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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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9,194 public posts

Methotrexate and blood tests

I was switched from oral methotrexate to metoject pens 10 weeks ago and have shared care between GP and rheumatology meaning I can have my bloods taken at my local hospital or my GP surgery , rheumatology issue the blood forms as the monthly results need to go back to rheumatology first so that my next
I was switched from oral methotrexate to metoject pens 10 weeks ago and have shared care between GP and rheumatology meaning I can have my bloods taken at my local hospital or my GP surgery , rheumatology issue the blood forms as the monthly results need to go back to rheumatology first so that my next
Topcar profile image
Topcar
in PMRGCAuk
7 months ago

Potential Potency of Methotrexate taken by Metoject.

I am taking 7.5mg of methotrexate by Metoject, the nurse who instructed me advised that this method could increase the potency significantly as it goes straight into the blood stream rather than being metabolised as tablets are.
I am taking 7.5mg of methotrexate by Metoject, the nurse who instructed me advised that this method could increase the potency significantly as it goes straight into the blood stream rather than being metabolised as tablets are.
Rachmaninov2 profile image
Rachmaninov2
in PMRGCAuk
4 months ago

Adalimumab?

It seems to be called a few different names and also seems to be used alongside Methotrexate or something else. I will only be taking it on its own as I can’t take Methotrexate. Is anyone else using it on its own?
It seems to be called a few different names and also seems to be used alongside Methotrexate or something else. I will only be taking it on its own as I can’t take Methotrexate. Is anyone else using it on its own?
barbieg profile image
barbieg
in NRAS
8 months ago
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None bleeds

Has anyone on Rituximab and methotrexate experienced nose bleeds I'm trying to figure out if its related to the meds.
Has anyone on Rituximab and methotrexate experienced nose bleeds I'm trying to figure out if its related to the meds.
Youelbeverly profile image
Youelbeverly
in NRAS
8 months ago

RA review

My drugsBenepali and Methotrexate both prescribed by the consultant at hospital. I have never before had a review at the medical centre and until now I had never heard of an assistant physician. (Google helped me here)! Has anyone else had a review ?
My drugsBenepali and Methotrexate both prescribed by the consultant at hospital. I have never before had a review at the medical centre and until now I had never heard of an assistant physician. (Google helped me here)! Has anyone else had a review ?
Pythagorus profile image
Pythagorus
in NRAS
3 months ago

Cough cough cough - Methotrexate?

I have PMR/GCA/LVV – all currently under control on 5mg Pred and 25mg MTX. However… I’ve had a terrible cough for three weeks now. Thank the Lord for Tena Ladies! I’ve gone through a bottle of Kovonia from the local pharmacist; a course of Doxycycline 100mg antibiotics from GP1 (telephone consult)
I have PMR/GCA/LVV – all currently under control on 5mg Pred and 25mg MTX. However… I’ve had a terrible cough for three weeks now. Thank the Lord for Tena Ladies! I’ve gone through a bottle of Kovonia from the local pharmacist; a course of Doxycycline 100mg antibiotics from GP1 (telephone consult)
JanetRosslyn profile image
JanetRosslyn
in PMRGCAuk
7 months ago

Lower back pain

Neurontin, Losartan, Amitriptyline, OMEPRAZOLE, Methotrexate, Furosemide, Amlodipine, Atorvastatin, Eternacept Injections, Prednisolone, Folic Acid, Aspirin and Aciferol(Colecalciferol).
Neurontin, Losartan, Amitriptyline, OMEPRAZOLE, Methotrexate, Furosemide, Amlodipine, Atorvastatin, Eternacept Injections, Prednisolone, Folic Acid, Aspirin and Aciferol(Colecalciferol).
gulshanmunshi profile image
gulshanmunshi
in NRAS
26 days ago

Methotrexate and folic acid

Hey Fam I'm starting these meds tomorrow 10 mg methotrexate weekly and 1mg folic acid daily. i have read several post about these meds and feel a little better about taking them. Most post are for RA, but i have OA in multiple joints and it's been miserable for the last month or more.
Hey Fam I'm starting these meds tomorrow 10 mg methotrexate weekly and 1mg folic acid daily. i have read several post about these meds and feel a little better about taking them. Most post are for RA, but i have OA in multiple joints and it's been miserable for the last month or more.
1bozyact profile image
1bozyact
in NRAS
7 months ago

sinusitis and RA

Methotrexate related? Has anyone else suffered this? I live in London so there is a lot of pollution around.
Methotrexate related? Has anyone else suffered this? I live in London so there is a lot of pollution around.
coralflux profile image
coralflux
in NRAS
7 months ago

covid and flu jam with methotrexate injections

Hello I have been taking methotrexate for about 6 months the last 2 months has been injections. do I take my methotrexate when I am going to have my covid and flu jabs?
Hello I have been taking methotrexate for about 6 months the last 2 months has been injections. do I take my methotrexate when I am going to have my covid and flu jabs?
Knitwits profile image
Knitwits
in PMRGCAuk
8 months ago

thyroid nodule treatment

I have Rheumatoid Arthritis and have been taking Methotrexate for a long time but I also have thyroid nodules which I have had for quite a few years . I had an ultrasound scan recently which confirmed this .
I have Rheumatoid Arthritis and have been taking Methotrexate for a long time but I also have thyroid nodules which I have had for quite a few years . I had an ultrasound scan recently which confirmed this .
Sue4983 profile image
Sue4983
in Thyroid UK
1 month ago

