Rasuvo (Methotrexate) - Injection

Warning:


Warning with use in pregnancy: Methotrexate can harm a developing fetus, potentially causing fetal death. Methotrexate should not be used during pregnancy for non-neoplastic diseases. For neoplastic diseases (e.g., cancer), females and males of reproductive potential who are taking methotrexate should use effective contraception.

Severe toxicities: Methotrexate use can lead to toxicities in the bone marrow, liver, skin, lung, and kidney. Long-term use can cause severe liver problems such as fibrosis and cirrhosis. When combined with nonsteroidal anti-inflammatory drugs (NSAIDs), high-dose methotrexate has caused bone marrow suppression, aplastic anemia, and gastrointestinal toxicity.

Severe side effects: Methotrexate can cause interstitial pneumonitis and potentially fatal skin reactions or opportunistic infections. It can also cause intestinal perforation (sometimes fatal) with diarrhea, mouth sores, and hemorrhagic enteritis.

Allergic reactions: Methotrexate should also not be used in people with a history of severe hypersensitivity reactions to methotrexate, including anaphylaxis.

What Is Rasuvo?

Rasuvo (methotrexate) is an injection given under the skin (subcutaneous) that treats several types of autoimmune diseases. Autoimmune diseases occur when the body’s immune system, meant to protect you from foreign bodies like viruses and bacteria, attacks your cells instead and causes conditions like rheumatoid arthritis (RA) and psoriasis.

The generic name for Rasuvo is methotrexate. Methotrexate is a dihydrofolate reductase inhibitor, which means that it interferes with DNA processes and the replication of cells. It is not well understood how this mechanism works to treat autoimmune diseases, but it seems to fight inflammation that contributes to many autoimmune conditions.

Rasuvo is one of several methotrexate products available. Other methotrexate administration forms include pills, liquid, vials, and syringes.

This medication is only available by prescription, so you can’t purchase the drug over-the-counter (OTC). You’ll receive a prescription from your healthcare provider and get it from your pharmacy. Rasuvo is currently only available as a brand-name product with no generic equivalent.

Drug Facts

Generic Name: Methotrexate

Brand Name: Rasuvo, Otrexup, RediTrex

Drug Availability: Prescription

Therapeutic Classification: Dihydrofolate reductase inhibitor, DMARD (disease-modifying antirheumatic drug)

Available Generically: No

Controlled Substance: N/A

Administration Route: Subcutaneous

Active Ingredient: Methotrexate

Dosage Form: Injection

What Is Rasuvo Used For?

The Food and Drug Administration (FDA) approved Rasuvo to treat a few different autoimmune diseases:

It is typically used when people have not responded to other therapy first. Unlike methotrexate's oral version, Rasuvo is not indicated for use in neoplastic diseases (e.g., cancer).

How to Take Rasuvo

Rasuvo is injected once a week. It comes in an autoinjector, which means you will not need to draw up any liquid using a syringe or needle. The specific dose is already prefilled in the injector.

While it can be intimidating or scary to think about having to inject your medicine yourself, the autoinjector makes the process easy. Rasuvo is given subcutaneously, which means the medicine is injected right under your skin, as opposed to into a muscle or a vein.

Follow the steps below to inject Rasuvo. You may also find it helpful to watch the administration video on the manufacturer’s website:

  1. Gather your supplies. You will need an alcohol pad and your autoinjector.
  2. Wash your hands.
  3. Select your injection site (use your thigh or abdomen, but avoid the area around your belly button or any bruised, tender, or scarred skin) and clean it using the alcohol pad.
  4. Remove the yellow cap from the injector.
  5. Take a large pinch of skin from your thigh or abdomen to pull the fatty tissue away from the muscle underneath it.
  6. Hold the injector in your fist at a 90-degree angle to your skin over the spot where you want to inject.
  7. Press straight down firmly to insert the small needle into your skin.
  8. Push the yellow button with your thumb to begin the injection. You will hear a click. Hold the injector still for five seconds, then remove the injector from your skin.
  9. If needed, you can apply a bandage or gauze, but this is usually not necessary with Rasuvo injections.

Do not throw your empty auto-injectors away in your household trash. You will most likely be given a sharps container for the best disposal. Your pharmacist can tell you where to bring your container once it's full.

If you are a female with any potential to get pregnant, use effective contraception while taking Rasuvo and for at least one menstrual cycle after your last dose. Males who are sexually active with females who have any potential to get pregnant should use effective contraception while on Rasuvo and for three months after their last dose. Methotrexate is associated with multiple birth defects when used during pregnancy.

