Jylamvo (Oral)

Methotrexate tablet is used alone or with other medicines to treat different types of cancer, including breast, head and neck, lung, blood (for example, acute lymphoblastic leukemia or ALL), bone, lymph node (for example, mycosis fungoides, relapsed or refractory non-Hodgkin lymphoma), or uterus cancer. It is also used to treat rheumatoid arthritis, severe psoriasis (a skin disease), lupus, multiple sclerosis, and polyarticular juvenile idiopathic arthritis (pJIA).

Methotrexate oral solution is used with other medicines to treat acute lymphoblastic leukemia (ALL) or relapsed or refractory non-Hodgkin lymphoma. It is also used alone or with other medicines to treat mycosis fungoides. This medicine is also used to treat rheumatoid arthritis and severe psoriasis (a skin disease), and to help manage polyarticular juvenile idiopathic arthritis (pJIA) in children who have not responded well to other treatments.

Methotrexate is part of a group of medicines called antineoplastics (cancer medicines). It blocks an enzyme that cells need to survive. This slows down the growth of cancer cells, which are eventually destroyed by the body.

This medicine is available only with your doctor's prescription.

It is very important for your doctor to check your progress regularly to ensure this medicine is working well and to look for any unwanted effects. You may need blood and urine tests to check for unwanted effects.

Using this medicine while you are pregnant can harm your unborn baby. It may also cause birth defects if the father uses it when his partner becomes pregnant. If you are a woman who can get pregnant, your doctor may give you a pregnancy test before you start this medicine to ensure you are not pregnant. Female patients should use an effective form of birth control during treatment and for at least 3 or 6 months after the last dose. Male patients with female partners should also use effective birth control during treatment and for at least 3 months after the last dose. Tell your doctor immediately if you become pregnant while using this medicine.

This medicine may cause serious allergic reactions, including anaphylaxis, which can be life-threatening and requires immediate medical help. Contact your doctor right away if you experience a rash, itching, dizziness, fainting, fast heartbeat, trouble breathing or swallowing, or chest tightness while using this medicine.

Talk to 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 while taking this medicine. Alcohol may increase the risk of liver problems.

Contact your doctor immediately if you have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, vomiting, or yellowing of the eyes or skin. These could be signs of a serious liver problem.

Methotrexate can reduce the number of white blood cells in your blood, which raises the risk of infections. It can also lower the number of platelets, which are needed for your blood to clot properly. If this happens, there are precautions you can take, especially when your blood count is low, to reduce the risk of infection or bleeding:

• If possible, avoid contact with people who have infections. Contact your doctor right away if you think you might have an infection or if you develop a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.
• Contact your doctor immediately if you notice any unusual bleeding or bruising, black, tarry stools, blood in urine or stools, or pinpoint red spots on your skin.
• Be careful when using a regular toothbrush, dental floss, or toothpick. Your doctor, dentist, or nurse may suggest other ways to clean your teeth and gums. Check with your 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 afterward.
• Be cautious when using sharp objects such as safety razors or fingernail or toenail clippers to avoid cuts.
• Avoid contact sports or other activities where bruising or injury could happen.

This medicine may cause stomach and bowel issues. Contact your doctor right away if you have stomach pain, black, tarry stools, constipation, diarrhea, loss of appetite, nausea, pain in the back of the throat or chest when swallowing, or vomiting blood or material that looks like coffee grounds.

Contact your doctor immediately if you have a cough, fever, or trouble breathing. These could be signs of serious lung or breathing problems (e.g., acute or chronic interstitial pneumonitis).

While you are being treated with methotrexate, and after stopping treatment, do not receive 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. Additionally, you should avoid contact with anyone in your household who receives live virus vaccines because they could pass the virus to you. Examples of live vaccines include measles, mumps, influenza (nasal flu vaccine), poliovirus (oral form), rotavirus, and rubella. Stay away from them and do not spend a long time in the same room with them. If you have questions about this, talk to your doctor.

