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Methotrexate

Methotrexate is a type of medicine called an immunosuppressant. It slows down your body's immune system and helps reduce swelling (inflammation).

It's used to treat inflammatory conditions, including:

  • rheumatoid arthritis
  • psoriasis (including psoriatic arthritis)
  • Crohn's disease

It can also be prescribed for cancer.

Methotrexate is available on prescription only.

It comes as tablets, a liquid that you swallow, and pre-filled injection pens or syringes that you inject into your skin. Your specialist doctor may recommend injections if the tablets or liquid are not working for you.

It can also be given as an injection to treat some types of cancer. This is usually done in hospital.

Who can take methotrexate

Most adults and children can take methotrexate.

Who may not be able to take methotrexate

Methotrexate is not suitable for some people. To make sure it's safe for you, tell your doctor before taking it if you:

  • have ever had an allergic reaction to methotrexate or any other medicine
  • are pregnant, trying to get pregnant or are breastfeeding
  • have severe liver or kidney disease, or a blood disorder
  • have an infection
  • have mouth ulcers, or have been diagnosed with a stomach ulcer or duodenal ulcer
  • are due to have a live vaccine (this includes the live flu vaccine usually given to children)

Dosage for inflammatory conditions

For inflammatory conditions such as psoriasis, rheumatoid arthritis or Crohn's disease, the dose of methotrexate will vary. This depends on your condition and blood test results. Always follow the instructions from your doctor.

For rheumatoid arthritis, the usual starting dose for adults is 7.5mg, taken once a week. This can be slowly increased up to 20mg (tablets) or 25mg (pre-filled injection pen or syringe) once a week.

For psoriasis, the usual starting dose for adults is 2.5mg to 10mg, taken once a week. It can be slowly increased up to 30mg once a week.

For Crohn's disease, the usual dose for adults to prevent flare-ups is 10mg to 25mg, taken once a week. This is often called a maintenance dose.

If your child is prescribed methotrexate, the doctor will use their height and weight to work out the right dose.

How to take it

How to take methotrexate tablets

Swallow the tablets whole with a drink of water. You can take your tablets before or after food. Wash your hands after touching the tablets to remove any traces of methotrexate powder.

Your doctor will tell you how many tablets to take each time. You may have to take up to 10 tablets to make up your dose.

How to take methotrexate liquid

Always use the oral syringe that comes with your medicine to measure your dose. It's important to use this syringe so that you get the right amount. If you do not have one, ask a pharmacist for one. Do not use a kitchen teaspoon as it will not measure the right amount.

It's a good idea to have a drink of water after taking your medicine.

Having methotrexate injections

You'll usually go to your GP surgery or a hospital outpatient clinic once a week to have your injection.

Alternatively, you may get a pre-filled injection pen or syringe for you to use at home. Your doctor or nurse will show you how to use this.

Methotrexate treatment for cancer

If you're having methotrexate treatment for cancer, a doctor or nurse will usually give you an injection. You may need to have treatment more than once a week and this will be done in hospital.

How long to take it for

If methotrexate works for you, you may need to take it for several years to control your symptoms.

If you forget to take it

If you forget to take a dose, take it as soon as you remember the next day or the day after.

If your dose is more than 2 days late, contact your doctor or the clinic for advice about what to do.

Never take 2 doses together to make up for a missed dose.

If you take too much

Taking too much methotrexate can cause serious side effects. In some cases, it can be fatal.

Store your weekly methotrexate separately, away from any other medicines that you take daily.

  • you've taken more than your prescribed dose of methotrexate
  • you've taken your methotrexate daily instead of weekly

Go to 111.nhs.uk or call 111 . If you need advice for a child under 5 years old, call 111.

If you need to go to A&E, do not drive yourself. Get someone else to drive you or call for an ambulance.

Take the methotrexate packet, or the leaflet inside it, plus any remaining medicine with you.

Taking folic acid

You may be prescribed folic acid tablets while you're taking methotrexate. This is a synthetic version of vitamin B9 (also called folate).

Folic acid helps protect the healthy cells in your body and reduces some of the side effects of methotrexate. It can make you less likely to be sick (vomit) or get diarrhoea.

Your doctor will usually start you on one 5mg folic acid tablet, taken once a week. Take it the day after your methotrexate.

If you're still bothered by side effects, your doctor may increase the dose of folic acid. You may need to take 1 tablet 6 times a week, starting the day after you take your methotrexate.

Do not take folic acid on the same day as your methotrexate. It can stop your medicine from working properly.

When you first start treatment, you'll have a check-up and blood tests every 1 to 2 weeks. This is to check if the methotrexate is working and if it's causing any side effects.

Your doctor may increase or decrease your methotrexate dose, depending on the results of your tests.