Storing Rasuvo

Store Rasuvo at room temperature (between 68 F and 77 F) in the original container, out of reach of children and pets. Do not keep it in an area with a lot of heat and moisture like the bathroom.

If you’re traveling by plane, you’ll want to keep Rasuvo in your carry-on luggage so that you aren’t separated from it if your checked baggage gets lost. If you’re traveling by car, do not leave Rasuvo in especially hot or cold temperatures for long periods, like overnight in the car.

Off-Label Uses

Healthcare providers may prescribe methotrexate for off-label uses, meaning for conditions not specifically indicated by the FDA.

While Rasuvo is a newer brand name methotrexate product, the generic drug methotrexate has been around for quite some time. It was first approved in the 1950s.

Methotrexate may be used off-label for other medical conditions, such as:

How Long Does Rasuvo Take to Work?

You can expect to see improvement from Rasuvo within about three to six weeks. However, noticeable improvement may take up to 12 weeks after your first dose. Talk to your healthcare provider if you don’t notice any improvement after several months.

What Are the Side Effects of Rasuvo?

This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 1-800-FDA-1088.

Common Side Effects

Common side effects associated with Rasuvo include:

Severe Side Effects

Potential side effects of Rasuvo that may be more serious include:

  • Severe diarrhea or vomiting: If you experience serious gastrointestinal side effects, let your healthcare provider know. These may require you to stop using Rasuvo or take a break from it, as they can lead to more severe conditions like intestinal perforation.
  • Serious infections: You may be at a higher risk of developing infections since methotrexate suppresses the immune system. These may be bacterial or fungal infections or viruses. If you have previously had hepatitis B or tuberculosis, the risk of these viruses reactivating may be higher due to taking Rasuvo.
  • Secondary cancers: People taking Rasuvo for psoriasis are at an increased risk of new skin cancer. There is also a risk of developing certain new blood cancers during treatment with Rasuvo.
  • Tumor lysis syndrome: This occurs when cancer cells are quickly destroyed. It can cause kidney failure, abnormal heart rhythm, or seizures. Your healthcare provider may need to monitor your blood for this reason if you are taking Rasuvo to treat cancer.
  • Leukopenia, or low white blood cells.
  • Myelosuppression, which makes the bone marrow less able to produce all other types of blood cells (red blood cells, white blood cells, and platelets)

Call your healthcare provider immediately if you experience any potentially severe side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency.

Report Side Effects

Rasuvo may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your healthcare provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Rasuvo Should I Take?

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The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For injection dosage form (solution):
    • For psoriasis:
      • Adults—At first, 10 to 25 milligrams (mg) once per week. Your doctor may adjust your dose as needed. However, the dose is usually not more than 30 mg once per week.
      • Children—Use and dose must be determined by your doctor.
    • For rheumatoid arthritis or juvenile arthritis:
      • Adults—At first, 7.5 milligrams (mg) once per week. Your doctor may adjust your dose as needed.
      • Children—Dose is based on body size and must be determined by your doctor. The starting dose is 10 milligrams (mg) per square meter (m(2)) of body size once per week. Your doctor may adjust your dose as needed.

Modifications

In pregnancy:

Rasuvo should never be used in pregnant people. Exposure to methotrexate during the first trimester of pregnancy is linked to an increased risk of spontaneous abortions, plus birth defects like skull anomalies, facial dysmorphism, central nervous system and limb abnormalities, and sometimes cardiac anomalies and intellectual impairment.

Exposure during the second and third trimesters of pregnancy can cause growth restrictions and functional abnormalities. Talk to your healthcare provider if you become pregnant or plan to become pregnant.

In breastfeeding:

Avoid breastfeeding during treatment with methotrexate and for a week after your final dose. It is unknown exactly how much of the drug gets into breast milk and how it may affect an infant.

In children:

The only use that Rasuvo injection is approved for in children is pJIA.

Other formulations of methotrexate have been approved to treat pediatric acute lymphoblastic leukemia (ALL). Rasuvo and other formulations may also be used in children off-label for conditions such as Crohn’s disease.

Although Rasuvo does not contain this preservative, some injectable methotrexate products may contain a preservative called benzyl alcohol. Products that contain this are not recommended for use in neonates (younger than 1 month) due to fatal cases of gasping syndrome. Symptoms include gasping, low blood pressure, slow heart rate, and loss of blood circulation.

In kidney impairment:

Make sure to let your healthcare provider know if you have any kidney disease. This may cause methotrexate to stay in your system longer. Your dose may need to be adjusted, especially if your creatinine clearance is less than 90 milliliters per minute.

