How to self inject Methotrexate?

1. Methotrexate injections are available either as an ampoule or vial. Check the exact dose prescribed to you. The concentration of Methotrexate is mentioned on the ampoule/ vial as mg per 1 ml. So, for example, if you have been advised 15 mg Methotrexate dose & your ampoule has 10mg/ 1 ml concentration; that means you will have to take 1.5 ml. Always confirm the same with your Rheumatologist beforehand to avoid any mistakes.

2. The vial/ ampoule is best stored in a refrigerator. It should not be kept in the freezer compartment. For administration, remove & keep the same at room temperature for 30 minutes.
3. Check the expiry date on the pack.
4. Select a clean, dry area for preparation of the injection.
5. Gather the things you require for the injection.
            a. The medication
            b. Alcohol swab
            c. Disposal container
6. Wash your hands.
7. Select the injection site.
            a. outer surface of the upper arm
            b. top of thighs
            c. buttocks
            d. abdomen, except the navel or waistline

8. Select the site & clean it with a sterile alcohol swab.
9. Wait for the site to dry.

1.       10. Prepare the injection. You may break the ampoule & load the syringe with the appropriate dose. Vial is a multi dose option & does not require breaking.  (see the photos).

11. You can use a routine syringe & needle or an insulin syringe. Attach the needle to the syringe & load the syringe with the appropriate dose. Do not touch the needle anywhere. Gently tap the needle to remove any air bubbles.
12. Pinch a skin fold between your thumb & index finger.
13. Hold the syringe like a pencil & insert it under the skin fold at 45 degree angle.
14. Hold the syringe with one hand & pull back the plunger to look for any blood. Do not inject if blood is seen In the syringe. In that case, remove the needle & insert at a fresh site.
15. If there is no blood in the syringe, push the plunger all the way down to inject Methotrexate.
16. Once done, put the needle & the syringe in the disposal container.
17. Take the injection on the same day & roughly the same time every week.
 

About the injection site---
a. Injections sites---
b. Rotate the injection site, the new one should at least be 5 cms away from the prior one.
c. Do not inject near a wound/ abrasion/ infection.
d. Do not inject in a scar/ stretch mark.
e. Do not inject at a site where a blood vessel is seen underneath.

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