Serious skin reactions (e.g., toxic epidermal necrolysis, Stevens-Johnson syndrome, exfoliative dermatitis, skin necrosis, or erythema multiforme) can occur with this medicine. Contact your doctor immediately if you have blistering, peeling, or loosening of the skin, blue-green to black skin discoloration, cough, cracks in the skin, diarrhea, itching, joint or muscle pain, loss of heat from the body, red irritated eyes, red skin lesions, often with a purple center, sore throat, sores, ulcers, or white spots in the mouth or on the lips, fever or chills, or unusual tiredness or weakness while using this medicine.

This medicine may make your skin more sensitive to sunlight. Wear sunscreen, eye protection, and a hat. Do not use sunlamps or tanning beds.

Tell your doctor right away if you notice a change in how much or how often you urinate, rapid weight gain, swelling in the legs, ankles, or feet, or trouble breathing. These could be symptoms of a serious kidney problem.

This medicine may cause serious nerve issues. Contact your doctor immediately if you experience seizures, confusion, tingling or numbness in your hands, feet, or lips, trouble seeing, or headaches.

This medicine may increase your risk of other cancers, including blood or skin cancer. The risk for skin cancer may be higher if you take cyclosporine after receiving treatment with methotrexate for psoriasis.

This medicine may cause a serious reaction called tumor lysis syndrome. Your doctor may prescribe another medicine to help prevent this. Tell your doctor immediately if you notice changes in your 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.

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

In deciding to use a drug, the chances of using the drug must be weighed against the beneficial it will do. This is a decision you and your clinician will make. For this medication, the following should be considered:

Allergies

Inform your physician if you have ever had any unusual or allergic reaction to this medicine or any other drugs. Additionally tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of Jylamvo® in the pediatric population. This medicine is not approved for use in children.

Appropriate studies performed to date have not demonstrated pediatric-specific issues that would limit the usefulness of methotrexate for the therapy of acute lymphoblastic leukemia and polyarticular juvenile idiopathic arthritis in children. Nevertheless, safety and efficacy have not been established in children with other conditions.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific issues that would limit the usefulness of methotrexate in the elderly.

Breast Feeding

Studies in women breastfeeding have demonstrated harmful infant effects. An alternative to this drug should be prescribed or you should discontinue breastfeeding while using this medication.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this drug, it is especially important that your healthcare professional know if you are taking any of the drugs listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medication with any of the following medicines is not recommended. Your doctor may decide not to treat you with this drug or change some of the other medicines you take.

• Measles Virus Vaccine, Live
• Mumps Virus Vaccine, Live
• Rotavirus Vaccine, Live
• Rubella Virus Vaccine, Live
• Varicella Virus Vaccine, Live
• Zoster Vaccine, Live

Using this drug with any of the following medications is normally not advised, but may be required in some cases. If both drugs are prescribed together, your clinician may change the dose or how frequently you use one or both of the drugs.

