UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE
TITLE: METHOTREXATE INJECTION
Effective Date: August, 2004 Approval: See Authorization
Supersedes Protocol: None Contact: Clinical Staff Education
Reviewed April, 2005 April, 2008 October, 2008 May 2009
November 2009 July 2010 August 2011
PURPOSE: To provide guidelines for administration of methotrexate at UWMF Clinics.
DEFINITION: Methotrexate is a chemotherapy agent used most often to treat Rheumatologic
diseases, Rheumatoid Arthritis, some cancers and tubal pregnancies.
POLICY: The clinical staff will utilize the following guidelines to administer Methotrexate to
SUPPLIES: Provider’s order, Patient’s chart, Labeled syringe with appropriate drug
doseMethotrexate in prepared syringe from pharmacy, Yellow hazard waste
receptacle, alcohol swab, sterile gauze, Band-Aid, needle and syringe
appropriate for IM or SQ injection (depending on MD order), Nitrile exam
gloves, blue gown, eye/ face protection (as needed)
ADDITIONAL INFORMATION: Methotrexate will be drawn up and sent from central
pharmacy. The pre-drawn syringes should be stored under refrigeration for no more than 14 days.
Care should be given when handling pre-drawn syringes to prevent crystallizations. DO NOT
shake or perform any excess motion with the syringe.
1. Check the name and dose of medication against the provider’s order. Clarify any
2. Review the potential side effects of Methotrexate.
3. Review patient’s laboratory results: CBC w/differential, platelets, AST.
Lab work done monthly for 3-6 months, then every 3 months (physician directed)
4. Wash hands and put on nitrile gloves, blue gown and eye/ face protection as needed (see
UWMF Hazardous Drug Administration Policy).
5. Retrieve medication from refrigerator adhering to the five rights of drug administration.
Right – drug, dose, time, route, patient
Check expiration date and discard drug if more than 14 days old.
If the syringe does not come with a needle, attach a needle to the syringe appropriate for
the route medication will be given (per UWMF IM Injection or SQ Injection Policy)
DO NOT change the needle on the pre-drawn syringe (if received from
DO NOT flush/prime the needle with drug.
**Flushing the needle can cause an exposure to the drug.
6. Introduce yourself, identify the patient, and provide good light and privacy.
7. Explain medication and procedure to the patient and answer any questions.
8. Review or if necessary take patient’s vital signs and review patient’s allergies with the
9. Clean the site with alcohol swab and have cotton or gauze ready in case medication drips
from injection site.
10. Administer medication as ordered; either IM or SQ.
* Drug maybe given IV or intrathecal by MD.
11. Immediately dispose of needle and syringe in yellow chemotherapy sharps container. Refer
to UWMF Hazardous Drug Waste Policy for further clarifications.
12. Remove gloves and other PPE. Perform hand hygiene. Refer to UWMF Hazardous Drug
Waste Disposal Policy for further clarifications.
13. Allow patient to remain in waiting room for 20 minutes (or designated time per provider) to
observe for any adverse reactions. NOTE: If reaction occurs:
Contact provider and begin Anaphylaxis Protocol
Call 911 if reaction is anaphylactic in nature
14. Perform discharge teaching regarding medication and verify next appointment and
lab testing (if appropriate).
15. Documentation (HealthLink)
Manufacture, Lot #, Expiration date (as indicated)
Name, dosage, route of medication, site of injection, and time given
Progress Notes utilizing SmartPhrases: .npinjectstart and .npinjectend
Assessment and laboratory results relevant to purpose of the medication
Effects of the medication on patient
Teaching about the drug or injection technique
How patient tolerated procedure, i.e., desired effect, adverse reactions.
WRITTEN BY: Ronnie Peterson, R.N., M.S., Manager of Clinical Support
REVIEWED BY: Jody Lease, RN, Osteoporosis Case Manager, UWMF Rheumatology
Paul J. Brooks, William J. Spruill, Roy C. Parish, and Daniel A. Birchmore.
Pharmacokinetics of Methotrexate Administered by Intramuscular and Subcutaneous
Injections in Patients with Rheumatoid Arthritis. Arthritis and Rheumatism, Vol 33, No.
K Visser, D van der Heijde. Optimal dosage and route of administration of methotrexate
in rheumatoid arthritis: a systematic review of literature. Ann Rheum Dis 2009; 68:
Nursing 2009 Drug Handbook
Methotrexate Injection package insert
Medical Director Date