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Zlatal Methotrexate Injections

I've just received a letter from my hospital telling me that they are going to change my injections to Zlatal Methotrexate. In the letter it says that at the moment my normal MTX is an unlicensed preparation and that new pharmaceutical legislation states they should prescribe a preparation with a product licence where one is available so they are changing it. They do say that it is the same, but I'm still not happy about it. Thanks to MTX and Enbrel I've been in clinical remission for over three years. Just wondering if anyone else has changed to this.

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Seems odd. I have RD & I inject MTX (17.5mg Metoject pen manufactured by Medac Germany) & that has a marketing authorisation number (or product licence) printed on the front of the box (PL 11587/0080). Maybe it's a cost-cutting exercise for prescribing? Zlatal is manufactured by Nordic Pharma Ltd & is cheaper than Metoject, Zlatal is £15.75 for 17.5mg & Metoject is £17.50. Is it a pen or a syringe you're normally prescribed? I only ask as I think that Zlatal is syringe not a pen.

Going back to the reason given for the change, being unlicenced, I know that MTX is used off-licence for Crohn's but has been licenced for use in RD for a good while now. Ever the dog with a bone I think I'd be asking questions why you've til now you've been prescribed a med without a licence.


Thanks for your reply. I use a syringe to inject MTX. I have to unscrew a red top one the top of the injection and then screw on the needle, stupid really because RA affects our hands so much. I once didn't screw the top on properly and all the injection went on me and my clothes.

It does say on the bag that the injections come in that it is an unlicenced drug and I did ask my consultant about it and he said that it wasn't tested for RA adding that all children's drugs are unlicenced because they are not tested on children.

My hospital trust was in big trouble had a huge debt and was put into special measures. Its just been taken over by another hospital trust and if it is cheaper than this may be the reason. I'm just keeping my fingers crossed that they don't change my Enbrel to the new bio similar ones, I know that they are cheaper but they are not the same drug. I have asked my specialist nurse about it and was assured that they wouldn't change me because I am doing so well on Enbrel and if the did start to use it, it would be for patients just starting the drug. But this could all change if people higher up say so.

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I'm surprised that you've not been prescribed prefilled complete syringes, from starting on injections 7 years ago I've had them & now pens. I've read that some members from the US have to prep them themselves but it seems a faff, particularly as you say with our hands. Anyway, let's hope they're the prefilled & that your Enbrel is not changed for it's biosimilar.

This is what they look like


Thanks nomoreheels. Yes your right, should of been put on a complete syringe from the start, no messing around. I do find the cap on the Enbrel injection difficult to pull of as well and my hands are pretty much ok at the moment. Obviously not a lot of thought went in to these injections. x


Actually my h used to have to take the bung off the end of the needle of the syringes (not a hard cover as it would seem your new ones will be). I couldn't grip well enough to get it off without risking bending or breaking the needle but with the pens it's a wider plastic cap & far easier. That said I'd still prefer to have syringes because I could control the plunger & the 'wings' made the syringe easy to hold inbetween the index & middle fingers whereas I'm a bit cackhanded with the pens plus they're spring-loaded so auto-inject & pack a punch!


Hi Paula-C

It's a while back now but when I first went on MTX injections they were made up by the hospital pharmacy, not pre-prepared like it sounds like Metoject / Zlatal are?

If so, and you have to put the needle on yourself it could be that this is using MTX 'unlicensed' as they are essentially taking a chemo drug and preparing it themselves for RA use.

To me it sounds less risky to buy in pre-packed doses that are labelled for RA use (meaning fewer people are involved in the process = less risk of human error).

Besides all generic versions of standard drugs should be chemically identical, perhaps with different carriers or preservatives etc, but essentially the same thing.

I know biosimilars don't quite fit this description but I'd have thought MTX is identical.

Might be wrong.



Hi Ade

I do think somewhere someone told me that the hospital makes up the drug and then Health Care at Home collects them. When I once had my dosage altered I had to go to my hospital for them to inject me a few times, the syringe looked the same as the one that I use, like you said I have to screw the needle on myself. I was going away on holiday at the time and I was given a prescription to take to the hospital pharmacy and the injection was identical to the one that I get delivered. I do know that someone else on another forum changed to metoject and they had a site reaction, was told at the time that they use a different preservatives than the one she was on before. So even if it is the same mix so to speak it can be slightly different.

I will ring Health Care at Home and ask to speak to one of the pharmacists about it. I'll ask when I'm on the phone about xray scanners and can the drug go through it (this was discussed on here a while back). I was suppose to be getting a call back from one of the pharmacists about two weeks ago about this when I asked, but know one has called yet!

When I get to know something about it I will post on here. x


Apart from injection site responses though the preservatives etc should make no difference to the efficacy of the agent they are preserving. MTX is MTX, just as paracetamol is paracetamol.

Some people claim they need a certain brand of things but IMO that's just a psychological issue, nothing to do with the actual effects of the drug.

As an aside there has been research that shows people get more effect from branded OTCs even though they are identical in every way to a control drug. The mind is a powerful tool.

Which is why I try not to think about things too much. 😀


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