• Abacavir
• Acarbose
• Aceclofenac
• Acemetacin
• Acetazolamide
• Acetohexamide
• Adalimumab
• Adenovirus Vaccine
• Adenovirus Vaccine, Live
• Albendazole
• Allopurinol
• Alprazolam
• Ambrisentan
• Amiodarone
• Amoxicillin
• Ampicillin
• Amtolmetin Guacil
• Anidulafungin
• Apixaban
• Asparaginase
• Aspirin
• Atomoxetine
• Atovaquone
• Azacitidine
• Azanidazole
• Azithromycin
• Bacampicillin
• Bacillus of Calmette and Guerin Vaccine, Live
• Balofloxacin
• Balsalazide
• Balsalazide Disodium
• Beet Root
• Bentiromide
• Benznidazole
• Bexarotene
• Bicalutamide
• Bortezomib
• Bosentan
• Bromfenac
• Bufexamac
• Bumetanide
• Busulfan
• Capecitabine
• Capmatinib
• Captopril
• Carbamazepine
• Caspofungin
• Cefaclor
• Cefadroxil
• Cefatrizine
• Cefdinir
• Cefditoren
• Cefetamet
• Cefixime
• Cefpodoxime
• Cefprozil
• Cefteram Pivoxil
• Ceftibuten
• Cefuroxime
• Celecoxib
• Cephalexin
• Cephradine
• Chenodiol
• Chloral Hydrate
• Chlorpropamide
• Chlortetracycline
• Chlorthalidone
• Chlorzoxazone
• Cholera Vaccine, Live
• Choline Salicylate
• Cinoxacin
• Ciprofloxacin
• Citalopram
• Clarithromycin
• Clindamycin
• Clofarabine
• Clomipramine
• Clonixin
• Clopidogrel
• Cloxacillin
• Cyclosporine
• Cyproheptadine
• Dabigatran Etexilate
• Dactinomycin
• Danazol
• Dantrolene
• Dapsone
• Darolutamide
• Darunavir
• Deferasirox
• Delamanid
• Demeclocycline
• Dengue Tetravalent Vaccine, Live
• Dexibuprofen
• Dexketoprofen
• Dexlansoprazole
• Dexmethylphenidate
• Diclofenac
• Dicloxacillin
• Diflunisal
• Dipyrone
• Dirithromycin
• Disulfiram
• Divalproex Sodium
• Doxifluridine
• Doxycycline
• Dronedarone
• Droxicam
• Duloxetine
• Ebola Zaire Vaccine, Live
• Edoxaban
• Efavirenz
• Elexacaftor
• Enalapril
• Enalaprilat
• Enasidenib
• Encorafenib
• Entecavir
• Epoprostenol
• Eravacycline
• Erlotinib
• Erythromycin
• Escitalopram
• Esomeprazole
• Ethambutol
• Etodolac
• Etofenamate
• Etravirine
• Febuxostat
• Felbamate
• Felbinac
• Fenbufen
• Fenoprofen
• Fepradinol
• Feprazone
• Flecainide
• Floctafenine
• Floxacillin
• Fluconazole
• Flufenamic Acid
• Flumequine
• Fluorouracil
• Flurbiprofen
• Flutamide
• Folic Acid
• Foscarnet
• Fosfomycin
• Fosphenytoin
• Framycetin
• Fulvestrant
• Furosemide
• Fusidic Acid
• Ganciclovir
• Gemcitabine
• Gemtuzumab Ozogamicin
• Gliclazide
• Glimepiride
• Glipizide
• Gliquidone
• Glyburide
• Golimumab
• Griseofulvin
• Hydrochlorothiazide
• Hydroxychloroquine
• Hydroxyurea
• Ibuprofen
• Ibuprofen Lysine
• Imatinib
• Indapamide
• Indomethacin
• Infliximab
• Influenza Virus Vaccine, Live
• Interferon Beta-1a
• Interferon Beta-1b
• Isoniazid
• Itraconazole
• Ixabepilone
• Josamycin