It's important to record how much methotrexate you take and the results of your blood tests. You'll usually get a booklet for this.

Once you and your doctor have found the right dose and your treatment is working well, you'll have a check-up and blood tests every 2 to 3 months.

Common side effects

These common side effects of methotrexate may happen in more than 1 in 100 people. There are things you can do to help cope with them:

Speak to a doctor or pharmacist if the advice on how to cope does not help and a side effect is still bothering you or does not go away.

Serious side effects

Serious side effects are rare and happen in less than 1 in 10,000 people.

Tell your doctor or contact 111 immediately if you get:

  • yellowing of the whites of your eyes, or yellowing of your skin although this may be less obvious on brown or black skin – these may be signs of liver problems
  • a persistent cough, chest pain, difficulty breathing, or you become breathless – these may be signs of inflammation of your lungs
  • swollen hands, ankles or feet, changes to how often you pee or not peeing at all – these may be signs of kidney problems
  • a high temperature, chills, muscle aches, sore throat – these may be signs of an infection
  • bleeding gums, blood in your pee, vomiting blood or unexplained bruising – these may be signs of a blood disorder

Serious allergic reaction

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to methotrexate.

Methotrexate may increase the risk of problems with your liver or lungs, especially if you take a high dose.

However, your doctor will monitor you very closely and any concerns or problems will be found during routine check-ups.

Other side effects

These are not all the side effects of methotrexate. For a full list see the leaflet inside your medicines packet.

Methotrexate and pregnancy

Methotrexate is not recommended in pregnancy, as it can cause birth defects.

If you're taking methotrexate and want to get pregnant, speak to your doctor. They'll discuss whether you need to switch to a different medicine before stopping your contraception.

If you become pregnant while taking methotrexate, do not stop taking your medicine but speak to your doctor as soon as possible. They'll review your treatment and help you decide what to do next.

Your doctor will only prescribe methotrexate for you while you're pregnant if the benefits of the medicine outweigh the chances of it being harmful.

Methotrexate and breastfeeding

There is not much information about methotrexate and breastfeeding, but it shows that methotrexate passes into breast milk in tiny amounts. Your doctor or specialist will advise what's best for you and your baby.

If your weekly dose of methotrexate is 25mg or less, it may be possible to breastfeed. However, you must not breastfeed for 24 hours after taking your medicine. Your midwife or health visitor can give you advice about how to feed your baby while you wait 24 hours.

If your weekly dose is more than 25mg, your doctor will talk to you about what's best for you and your baby. You may still be able to breastfeed, but it will depend on your dose of methotrexate and any other medicines you're taking.

If you breastfeed while taking methotrexate, your baby will have blood tests to check for any side effects.

If you notice that your baby is not feeding as well as usual, is being sick or has diarrhoea, seem to be getting infections more regularly, or if you have any other concerns about your baby, talk to your health visitor, midwife or doctor as soon as possible.

Methotrexate and fertility

Methotrexate may reduce fertility. It may damage sperm in men and egg production in women.

Methotrexate can cause birth defects if taken during pregnancy. Ask your doctor about changing to a different medicine before you stop using contraception.

Cautions with other medicines

There are many medicines that affect the way methotrexate works.

Always show your patient card to healthcare professionals who may not know about your methotrexate treatment to alert them about your once weekly dose. For example, if you go to hospital or have a change in your care.

Children taking methotrexate must not have a live children's flu vaccine (this usually applies to children aged 2 to 17 years). Adults are given an inactivated flu vaccine and this usually does not cause problems with methotrexate.

Tell your doctor if you're taking any of these medicines before you start taking methotrexate:

  • non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, or cough and cold remedies containing NSAIDs
  • co-trimoxazole, trimethoprim or other antibiotics for bacterial infections
  • medicines that make you pee more (diuretics), such as indapamide or bendroflumethiazide
  • epilepsy medicines such as phenytoin or levetiracetam
  • theophylline, a medicine used to treat asthma
  • medicines used to treat indigestion, such as omeprazole
  • folic acid or vitamin supplements that contain folic acid (or folate) – this is because your doctor may prescribe folic acid to take with your methotrexate

These are not all the medicines that may affect methotrexate. Check the leaflet that comes with your medicine.

Mixing methotrexate with herbal remedies and supplements

Do not take vitamin and mineral supplements or any other products that contain folic acid (folate) if you're already taking folic acid prescribed by your doctor. Check the ingredients on the labels of any supplements.

There's not enough information to say whether it's safe to take other herbal remedies or supplements together with methotrexate. They're not tested in the same way as pharmacy and prescription medicines. They're generally not tested for the effect they have on other medicines.