Just little help

Came off that and spent months just on methotrexate in the mean time I just got sicker and sicker some times just spending days upon end in bed...
Came off that and spent months just on methotrexate in the mean time I just got sicker and sicker some times just spending days upon end in bed...
Sueh121268 profile image
Sueh121268
in NRAS
3 months ago

Bad pain day - tips

I had a stomach bug over Christmas, missed a dose of methotrexate, and now I have a killer RA flare. I've been resting, gentle movement, painkillers, hot baths etc and am hoping it will resolve. If it lasts 7 days I'll get in touch with my team for steroids .
I had a stomach bug over Christmas, missed a dose of methotrexate, and now I have a killer RA flare. I've been resting, gentle movement, painkillers, hot baths etc and am hoping it will resolve. If it lasts 7 days I'll get in touch with my team for steroids .
snotts profile image
snotts
in NRAS
5 months ago

Headaches and dizziness

feeling generally lousy while taking sulfasalazine,was advised to stop taking it a couple of years ago for a couple of weeks by rheumie nurses because of bad headaches, they cleared up and was told to start them again, been okay up until recently now all the above symptoms have come back, also take methotrexate
feeling generally lousy while taking sulfasalazine,was advised to stop taking it a couple of years ago for a couple of weeks by rheumie nurses because of bad headaches, they cleared up and was told to start them again, been okay up until recently now all the above symptoms have come back, also take methotrexate
Jeremycfc profile image
Jeremycfc
in NRAS
5 months ago

Adalimumab & Fatigue

I started on Amgevita (Adalimumab) in mid-December after 6 wobbly years on Methotrexate (15mg injection). Disease activity was increasing but other drugs tried made me unwell. Steroids worked well but not sustainable. I eventually agreed to get onto biologics with some trepidation.
I started on Amgevita (Adalimumab) in mid-December after 6 wobbly years on Methotrexate (15mg injection). Disease activity was increasing but other drugs tried made me unwell. Steroids worked well but not sustainable. I eventually agreed to get onto biologics with some trepidation.
hope-always316 profile image
hope-always316
in NRAS
4 months ago

Methotrexate injections and bleeding.

I had been on 15mg mtx injections for 7 months about to increase to 20mgs. However, they discovered blood in stool as well as increased size in blood cells. MTX was stopped, and I had a colonscope as well as endoscopy to find source of bleeding. Nothing sinister was found apart from a few polyps.
I had been on 15mg mtx injections for 7 months about to increase to 20mgs. However, they discovered blood in stool as well as increased size in blood cells. MTX was stopped, and I had a colonscope as well as endoscopy to find source of bleeding. Nothing sinister was found apart from a few polyps.
Cheylann profile image
Cheylann
in NRAS
7 months ago

Diagnosis - What to expect?

Hi, I was diagnosed with Sjogren's and auto immune hypothyroidism in 2017, currently taking 10mg methotrexate, I have suspected I have lupus too for a while, but lack of doctor appointments due to Covid and their general disinterest when I did have an appointment meant I carried on with no formal tests
Hi, I was diagnosed with Sjogren's and auto immune hypothyroidism in 2017, currently taking 10mg methotrexate, I have suspected I have lupus too for a while, but lack of doctor appointments due to Covid and their general disinterest when I did have an appointment meant I carried on with no formal tests
MyAngels profile image
MyAngels
in LUPUS UK
19 days ago

The result - PMR!

Methotrexate will be added in at next appointment at the end of January in the hope that the Pred can be tapered faster than usual. He’s testing for Rheumatoid Arthritis and blood cancers. That’s it. I’m relieved but utterly dreading the whole Pred thing again.
Methotrexate will be added in at next appointment at the end of January in the hope that the Pred can be tapered faster than usual. He’s testing for Rheumatoid Arthritis and blood cancers. That’s it. I’m relieved but utterly dreading the whole Pred thing again.
Bramble2000 profile image
Bramble2000
in PMRGCAuk
5 months ago

Leflunomide or Tocilizumab

Initially I resisted the offer of methotrexate and tried to reduce prednisolone gradually, however after more flares and unable to get below 12 mg prednisolone I opted to add Methotrexate as a steroid sparing agent in August 2021.
Initially I resisted the offer of methotrexate and tried to reduce prednisolone gradually, however after more flares and unable to get below 12 mg prednisolone I opted to add Methotrexate as a steroid sparing agent in August 2021.
Talyfan profile image
Talyfan
in PMRGCAuk
1 month ago

rhuematoid arthritis

Methotrexate
Methotrexate
remission profile image
remission
in NRAS
4 months ago
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