• Kanamycin
• Ketoconazole
• Ketoprofen
• Ketorolac
• Labetalol
• Lamotrigine
• Lansoprazole
• Lapatinib
• Leflunomide
• Leniolisib
• Levetiracetam
• Levofloxacin
• Linezolid
• Lornoxicam
• Loxoprofen
• Lumiracoxib
• Lymecycline
• Mafenide
• Meclocycline
• Meclofenamate
• Mefenamic Acid
• Mefloquine
• Meloxicam
• Memantine
• Mepartricin
• Mercaptopurine
• Mesalamine
• Methacycline
• Methazolamide
• Methicillin
• Methimazole
• Metolazone
• Metronidazole
• Micafungin
• Midostaurin
• Milnacipran
• Minocycline
• Miokamycin
• Momelotinib
• Morniflumate
• Moxifloxacin
• Nabumetone
• Nafcillin
• Nalidixic Acid
• Naproxen
• Nefazodone
• Neomycin
• Nepafenac
• Nevirapine
• Niacin
• Niflumic Acid
• Nilutamide
• Nimesulide
• Nimesulide Beta Cyclodextrin
• Nimorazole
• Nitisinone
• Nitrofurantoin
• Nitrous Oxide
• Nortriptyline
• Oleandomycin
• Olsalazine
• Olsalazine Sodium
• Omadacycline
• Omeprazole
• Ondansetron
• Orlistat
• Ornidazole
• Oxacillin
• Oxandrolone
• Oxaprozin
• Oxyphenbutazone
• Oxytetracycline
• Pantoprazole
• Parecoxib
• Paromomycin
• Paroxetine
• Pazopanib
• Pazufloxacin
• Pefloxacin
• Peginterferon Alfa-2a
• Pemetrexed
• Penicillin G
• Penicillin V
• Pexidartinib
• Phenylbutazone
• Phenytoin
• Piketoprofen
• Pipemidic Acid
• Piperacillin
• Piroxicam
• Pirprofen
• Pivampicillin
• Poliovirus Vaccine, Live
• Posaconazole
• Pristinamycin
• Probenecid
• Proglumetacin
• Proguanil
• Propionic Acid
• Propylthiouracil
• Propyphenazone
• Proquazone
• Pyrimethamine
• Rabeprazole
• Raltegravir
• Ramipril
• Ribavirin
• Rifabutin
• Rifampin
• Rifapentine
• Rifaximin
• Riluzole
• Ritonavir
• Rivaroxaban
• Rokitamycin
• Rolitetracycline
• Rosoxacin
• Rufloxacin
• Salicylic Acid
• Salsalate
• Sapropterin
• Sarecycline
• Secnidazole
• Silver Sulfadiazine
• Simeprevir
• Sirolimus
• Smallpox Monkeypox Vaccine, Live Non-Replicating
• Smallpox Vaccine
• Sodium Salicylate
• Sorafenib
• Spiramycin
• Sulfacetamide
• Sulfacytine
• Sulfadiazine
• Sulfamethizole
• Sulfamethoxazole
• Sulfapyridine
• Sulfasalazine
• Sulfisoxazole
• Sulindac
• Sultamicillin
• Sunitinib
• Tafamidis
• Tamoxifen
• Tedizolid Phosphate
• Tegafur
• Teicoplanin
• Temocillin
• Tenoxicam
• Terbinafine
• Teriflunomide
• Testosterone
• Tetracycline
• Tiaprofenic Acid
• Ticarcillin
• Tigecycline
• Tipranavir
• Tizanidine
• Tolazamide
• Tolbutamide
• Tolcapone
• Tolfenamic Acid
• Tolmetin
• Tolvaptan
• Torsemide
• Tramadol
• Triamterene
• Trimethoprim
• Trofinetide
• Typhoid Vaccine, Live
• Valdecoxib
• Valproic Acid
• Venlafaxine
• Vincristine
• Voriconazole
• Warfarin
• Yellow Fever Vaccine
• Zafirlukast
• Zidovudine
• Zolpidem
• Zonisamide

