Methotrexate is given weekly as an intramuscular injection of 15 to 25 mg. Side effects are rare and include leukopenia and hypersensitivity interstitial pneumonitis. Hepatic fibrosis is the most severe potential sequela of long-term therapy. Patients with concomitant alcohol abuse and/or morbid obesity are more likely to develop hepatic fibrosis and therefore should not be treated with methotrexate. It is prudent to obtain a baseline chest radiograph and to monitor complete blood count, liver function and renal function every two weeks until the patient is receiving oral therapy, and every one to three months thereafter. Before methotrexate therapy is initiated, the risks of treatment and the possible need for a liver biopsy should be discussed with the patient.
Pennsylvania is starting to allow grocery stores and gas stations to sell alcohol. Wines and spirits are still sold at locations called "state stores", but wine kiosks are starting to be put in at grocery stores. The kiosks are connected to a database in Harrisburg , and purchasers must present valid ID, signature, and look into a camera for facial identification to purchase wine. Only after all of these measures are passed is the individual allowed to obtain one bottle of wine from the "vending machine". The kiosks are only open during the same hours as the state-run liquor stores, and are not open on Sundays.