Missed Dose

Rasuvo is injected once weekly. It may help to set a weekly reminder on your phone or calendar to remind yourself on the day of injection. Ask your healthcare provider what you should do if you miss a dose.

Overdose: What Happens If I Take Too Much Rasuvo?

Methotrexate overdose is also referred to as methotrexate toxicity. It can occur if there is too much in your body. Overdoses of methotrexate have generally been reported more with oral and intrathecal (injection into the spinal canal) administration.

Signs of early toxicity include:

  • Stomach problems like nausea, vomiting, or diarrhea
  • Mouth sores
  • Muscle pain
  • Headache
  • Dizziness

More serious cases of overdose can cause lung damage, liver damage, and nerve cell damage. Symptoms of lung damage may include a persistent dry cough and trouble breathing. Nerve cell damage may cause confusion, weakness, and seizures.

A drug called leucovorin is sometimes given with methotrexate to reduce its toxic effects. It can also treat cases of methotrexate overdoses.

Contact your healthcare provider immediately or go to the nearest emergency department if you experience any signs of toxicity or overdose.

What Happens If I Overdose on Rasuvo?

If you think you or someone else may have overdosed on Rasuvo, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Rasuvo, call 911 immediately.

Precautions

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It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly and to check for unwanted effects. Blood tests and chest x-rays may be needed to check for unwanted effects.

Using this medicine while you are pregnant can harm your unborn baby. The medicine may also cause birth defects if it is used by the father when his sexual partner becomes pregnant. Men should use birth control during and for at least 3 months after the last dose. Women should use birth control during and for at least one menstrual cycle after the last dose. Tell your doctor right away if pregnancy occurs while you are using this medicine.

Talk with your doctor before using this medicine if you plan to have children. Some men and women who use this medicine have become infertile (unable to have children).

Limit alcohol use with this medicine. Alcohol may increase the risk for liver problems.

This medicine may cause organ system toxicity. Call your doctor right away if you have the following symptoms: a fever, confusion, diarrhea, dry cough, irritability, neck stiffness, seizures, severe skin rash, sleepiness, trouble breathing, weakness, vomiting, or problems with coordination.

Check with your doctor right away if you have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, vomiting, or yellow eyes or skin. These could be symptoms of a serious liver problem.

Methotrexate can lower the number of white blood cells in your blood, which increases the chance of getting an infection. It can also lower the number of platelets, which are necessary for proper blood clotting. If this occurs, there are certain precautions you can take, especially when your blood count is low, to reduce the risk of infection or bleeding:

  • If you can, avoid people with infections. Check with your doctor immediately if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.
  • Check with your doctor immediately if you notice any unusual bleeding or bruising, black, tarry stools, blood in the urine or stools, or pinpoint red spots on your skin.
  • Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.
  • Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime.
  • Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail or toenail cutters.
  • Avoid contact sports or other situations where bruising or injury could occur.

While you are being treated with methotrexate, and after you stop treatment with it, do not have any immunizations (vaccines) without your doctor's approval. Methotrexate may lower your body's resistance and the vaccine may not work as well or you might get the infection the vaccine is meant to prevent. In addition, you should not be around other persons living in your household who receive live virus vaccines because there is a chance they could pass the virus on to you. Some examples of live vaccines include measles, mumps, influenza (nasal flu vaccine), poliovirus (oral form), rotavirus, and rubella. Do not get close to them and do not stay in the same room with them for very long. If you have questions about this, talk to your doctor.

Serious skin reactions can occur with this medicine. Check with your doctor right away if you have blistering, peeling, or loosening of the skin, red skin lesions, severe acne or a skin rash, sores or ulcers on the skin, or fever or chills while you are using this medicine.

This medicine may make your skin more sensitive to sunlight. Use a sunscreen when you are outdoors. Avoid sunlamps and tanning beds.

This medicine may make you dizzy or tired. Do not drive or do anything else that could be dangerous until you know how this medicine affects you.

This medicine may increase your risk of having a lymphoma (cancer of the lymph system). Discuss these possible effects with your doctor.

This medicine may cause a serious reaction called tumor lysis syndrome. Tell your doctor right away if you have a change in urine amount, joint pain, stiffness, or swelling, lower back, side, or stomach pain, rapid weight gain, swelling of the feet or lower legs, or unusual tiredness or weakness.

Using this medicine with radiation therapy may increase risk of tissue or bone problems, such as tissue or bone not receiving enough blood. Tell your doctor if you are receiving other treatments, such as radiation therapy, while using this medicine.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn't Take Rasuvo?

