How is Trexall Used?
Trexall is most commonly taken as a weekly dose of the medication to manage the condition for which it has been prescribed. It may be used alongside additional medications for treatment or may simply be used by itself.
Patients using this medication should be sure to follow all instructions provided by their physician regarding how to safely handle and take the medication for their specific condition. Patients should not modify their dosage or dosing schedule without explicit instructions to do so from their prescribing physician.
Trexall tablets should be stored between 68°F(68°C) and 77°F (25°C) and should not be exposed to light.
Keep this medication out of the reach of children at all times.
Trexall is prescribed for a variety of conditions, including the following:
- cutaneous T-cell lymphoma
- acute lymphoblastic leukemia
- refractory or relapsed non-Hodgkin lymphomas
- rheumatoid arthritis
- polyarticular juvenile idiopathic arthritis
How Does Trexall Work?
Trexall functions as an immunosuppressant and an anti-cancer agent known as an “anti-metabolite.”
When used for treating various cancers, this medication blocks the enzymes within the body that are associated with folate, and by doing this, it is able to slow down or stop cell division. It is specifically highly toxic to cancerous cells that exhibit rapid cell division, making this medication a powerful option to counteract the various cancers for which it is prescribed.
When using to manage psoriasis, its function is similar, as the medicine once again targets cells that are rapidly dividing and causing the symptoms associated with psoriasis.
When this medication is used to treat rheumatoid arthritis, it functions as an immunosuppressant and reduces the associated inflammation of RA.
Trexall is available in tablet form in the following strengths:
Patients using Trexall for the management of rheumatoid arthritis will typically take a weekly dose of 7.5 mg of the medication and increase the dosage over time as needed until their condition is well-controlled. Patients using it for RA should avoid weekly dosages that exceed 20 mg as this comes with an increased risk of adverse side effects, including the suppression of the patient’s immune system.
When used for the management of psoriasis, the most common dose of Trexall is between 10 mg and 25 mg, taken once per week. Patients using Trexall for psoriasis should not exceed a maximum weekly dose of 30 mg to avoid the risk of immunosuppression and adverse side effects. The dosage of Trexall should be adjusted in these patients to ensure optimal management of their condition while avoiding adverse reactions to weekly use of the medication.
Patients using Trexall for acute lymphoblastic leukemia will use the medication alongside additional chemotherapy treatments, and their dosage will be determined and adjusted based on their condition’s response to the medication, their platelet count, and their absolute neutrophil count (ANC). When used for the treatment of cutaneous T-cell lymphoma, most patients will begin with a once-weekly dose of Trexall ranging between 25 mg and 75 mg along with their current chemotherapy treatment. In the cases of refractory or relapsed non-Hodgkin lymphomas, the most common dosage for patients is 2.5 mg taken two to four times per week without exceeding a maximum weekly dosage of 10 mg).
If an overdose of Trexall has occurred or is suspected, the individual that has consumed too much of this medication should seek emergency medical assistance as soon as possible and contact their doctor immediately. Some of the potential side effects of overdosing can be severe and life-threatening.
Trexall is associated with a variety of side effects, including many that may be severe.
The most common side effects are as follows:
- abnormal liver function tests
- mouth sores
- upset stomach
Some of the following side effects may occur and should be reported to your doctor as soon as possible. Patients experiencing any of the following side effects should seek emergency medical assistance immediately:
- blood in stools or urine
- chest pain
- coordination issues
- cough with mucus
- dark urine
- dry cough
- jaundice (yellowing of the eyes or skin)
- loss of movement in any body parts
- muscle cramps
- night sweats
- no or little urination
- shortness of breath
- slow or rapid heart rate
- stiffness of the neck
- swelling of the ankles or feet
- swollen lymph glands
- tingling or numbness
- vision issues
- weight loss
- white sores or patches on the lips or in the mouth
Warnings & Precautions
Due to the strength and toxicity of Trexall, this medication comes with numerous warnings for those using this drug for treatment. Patients should discuss all current health conditions, current medications, and past medical history with their physician before beginning treatment with this medication.