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9,067 public posts

Methotrexate

Wallydb, I’m sorry but I have no experience with Methotrexate. Paddy
Wallydb, I’m sorry but I have no experience with Methotrexate. Paddy
GucciPaddy profile image
GucciPaddy
in PMRGCAuk
9 days ago

Methotrexate

I started on 15mg of Methotrexate on 18th March 2022 and ended up going up to 20mg of Methotrexate in November 2022 the idea of going on them was to cut down the Steroids and eventually come of Steroids.
I started on 15mg of Methotrexate on 18th March 2022 and ended up going up to 20mg of Methotrexate in November 2022 the idea of going on them was to cut down the Steroids and eventually come of Steroids.
Phed profile image
Phed
in PMRGCAuk
12 days ago

Methotrexate

Just wondering has this happened to anyone else After my weekly methotrexate injection in my leg it bruised and and bled more than usual, Will appreciate your replies love Anya
Just wondering has this happened to anyone else After my weekly methotrexate injection in my leg it bruised and and bled more than usual, Will appreciate your replies love Anya
Mattsdog1 profile image
Mattsdog1
in NRAS
14 days ago
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Methotrexate ;)

As I expected everything I have an issue with was explained to me then it was suggested I try Methotrexate So I said "OK" and there you go. I have to get back down to 5mg of pred from 9mg I've read so many good stories and some horrendous but I'm willing to give it a go.
As I expected everything I have an issue with was explained to me then it was suggested I try Methotrexate So I said "OK" and there you go. I have to get back down to 5mg of pred from 9mg I've read so many good stories and some horrendous but I'm willing to give it a go.
davidcantswim profile image
davidcantswim
in PMRGCAuk
1 month ago

methotrexate

Hi I am new on here, I was diagnosed 10 years ago and was given methotrexate tablets, they worked quite well an then about four months ago started making me feel dreadful nauseous and woolly headed, saw rheumatologist who said he would try and get me the injections, I stopped taking the tablets and now
Hi I am new on here, I was diagnosed 10 years ago and was given methotrexate tablets, they worked quite well an then about four months ago started making me feel dreadful nauseous and woolly headed, saw rheumatologist who said he would try and get me the injections, I stopped taking the tablets and now
JG52 profile image
JG52
in NRAS
2 months ago

Methotrexate

Hi I received a call yesterday from rheumatologist nurse she said my bloods last week are extremely high for liver tests I just moved up to 20mg of methotrexate last Monday. She said I have to stop them straight away. What will they try next. Thankyou
Hi I received a call yesterday from rheumatologist nurse she said my bloods last week are extremely high for liver tests I just moved up to 20mg of methotrexate last Monday. She said I have to stop them straight away. What will they try next. Thankyou
Brian1977 profile image
Brian1977
in NRAS
2 months ago

Methotrexate

For some reason doctors seem to want to get you off of Prednisone and often times put you on a dose of Methotrexate which was my case. Actually he wanted me on both and then when on the Methotrexate felt that I could immediately taper off of the Prednisone.
For some reason doctors seem to want to get you off of Prednisone and often times put you on a dose of Methotrexate which was my case. Actually he wanted me on both and then when on the Methotrexate felt that I could immediately taper off of the Prednisone.
Chris0808 profile image
Chris0808
in PMRGCAuk
2 months ago

methotrexate

Well normal for me… second attack came about a year later, this one is much worse, and having problems now lowering prednisolone below 25 mg … rheumatologist has now put me on methotrexate….
Well normal for me… second attack came about a year later, this one is much worse, and having problems now lowering prednisolone below 25 mg … rheumatologist has now put me on methotrexate….
TizzyS profile image
TizzyS
in PMRGCAuk
2 months ago

methotrexate

She said I have a choice that I can be on a low dose for the rest off my life or go onto methotrexate to help reduce. All I know about that is itt had very mixed reviews. Could anyone tell me more about this and whether it worked bea good idea to try it?
She said I have a choice that I can be on a low dose for the rest off my life or go onto methotrexate to help reduce. All I know about that is itt had very mixed reviews. Could anyone tell me more about this and whether it worked bea good idea to try it?
grannyouch profile image
grannyouch
in PMRGCAuk
3 months ago