Rasuvo is not or may not be the best choice for you if:

  • You’re pregnant or breastfeeding: Using Rasuvo while pregnant increases the likelihood of multiple different birth defects and spontaneous abortion. The exact amount of the drug that passes into your breast milk is unknown, but when this happens it may harm your baby.
  • You have an allergy to Rasuvo: If you have experienced any hypersensitivity reactions after taking Rasuvo, including anaphylaxis, you should not take it again.
  • You consume alcohol heavily: The risk of liver damage is increased in people who drink a heavy amount of alcohol. This risk is enhanced with higher methotrexate doses. In people with psoriasis, liver damage may occur without symptoms or abnormal liver tests.
  • You have a blood disorder such as low levels of white blood cells, red blood cells, or platelets.
  • Kidney disease: Make sure to let your healthcare provider know if you have any kidney disease. This may cause methotrexate to stay in your system longer, so your dose may need to be adjusted if your creatinine clearance is less than 90 milliliters per minute. You may not be able to take Rasuvo if your kidney function is very low.

What Other Medications Interact With Rasuvo?

Some drugs can interact with Rasuvo and should be monitored by your healthcare provider.

When taken with Rasuvo, the following drugs may increase the amount of methotrexate in your system, leading to more side effects:

If you need to take any of these drugs with methotrexate, be extra vigilant about side effects. Let your healthcare provider know immediately if you start to experience any adverse reactions.

What Medications are Similar to Rasuvo?

Methotrexate is available generically in several formulations under different brand names:

  • Methotrexate: Available generically as 2.5-milligram (mg) tablets and 25 milligrams per milliliter (mL) vials for injection
  • Trexall: Brand name tablet that comes in blister packs (or dose packs) of various quantities
  • Reditrex: Brand name injectable methotrexate that comes in prefilled syringes at 25 milligrams per milliliter concentration
  • Otrexup: Another brand name for injectable methotrexate that comes in an autoinjector with a variety of dosages available
  • Xatmep: Brand name 2.5 milligrams per milliliter methotrexate liquid taken by mouth

Methotrexate is called a disease-modifying antirheumatic drug (DMARD). Other DMARDs that are sometimes used to treat autoimmune diseases include:

  • Arava (leflunomide) has similar side effects to methotrexate. It is sometimes used in combination with methotrexate and can treat psoriasis and psoriatic arthritis.
  • Plaquenil (hydroxychloroquine) is an antimalarial drug that somewhat tempers the immune system to fight rheumatoid arthritis.
  • Azulfidine (sulfasalazine) is commonly used for juvenile rheumatoid arthritis, and sometimes for Crohn’s disease and psoriasis.

This is NOT a list of drugs recommended to take with Rasuvo, though some may be used in combination. Ask your pharmacist or a healthcare provider if you have questions.

Frequently Asked Questions

  • What is Rasuvo used for?

    Rasuvo is approved to treat several autoimmune diseases including rheumatoid arthritis and severe psoriasis, plus polyarticular juvenile idiopathic arthritis (pJIA) in children.

  • What are the side effects of Rasuvo?

    Side effects that are common when taking Rasuvo include mouth sores (also called stomatitis), nausea and upset stomach, and thrombocytopenia (low platelet count). Some more severe side effects include infections, which are possible because methotrexate suppresses your immune system, and blood issues such as leukopenia or myelosuppression.

  • What medicines interact with Rasuvo?

    Some medicines may cause too much Rasuvo to accumulate in your system, increasing the risk of side effects. These medicines include proton pump inhibitors like Protonix (pantoprazole), certain antibiotics like Bactrim and doxycycline, NSAID drugs like Advil (ibuprofen), and salicylates like aspirin.

How Can I Stay Healthy While Taking Rasuvo?

Rasuvo, or methotrexate, is used for a wide variety of conditions. It can be a very effective drug for treating autoimmune diseases like rheumatoid arthritis and psoriasis.

Methotrexate's list of side effects may make you wary of taking this medication. While it's important to be aware of these potential adverse effects, there are things you can do to minimize them. Work with your healthcare provider to ensure you take the correct dose and use your medication exactly as prescribed. Make sure to ask your healthcare provider or pharmacist if you are unsure how to take it.

Methotrexate also tends to lower the amount of folic acid in your body, contributing to some side effects. Ask your healthcare provider about taking a folic acid supplement along with your Rasuvo injections. This may help prevent some side effects.

It may take a couple of weeks to get used to giving yourself injections, especially if you've never had to do so before. Be patient with yourself, and watch videos online of other people using their Rasuvo autoinjectors until you get the hang of it. It will be second nature before you know it.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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