastic leukemia (ALL)
  • Osteosarcoma
  • Non-Hodgkin’s lymphoma (NHL)
  • Choriocarcinoma, chorioadenoma and gestational trophoblastic diseases
  • Mycosis fungoides (cutaneous T-cell lymphoma)
  • Used in the treatment of breast, advanced head and neck, lung, and stomach cancers
  • Also used in non-cancerous conditions such as psoriasis and rheumatoid arthritis

Note: If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful. This is called “off-label” use.

  • Some off-label cancer uses for methotrexate include nonleukemic meningeal cancer, soft tissue sarcoma (desmoid tumors, aggressive fibromatosis), bladder cancer, Central Nervous System (CNS) lymphoma, and prevention of graft-versus-host disease.
  • Some off-label non-cancer uses include Crohn disease, dermatomyositis/polymyositis, ectopic pregnancy, systemic lupus erythematosus, and Takayasu arteritis.

How Methotrexate Is Given:

  • As an infusion into the vein (intravenous, IV).
  • As an injection into the muscle (intramuscular, IM).
  • Another method is by intraventricular or intrathecal infusion. This method is used when drugs need to reach the cerebrospinal fluid (CSF), the fluid that is surrounding the brain and spinal cord. The drug is infused directly into the spinal fluid.
  • There is also a pill form of methotrexate to be taken by mouth.

The amount of methotrexate and how it is given depends on many factors, including your height and weight, your general health or other health problems, and the type of cancer or condition being treated. Your doctor will determine your dose, schedule and how it is given.

Side Effects:

Important things to remember about the side effects of methotrexate:

  • Most people do not experience all of the side effects listed.
  • Side effects are often predictable in terms of their onset and duration.
  • Side effects are almost always reversible and will go away after treatment is complete.
  • There are many options to help minimize or prevent side effects.
  • There is no relationship between the presence or severity of side effects and the effectiveness of the medication.
  • The side effects of methotrexate and their severity depend on how much of the drug is given. In other words, high doses may produce more severe side effects.
  • In some cases leucovorin infusion (see leucovorin) may be given 24 hours after methotrexate to lessen the side effects of methotrexate.

The following side effects are common (occurring in greater than 30%) for patients taking methotrexate:

  • Low blood counts . Your white and red blood cells and platelets may temporarily decrease. This can put you at increased risk for infection, anemia and/or bleeding.

Nadir: Meaning low point, nadir is the point in time between chemotherapy cycles in which you experience low blood counts.

Onset: 7 days
Nadir: 10 days
Recovery: 21 days

These side effects are less common side effects (occurring in about 10-29%) of patients receiving methotrexate:

  • Kidney toxicity (see kidney problems) particularly with high-doses. In severe cases can lead to kidney failure. Care is taken to make sure patient is well hydrated with IV fluids before infusion of high-dose methotrexate.
  • Skin rash , reddening of the skin (with high doses).
  • Diarrhea
  • Nausea and Vomiting(uncommon with low dose)
  • Increases in blood tests measuring liver function, often seen with high dose treatment. These return to normal within about 10 days (see liver problems).
  • Darkening of the skin where previous radiation treatment has been given (radiation recall – see skin reactions).
  • Loss of fertility. Meaning, your ability to conceive or father a child may be affected by methotrexate. Discuss this issue with your health care provider. (see fertility).
  • Alopecia
  • Skin photosensitivity

Side effects specific to intrathecal administration of methotrexate (the drug is infused directly into the cerebrospinal fluid (CSF) the fluid that is surrounding the brain and spinal cord):

  • Acute chemical arachnoiditis: a syndrome that can be seen immediately after the infusion of methotrexate intrathecally. It is an inflammation of the membrane surrounding the brain and spinal column. Symptoms are: severe headache, stiff neck, seizures, vomiting, and fever.
  • Central neurotoxicity: Less-common, seen with intrathecal or very high IV dose methotrexate. Symptoms are; difficulty with speech, paralysis of the arms and legs, seizures, or coma. This may develop within 6 days of treatment and resolves within 48-72 hours.

Some serious, but uncommon side effects of Methotrexate may include acute renal failure, bone marrow suppression, serious skin reactions, gastrointestinal and liver toxicity, acute or chronic interstitial pneumonitis, opportunistic infections (especially Pneumocystis carinii pneumonia), secondary malignancies such as lymphoma, “tumor lysis syndrome” in patients with rapidly growing tumors.

Methotrexate given concomitantly with radiotherapy may increase the risk of soft tissue necrosis and osteonecrosis.

Not all side effects are listed above. Some that are rare (occurring in less than 10% of patients) are not listed here. However, you should always inform your health care provider if you experience any unusual symptoms.

