Methotrexate is one of the important medications used in the management of patients with rheumatoid arthritis. It comes in tablet and injection forms. This article answers an important question that patients ask about methotrexate injections, the vials: how many times can I use the methotrexate vial?
If the methotrexate vial you have does not contain a preservative, this means it should be used once only and discarded after that. Because these vials contain no antimicrobial preservative, there is nothing to inhibit the growth of bacteria that may be inadvertently introduced when the stopper is penetrated by the needle.
However, some doctors will advise their patients to use those vials without the preservative more than one time. The reason here is that they might be concerned about allergy or adverse effects to preservatives that some patients complain of. Strict aseptic technique must be followed here.
If the vial does contain a preservative, this means it can be used several times because the preservative stops or prevents bacteria from growing. After the vial with the preservative is punctured, that is, after the first dose, it should no longer be stored at room temperature. It should be stored now in the refrigerator between 2°C and 8°C and can be reused after that for a maximum of four weeks no more.
Why no more than 4 weeks? Because the antimicrobial effect of the preservatives are not guaranteed to last beyond 4 weeks following initial penetration of the stopper, unless where otherwise specified by the manufacturing company. So in general, you should date the vial upon initial penetration of the stopper, store the vial in the refrigerator, and discard it after 4 weeks.
Reference:
http://cdn.rasuvo.com/assets/pdf/Patient-Information-current.pdf
https://www.pfizermedicalinformation.ca/en-ca/methotrexate?section=storage-and-stability&tab=pm
https://www.mcguffpharmacy.com/CompoundingPhysicians/PreservativeFreeVials.aspx
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This post was prepared and published by Dr. Hatem Eleishi. Dr. Hatem Eleishi is a professor of rheumatology at Cairo university (Egypt) and is especially dedicated to supporting arthritis patients with online educational videos and articles about arthritis causes and treatment. He also runs a rheumatology clinic in Cairo and a center for www.tabibakom.com/en that, in addition to providing online rheumatology consultations, also provides online medical consultations in several different medical specialties by expert consultants from Egypt, Canada and the United States.
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