Using this medicine with any of the following medicines may cause an increased chance of certain side effects, but using both drugs may be the best treatment for you. If both medications are prescribed together, your physician may change the dose or how frequently you use one or both of the medicines.

• Eltrombopag
• Etoricoxib
• Procarbazine
• Rofecoxib
• Rolapitant
• Theophylline

Interactions with Food/Tobacco/Alcohol

Certain medications should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medications may additionally cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following is usually not advised, but may be unavoidable in some cases. If used together, your physician may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.

• Cola

Other Medical Issues

The presence of other medical problems may affect the use of this drug. Make sure you inform your physician if you have any other medical issues, especially:

• Alcohol abuse, or history of or
• Anemia or
• Leukopenia (low white blood cells) or
• Liver disease, severe or
• Thrombocytopenia (low platelet blood level) or
• Weak immune system—Methotrexate tablets should not be used in patients with these conditions.

• Ascites (extra fluid in the stomach area) or
• Kidney disease or
• Pleural effusion (extra fluid in the lung)—Use with caution. The effects may be increased because of slower removal of the medicine from the body.

• Diabetes or
• Obesity or
• Stomach or bowel problem (eg, peptic ulcers, ulcerative colitis)—Use with caution. May cause side effects to become worse.

• Infection (eg, bacteria, fungus, virus)—Use with caution. May decrease your ability to fight an infection.

Along with its necessary effects, a medicine may also cause some unwanted effects. Not all of these side effects may happen, but if they do, they may require medical attention.

Check with your doctor right away if any of the following side effects happen:

More common

• Black, tarry stools
• bleeding gums
• blood in the urine or stools
• bloody vomit
• diarrhea
• increased heartbeat
• itching, rash, reddening of the skin
• joint pain
• nausea
• pinpoint red spots on the skin
• sores in the mouth or lips
• stomach pain
• swelling of the eyelids, face, lips, hands, feet, or lower legs
• swelling or inflammation of the mouth
• trouble breathing
• unusual bleeding or bruising
• vomiting
• yellow eyes or skin

Less common

• Back pain
• bloody nose
• blurred vision
• body and muscle pain
• burning while urinating
• confusion
• continuing ringing, buzzing, or other unexplained noise in the ears
• cough or hoarseness
• cracked, dry, scaly skin
• dark urine
• dizziness
• drowsiness
• ear congestion
• fever or chills
• headache
• loss of appetite
• loss of hearing
• loss of voice
• lower back or side pain
• painful or difficult urination
• pale skin
• runny nose
• seizures
• sneezing
• sore throat
• stuffy or runny nose
• unusual tiredness or weakness
• weight loss
• white or brownish vaginal discharge

Incidence not known

• Anxiety
• blistering, peeling, or loosening of the skin
• bloating
• blurred or change in vision
• changes in skin color
• confusion
• constipation
• decreased interest in sexual intercourse
• difficulty in moving
• dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
• dry mouth
• dryness or soreness of the throat
• eye pain
• fruit-like breath odor
• heartburn
• inability to have or keep an erection
• increased hunger or thirst
• indigestion
• irritation in the mouth
• large, flat, blue, or purplish patches in the skin
• loss in sexual ability, desire, drive, or performance
• loss of consciousness
• menstrual problem
• night blindness
• pain in the chest or groin
• pain, redness, swelling, or tenderness in the arm or leg
• red skin lesions, often with a purple center
• red, wart-like spots on the skin
• sudden loss of coordination
• sudden onset of slurred speech
• swelling or soreness of the breasts
• swollen, painful, or tender lymph glands in the neck or armpit
• tingling or numbness in the hands, feet, or lips

Some side effects may happen that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you how to prevent or lessen some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

• Hair loss or thinning

Less common

• Blemishes on the skin
• hard, red, swollen skin irritation
• pimples

Other side effects not listed may also happen in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You can report side effects to the FDA at 1-800-FDA-1088.

In the U.S.

• Jylamvo
• Rheumatrex Dose Pack
• Trexall
• Xatmep

Available Dosage Forms:

• Solution
• Tablet

Therapeutic Class: Antineoplastic Agent

Pharmacologic Class: Antimetabolite

Take this medicine only as directed by your doctor. Do not use more of it, do not use it more often, and do not use it for a longer time than your doctor ordered. Do not take this medicine everyday to treat conditions other than cancer.

Read and follow the patient instructions that come with this medicine. Talk to your doctor or pharmacist if you have any questions.

Measure the oral liquid medicine with a marked measuring spoon, oral syringe, or medicine cup.