Methotrexate

I did not accept methotrexate after reading other people's bed ridden experiences, I continued with prednisolone, I am now a lot better and off steroids after 5 years.
I did not accept methotrexate after reading other people's bed ridden experiences, I continued with prednisolone, I am now a lot better and off steroids after 5 years.
cherrysteps profile image
cherrysteps
in PMRGCAuk
3 months ago

methotrexate and night sweats

Hi all, just wondering if anyone else experiences night sweats from methotrexate?, and if so, any suggestions how to deal with it? I’m post menopausal but unsure if the night sweats are from the RA or the methotrexate. I take 25mg injections once a week. thanks for any suggestions
Hi all, just wondering if anyone else experiences night sweats from methotrexate?, and if so, any suggestions how to deal with it? I’m post menopausal but unsure if the night sweats are from the RA or the methotrexate. I take 25mg injections once a week. thanks for any suggestions
Frogsmack profile image
Frogsmack
in FieryBones - RA Community
27 days ago

methotrexate and night sweats

Hi all, just wondering if anyone else experiences night sweats from methotrexate?, and if so, any suggestions how to deal with it? I’m post menopausal but unsure if the night sweats are from the RA or the methotrexate. I take 25mg injections once a week.  thanks for any feedback or suggestions
Hi all, just wondering if anyone else experiences night sweats from methotrexate?, and if so, any suggestions how to deal with it? I’m post menopausal but unsure if the night sweats are from the RA or the methotrexate. I take 25mg injections once a week.  thanks for any feedback or suggestions
Frogsmack profile image
Frogsmack
in NRAS
27 days ago

Methotrexate query

Hi All,I started 15g Methotrexate injections 3 weeks ago. A variety of mini reactions, but expected. Nausea a bit, spots, but had a temp on Sat ( take it Wednesday evening), and feel a bit wheezy today. Has anybody had that when starting?
Hi All,I started 15g Methotrexate injections 3 weeks ago. A variety of mini reactions, but expected. Nausea a bit, spots, but had a temp on Sat ( take it Wednesday evening), and feel a bit wheezy today. Has anybody had that when starting?
cyprusmum profile image
cyprusmum
in NRAS
3 days ago

Avoiding Methotrexate

I have not been taking Methotrexate since 2012 . Is it a bad idea? Do I need to worry about long term effects of not using MTX? Thank you!
I have not been taking Methotrexate since 2012 . Is it a bad idea? Do I need to worry about long term effects of not using MTX? Thank you!
Amg21 profile image
Amg21
in NRAS
19 days ago

leflunomide/eye monitoring?

Not the methotrexate, and not leflunomide. hello, I have an appointment today for specialist eye monitoring. This has been done at regular intervals since I started methotrexate, HOWEVER…. I no longer take methotrexate as I’ve recently changed to leflunomide.
Not the methotrexate, and not leflunomide. hello, I have an appointment today for specialist eye monitoring. This has been done at regular intervals since I started methotrexate, HOWEVER…. I no longer take methotrexate as I’ve recently changed to leflunomide.
girli1111 profile image
girli1111
in NRAS
2 months ago

methotrexate/Breathing issues

and I didn’t dig deeper into the cause methotrexate was only recently added this summer has anyone had similar symptoms from methotrexate?
and I didn’t dig deeper into the cause methotrexate was only recently added this summer has anyone had similar symptoms from methotrexate?
Myfoe profile image
Myfoe
in PMRGCAuk
3 months ago

Methotrexate Injection

Have just received a phone call telling me that my first injection/instruction is indeed taking place today in half an hour. Feeling apprehensive, any support would be welcome. Thanks.
Have just received a phone call telling me that my first injection/instruction is indeed taking place today in half an hour. Feeling apprehensive, any support would be welcome. Thanks.
Rachmaninov2 profile image
Rachmaninov2
in PMRGCAuk
2 months ago

Change of medication

RA diagnosis December 2020.Due to lockdown wasn't put on methotrexate till March 2021.Felt great but it caused scarring on my liver so had to stop methotrexate January 2022.Waited till August to start Filgotinib but this didn't help me.Have waited since November 2022 for Etanercept.Feel really awful
RA diagnosis December 2020.Due to lockdown wasn't put on methotrexate till March 2021.Felt great but it caused scarring on my liver so had to stop methotrexate January 2022.Waited till August to start Filgotinib but this didn't help me.Have waited since November 2022 for Etanercept.Feel really awful
GrannyCarson profile image
GrannyCarson
in FieryBones - RA Community
18 days ago

Psoriasis

Psoriasis and methotrexate
Psoriasis and methotrexate
Juliscool profile image
Juliscool
in Women's Health
3 months ago

methotrexate

Hello to all I started Methotrexate on Monday, my first dose. On Wednesday afternoon my body temperature dropped to 35 and I feel cold sweats. Today I am still having low temperature. Went to the ER where they listened my lungs and tested my urin. All good. anyone with similar symptoms?
Hello to all I started Methotrexate on Monday, my first dose. On Wednesday afternoon my body temperature dropped to 35 and I feel cold sweats. Today I am still having low temperature. Went to the ER where they listened my lungs and tested my urin. All good. anyone with similar symptoms?
CREATIA6_ profile image
CREATIA6_
in LUPUS UK
4 months ago
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