When to contact your doctor or health care provider:

Contact your health care provider immediately, day or night, if you should experience any of the following symptoms:

  • Fever of 100.4° F (38° C) or higher, chills (possible signs of infection)

The following symptoms require medical attention, but are not an emergency. Contact your health care provider within 24 hours of noticing any of the following:

  • Unusual bleeding or bruising
  • Black or tarry stools, or blood in your stools or urine
  • Extreme fatigue (unable to carry on self-care activities)
  • Mouth sores (painful redness, swelling or ulcers)
  • Nausea (interferes with ability to eat and unrelieved with prescribed medication)
  • Vomiting (vomiting more than 4-5 times in a 24 hour period)
  • Diarrhea (4-6 episodes in a 24-hour period)
  • No urine output in a 12 hour period
  • Yellowing of the skin or eyes
  • Severe skin reaction within days of methotrexate administration (see severe hypersensitivity skin reactions)
  • Dry, unproductive cough
  • Trouble thinking or speaking, change in eyesight, severe headache, or seizures
  • Swelling of the feet or ankles. Sudden weight gain.
  • Signs of infection such as redness or swelling, pain on swallowing, coughing up mucous, or painful urination.
  • Unable to eat or drink for 24 hours or have signs of dehydration: tiredness, thirst, dry mouth, dark and decrease amount of urine, or dizziness.

Always inform your health care provider if you experience any unusual symptoms.

Precautions:

  • Before starting methotrexate treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.). Do not take aspirin, or products containing aspirin unless your doctor specifically permits this.
  • Do not take non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen or naproxen unless your doctor specifically permits this. Bone marrow suppression, intestinal irritation and severe anemia have occurred with combined usage of non-steroidal anti-inflammatory drugs (NSAIDS) and methotrexate.
  • Folic acid supplements should be avoided while on methotrexate. Folic acid may counteract the anti-cancer effects of methotrexate.
  • If you are on warfarin (Coumadin®) as a blood-thinner, adjustments may need to be made to your dose based on blood work.
  • Do not receive any kind of immunization or vaccination without your doctor’s approval while taking methotrexate.
  • Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category X (methotrexate may be hazardous to the fetus. Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus).
  • For both men and women: Do not conceive a child (get pregnant) while taking methotrexate. Barrier methods of contraception, such as condoms, are recommended. Pregnancy should be avoided for > 3 months following treatment in male patients and > 1 ovulatory cycle in female patients. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
  • Do not breast feed while taking this medication.

Self-Care Tips:

  • Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
  • You may be at risk of infection so try to avoid crowds or people with colds and those not feeling well, and report fever or any other signs of infection immediately to your health care provider.
  • Wash your hands often.
  • To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times a day with 1/2 to 1 teaspoon of baking soda and/or 1/2 to 1 teaspoon of salt mixed with 8 ounces of water.
  • Use an electric razor and a soft toothbrush to minimize bleeding.
  • Avoid contact sports or activities that could cause injury.
  • To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals.
  • Avoid sun exposure. Wear SPF 30 (or higher) sunblock and protective clothing.
  • In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor.
  • Get plenty of rest.
  • Maintain good nutrition.
  • If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and Testing:

You will be checked regularly by your health care provider while you are taking methotrexate, to monitor side effects and check your response to therapy. Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor. Blood levels of this drug may be monitored in patients receiving high-dose methotrexate.

How Methotrexate Works:

Cancerous tumors are characterized by cell division, which is no longer controlled as it is in normal tissue. “Normal” cells stop dividing when they come into contact with like cells, a mechanism known as contact inhibition. Cancerous cells lose this ability. Cancer cells no longer have the normal checks and balances in place that control and limit cell division. The process of cell division, whether normal or cancerous cells, is through the cell cycle. The cell cycle goes from the resting phase, through active growing phases, and then to mitosis (division).

The ability of chemotherapy to kill cancer cells depends on its ability to halt cell division. Usually, the drugs work by damaging the RNA or DNA that tells the cell how to copy itself in division. If the cells are unable to divide, they die. The faster the cells are dividing, the more likely it is that chemotherapy will kill the cells, causing the tumor to shrink. They also induce cell suicide (self-death or apoptosis).

Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle specific. Chemotherapy drugs that affect cells when they are at rest are called cell-cycle non-specific. The scheduling of chemotherapy is set based on the type of cells, rate at which they divide, and the time at which a given drug is likely to be effective. This is why chemotherapy is typically given in cycles.

Chemotherapy is most effective at killing cells that are rapidly dividing. Unfortunately, chemotherapy does not know the difference between the cancerous cells and the normal cells. The “normal” cells will grow back and be healthy but in the meantime, side effects occur. The “normal” cells most commonly affected by chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea, and/or hair loss. Different drugs may affect different parts of the body.

Methotrexate belongs to the class of chemotherapy drugs called antimetabolites. Antimetabolites are very similar to normal substances within the cell. When the cells incorporate these substances into the cellular metabolism, they are unable to divide. Antimetabolites are cell-cycle specific. They attack cells at very specific phases in the cycle. Antimetabolites are classified according to the substances with which they interfere.

Methotrexate exerts its chemotherapeutic effect by being able to counteract and compete with folic acid in cancer cells resulting in folic acid deficiency in the cells and causing their death. This action may also effect normal cells which can cause significant side effects in the body, such as: low white, red and platelet blood cell counts, hair loss, mouth sores, difficulty swallowing, diarrhea, liver, lung, nerve and kidney damage. These complications and side effects of high-dose methotrexate can be either prevented or decreased by using leucovorin, which provides a source of folic acid for the body’s cells. Leucovorin is normally started 24 hours after high-dose methotrexate is given. This delay gives the methotrexate a chance to exert its anti-cancer effects.

Note: We strongly encourage you to talk with your health care provider about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.