Patients using Trexall may have secondary malignancies occur during treatment. This risk is higher for patients with psoriasis that use cyclosporine, but some patients experience lymphoproliferative disease when using lower doses without any additional risk factors being present. Additionally, patients with tumors that exhibit rapid growth may develop tumor lysis syndrome when using Trexall, and their physician should discuss the preventative measures that need to be in place to prevent this development from occurring during treatment.
Adverse Gastrointestinal Effects
Severe adverse gastrointestinal side effects have been reported by those using Trexall, especially patients with ulcerative colitis or peptic ulcer disease. Some of the potential conditions and risks include the following: fatal intestinal perforation, hemorrhagic enteritis, stomatitis, vomiting, nausea, and diarrhea.
Trexall’s immunosuppressant effects place patients using the medication at an increased risk of infection and experiencing infections that can become life-threatening. Patients using Trexall should be monitored closely throughout treatment and should report any symptoms of potential infection to their doctor immediately.
Trexall has been reported to cause oligospermia, menstrual dysfunction, and impaired fertility. Patients desiring to have children in the future should discuss the potential fertility-related risks with their physician before beginning treatment with this medication. It has not been determined if the infertility associated with Trexall is reversible.
Trexall can strongly inhibit the production of all types of blood cells (hematopoiesis), and this can result in the following potentially fatal conditions: thrombocytopenia, neutropenia, leukopenia, pancytopenia, and anemia. Patients using Trexall should have their blood monitored regularly and their dosage of the medication adjusted as needed to avoid the development of these conditions.
Trexall is known to cause irreversible damage to some patients’ kidney function, and this includes the development of acute renal failure. Patients using Trexall should have their kidney function monitored throughout treatment and their dosage of the medication adjusted as needed to prevent such conditions from occurring.
Trexall has been associated with severe and irreversible adverse effects on patients’ kidney function, including conditions such as fatal liver failure, cirrhosis, and fibrosis. Alcohol is known to increase a patient’s risk of developing such conditions when consumed during treatment with Trexall. Patients’ liver function should be regularly monitored throughout treatment, and their dosage of the medication should be adjusted as needed, or use of the medication be ceased entirely, depending on the impact that Trexall is having on hepatic function.
Trexall is capable of causing damage to the lungs, including the development of chronic or acute interstitial pneumonitis, which may become irreversible and even be fatal for some individuals. Patients’ lung health should be monitored during treatment with Trexall as a preventative measure against any serious effects of pulmonary toxicity.
Trexall is not safe for use during pregnancy, as it has been directly linked to fetal death. Patients capable of becoming pregnant should avoid conception while using Trexall and continue to prevent pregnancy from occurring for at least six months after having received their last dose of the medication. Patients that may potentially impregnate a partner should take measures to avoid pregnancy from occurring while being treated with Trexall and should continue these practices for a minimum of three months after having received their last dose of the medication.
Patients using Trexall may experience a worsening of their psoriasis if exposed to ultraviolet radiation during treatment. Sunburn reactivation (photodermatitis reactivation) and radiation recall dermatitis may also occur. Some individuals may also experience severe adverse reactions to this medication, such as exfoliative dermatitis, erythema multiforme, skin necrosis, Stevens-Johnson syndrome, and toxic epidermal necrolysis. Patients should exercise caution when outside while taking Trexall and should report any changes in their skin’s health to their prescribing physician as soon as possible.
Due to the immunosuppressant effects of Trexall use, patients using this medication should not receive any live vaccines due to the high risk of infection rather than patients experiencing the appropriate immune response associated with vaccinations. Individuals desiring or requiring vaccinations while using Trexall for treatment should discuss the risks and options available to them with their physician.
Speak to your doctor about any medications or herbal supplements you are currently taking before beginning treatment with Trexall. Discuss any concerns you may have with your doctor or a trusted pharmacist.
The following medications are known to interact with Trexall:
- antifolate medications
- hepatotoxic substances
- highly protein-bound drugs
- nephrotoxic products
- nitrous oxide
- nonsteroidal anti-inflammatory drugs (NSAIDs)
- oral antibiotics
- oral anticoagulants
- penicillin (intravenous or oral)
- proton pump inhibitors
- sulfonamide antibiotics (intravenous or oral)
- weak acids
Patients using folic acid during treatment with Trexall should discuss this with their physician to ensure they are receiving safe and appropriate amounts of folic acid when simultaneously using Trexall.