<b>Methotrexate Information:</b> Rarely, methotrexate has caused serious (possibly fatal) side effects. This medicine should be used only to treat cancer or severe cases of psoriasis or rheumatoid arthritis. Methotrexate has caused birth defects and fetal death. Women must avoid becoming pregnant while taking this medicine. Pregnant women who have psoriasis or rheumatoid arthritis must not use methotrexate. (See Cautions) If you have kidney problems/excess body water (ascites, pleural effusion), you must be monitored and your dose may be adjusted or stopped by your doctor. Infrequently, methotrexate (usually at high dosages) has caused severe (possibly fatal) bone marrow suppression (decreasing your body's ability to fight infection) and stomach/intestinal disease (e.g., bleeding) when used with nonsteroidal anti-inflammatory medicines (NSAIDs) (e.g., ibuprofen, naproxen). This medicine may rarely cause liver problems when used for long periods of time. If you are using methotrexate long-term, liver biopsies should be performed. Rarely, methotrexate use has resulted in serious (possibly fatal) lung problems/infections (Pneumocystis carinii pneumonia), skin reactions, diarrhea and mouth sores (ulcerative stomatitis). (See Side Effects) Very rarely, lumps (tumors/abnormal growths) may appear during methotrexate use. The drug must be stopped and treatment may be needed. Consult your doctor immediately if new lumps/growths occur. When used to treat tumors, methotrexate may cause side effects due to the rapid destruction of cancer cells (tumor lysis syndrome). Tell your doctor immediately if you experience symptoms such as irregular heartbeat or muscle weakness. Although rare, this medicine when used with radiation therapy may increase the risk of tissue/bone damage. Discuss the risks/benefits of your treatment with your doctor. 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, asparaginase, live vaccines, NSAIDs with high-dose methotrexate therapy for certain cancers, or pyrimethamine. ADDITIONAL MONITORING OF YOUR DOSE OR CONDITION may be needed if you take aspirin/NSAIDs, cancer treatments possibly toxic to the kidney (e.g., cisplatin), digoxin, leflunomide, medicines possibly toxic to the liver (e.g., azathioprine, sulfasalazine, isotretinoin), penicillins, phenytoin, probenecid, procarbazine, sulfa medicines, or theophylline. DO NOT START OR STOP any medicine without doctor or pharmacist approval. Inform your doctor of other medical conditions including stomach/intestinal disease (e.g., peptic ulcer, ulcerative colitis), kidney disease, active infection (including chickenpox or recent exposure to it), folic acid deficiency, allergies, pregnancy, or breast-feeding. USE OF THIS MEDICINE IS NOT RECOMMENDED if you have liver disease, severe kidney/lung disease (e.g., pulmonary fibrosis), alcohol use, suppressed immune system, or blood cell/bone marrow disorders.