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Caregiver precautions? Advice for oral Methotrexate?

I've been giving my son oral Methotrexate (Trexall) for almost two months now. I was required to cut in two and then crush tablets, but hadn't been given any info regarding precautions... so, I was handling them with bare hands, picking up the med dust, then washing good (or so I thought). However, past two weeks I have developed the worst itchy/burning palms and soles of feet that I could imagine. Benadryl helps somewhat, but there is still a slight numbing sensation left over. Is it possible the once-weekly brief handling of this med could cause this reaction? :eek2:

I am going to request that Evan get liquid form instead of capsules and am seeing my dr regarding this problem. How do you take/give these meds? Any precautions? Any gloves? How do you crush them safely?
I think I remember a couple of posts awhile back about handling MTX with gloves. My son is a teen so I don't handle them since he sets up his pill box and such. But I did in the beginning and freaked out a bit about it when reading the literature.

Hopefully, someone will be by shortly with more info. I think Dusty or possibly MLP had some info on handling the meds, so maybe they'll be by since I tagged them.


Super Moderator
Hey jess_mama,

The immunosuppressives...Azathioprine, 6MP and Methotrexate...fall under the realm of cytotoxic drugs. Therefore there are handling precautions but only if the medication is not handled whole.

So the precautions are as follows:

Whole tablets with a smooth coating - no precaution.

Whole tablets that have a powdery finish - gloves.

Tablets that are broken into halves - gloves.

Tablets that are crushed - mask and gloves.

These precautions only apply when the medication is being handled by anyone other than who they are prescribed to.

The reason for gloves is that the skin is not an impenetrable barrier so it is possible to absorb medication through it (transdermally). Also when you crush medication you can inhale the dust that is produced.

The vinyl gloves you get at the supermarket are fine to use and you can re use them. The mask only need be a paper type one and while ever it remains dry and only used for short periods you can re use it as well. Just something like this that is cheap and available from the pharmacy:

My children are on Imuran. I handled them initially but they have always had smooth coated whole tablets.

Good luck with your appointment. It is best that you are having it checked out and as to whether the Metho could cause it? I don't know but it could always be a possibility.

Dusty. xxx


Super Moderator
I should have mentioned that the same precautions would apply to liquid Methotrexate. You would need to wear gloves as the liquid can be absorbed through the skin too.

Dusty. xxx
Thank you all of you for your advice!

I am switching to using gloves and will follow the precautions listed when I prepare his meds and dispose of everything after.

I really appreciate this input.