Swallow the tablet whole. Do not crush, break, or chew it. Do not take the tablet if you cannot swallow it.

For patients with rheumatoid arthritis, psoriasis, or polyarticular juvenile idiopathic arthritis: Your doctor may give you folic acid or folinic acid supplement to help reduce the unwanted effects of this medicine.

For patients with cancer: Do not take folic acid or folinic acid supplement unless directed by your doctor.

Do not take this medicine with foods that are rich in milk.

Dosing

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 oral dosage form (tablets): For acute lymphoblastic leukemia (ALL):Adults and children—Dose is based on body size and must be determined by your doctor. At first, 20 milligrams (mg) per meter squared (m(2)) of body size once a week. Your doctor may adjust your dose as needed and tolerated. For mycosis fungoides: Adults— Used alone: 25 to 75 milligrams (mg) once a week. Used with other medicines: Dose is based on body size and must be determined by your doctor. The dose is usually 10 mg per meter squared (m(2)) of body size 2 times a week. Children—Use and dose must be determined by your doctor. For non-Hodgkin lymphoma: Adults—2.5 milligrams (mg) 2 to 4 times a week. Your doctor may adjust your dose as needed and tolerated. However, the dose is usually not more than 10 mg per week. Children—Use and dose must be determined by your doctor. For polyarticular juvenile arthritis (pJIA):Children—Dose is based on body size and must be determined by your doctor. At first, 10 milligrams (mg) per meter squared (m2) once a week. Your doctor may adjust your dose as needed and tolerated. For psoriasis: Adults—At first, 10 to 25 milligrams (mg) once a week. Your doctor may adjust your dose as needed and tolerated. However, the dose is usually not more than 30 mg per week. Children—Use and dose must be determined by your doctor. For rheumatoid arthritis: Adults—At first, 7.5 milligrams (mg) once a week. Your doctor may adjust your dose as needed and tolerated. Children—Use and dose must be determined by your doctor.
• For oral dosage form (Jylamvo® solution): For acute lymphoblastic leukemia (ALL): Adults—Dose is based on body size and must be determined by your doctor. At first, 20 milligrams (mg) per meter squared (m(2)) of body size once a week. Your doctor may adjust your dose as needed and tolerated. Children—Use and dose must be determined by your doctor. For mycosis fungoides: Adults— Used alone: 25 to 75 milligrams (mg) once a week. Used with other medicines: Dose is based on body size and must be determined by your doctor. The dose is usually 10 mg per meter squared (m(2)) of body size 2 times a week. Children—Use and dose must be determined by your doctor. For non-Hodgkin lymphoma: Adults—2.5 milligrams (mg) 2 to 4 times a week. Your doctor may adjust your dose as needed and tolerated. However, the dose is usually not more than 10 mg per week. Children—Use and dose must be determined by your doctor. For psoriasis: Adults—At first, 10 to 25 milligrams (mg) once a week. Your doctor may adjust your dose as needed and tolerated. However, the dose is usually not more than 30 mg per week. Children—Use and dose must be determined by your doctor. For rheumatoid arthritis: Adults—At first, 7.5 milligrams (mg) once a week. Your doctor may adjust your dose as needed and tolerated. Children—Use and dose must be determined by your doctor.
• For oral dosage form (Xatmep™ solution): For acute lymphoblastic leukemia (ALL):Children—Dose is based on body size and must be determined by your doctor. At first, 20 milligrams (mg) per meter squared (m(2)) of body size once a week. Your doctor may adjust your dose as needed. For polyarticular juvenile idiopathic arthritis (pJIA):Children—Dose is based on body size and must be determined by your doctor. At first, 10 milligrams (mg) per meter squared (m(2)) of body size once per week. Your doctor may adjust your dose as needed.

Missed Dose

This medicine needs to be given on a fixed schedule. If you miss a dose or forget to use your medicine, call your doctor or pharmacist for instructions.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

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