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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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9,204 public posts

Ultrasound scan of armpits tomorrow

I finished pred after 5 and 1/2 end of April, but still on 25 mg methotrexate once a week and fortnightly tocillizumab injections. As usual my bloods are unremarkable just had more done yesterday and results already on my patient access.
I finished pred after 5 and 1/2 end of April, but still on 25 mg methotrexate once a week and fortnightly tocillizumab injections. As usual my bloods are unremarkable just had more done yesterday and results already on my patient access.
Pamela60 profile image
Pamela60
in PMRGCAuk
2 years ago

Losing job

I have RA and take methotrexate and have been working from home for the last fifteen months Although I hate the job and it was minimum wage it came in handy at the time that it was remote and I desperately needed the money.
I have RA and take methotrexate and have been working from home for the last fifteen months Although I hate the job and it was minimum wage it came in handy at the time that it was remote and I desperately needed the money.
Sue4983 profile image
Sue4983
in NRAS
2 years ago

GCA and RA

I have been prescribed Methatrexate alongside prednisolone. I have tried Sulfasaladine, but can’t cope with side effects. Has any one got ant tips please about when to take Mtx please. Also are the side events unpleasant. Thanks
I have been prescribed Methatrexate alongside prednisolone. I have tried Sulfasaladine, but can’t cope with side effects. Has any one got ant tips please about when to take Mtx please. Also are the side events unpleasant. Thanks
Kyrenia profile image
Kyrenia
in PMRGCAuk
2 years ago
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Lupus and Covid19 Johnson and johnson vaccine

I have Lupus and taking methotrexate, prednisone and plasmquin. My doctor suggested that I take the vaccine and stop methotrexate for a week. I am so scared, any one who has been vaccinated already, please advise on the side effects.
I have Lupus and taking methotrexate, prednisone and plasmquin. My doctor suggested that I take the vaccine and stop methotrexate for a week. I am so scared, any one who has been vaccinated already, please advise on the side effects.
sthethela87 profile image
sthethela87
in LUpus Patients Understanding and Support
2 years ago

Sensible GP, Rheumatologist not so much…

He’s going to write to my GP and get him to prescribe methotrexate. Been reading up about it and really not sure about it. So, June 2021, I’m now back to taking 11mg of prednisolone, still have terrible fatigue but feeling less pain. Doing slow taper to 10mg.
He’s going to write to my GP and get him to prescribe methotrexate. Been reading up about it and really not sure about it. So, June 2021, I’m now back to taking 11mg of prednisolone, still have terrible fatigue but feeling less pain. Doing slow taper to 10mg.
Spittal9 profile image
Spittal9
in PMRGCAuk
2 years ago

CAN'T WAIT TO ACTUALLY SEE THE NHS RHEUMATOLOGY CLINIC!

I've been tapering off the steroids whilst waiting for the addition of Lef to take effect which was added in March this year alongside the Etoricoxib, Hydroxy, Methotrexate & Gabapentin, I finished the steroids completely at the end of August and the pain which had already started to come back just got
I've been tapering off the steroids whilst waiting for the addition of Lef to take effect which was added in March this year alongside the Etoricoxib, Hydroxy, Methotrexate & Gabapentin, I finished the steroids completely at the end of August and the pain which had already started to come back just got
Garnacha profile image
Garnacha
in NRAS
2 years ago

New RA diagnosis, feeling anxious!

I was diagnosed with RA a few weeks ago and have started sulfasalazine and hydroxychloriquine and will probably need to add methotrexate too as my disease is very active. I also had a steroid injection last week while I wait for the drugs to kick in.
I was diagnosed with RA a few weeks ago and have started sulfasalazine and hydroxychloriquine and will probably need to add methotrexate too as my disease is very active. I also had a steroid injection last week while I wait for the drugs to kick in.
Remembermylast profile image
Remembermylast
in NRAS
2 years ago

How to treat lethargy on MTX?

Hi there folks, I've been diagnosed with RA about 9 months now, in that time I've gone from 20mg MTX tablets and 5mg folic acid ( which worked well for the condition but gave intermittent nausea ) to 20mg Metoject pen ( which has been reduced from 25mg due to toxicity but provides 85 -90% symptom relief
Hi there folks, I've been diagnosed with RA about 9 months now, in that time I've gone from 20mg MTX tablets and 5mg folic acid ( which worked well for the condition but gave intermittent nausea ) to 20mg Metoject pen ( which has been reduced from 25mg due to toxicity but provides 85 -90% symptom relief
Buugs profile image
Buugs
in NRAS
2 years ago

Level of protection from the P

With reduced immunity due to methotrexate, how much protection does the covid vaccine give?
With reduced immunity due to methotrexate, how much protection does the covid vaccine give?
TEDDYM profile image
TEDDYM
in LUPUS UK
2 years ago

New member

I was diagnosed with fibromyalgia in 2012 and rheumatoid arthritis two days ago and I have started steroids and methotrexate.
I was diagnosed with fibromyalgia in 2012 and rheumatoid arthritis two days ago and I have started steroids and methotrexate.
Gloriana profile image
Gloriana
in FieryBones - RA Community
2 years ago

Positive rheumy appointment

He really listened and had a really gentle manner. 3 years ago I'd been advised by the rheumy nurse to take methotrexate every other week due to hair thinning. He was quite horrified by this and made me promise to take a lower dose but weekly.
He really listened and had a really gentle manner. 3 years ago I'd been advised by the rheumy nurse to take methotrexate every other week due to hair thinning. He was quite horrified by this and made me promise to take a lower dose but weekly.
Suet3942 profile image
Suet3942
in PMRGCAuk
2 years ago

Sun sensitivity

Methotrexate and Benepali. I always slap on sunscreen when playing golf but am not so careful when out and about or gardening.I shall now go for long sleeves but just wonder if anyone else has experienced the same and what have you found best to relieve the symptoms?
Methotrexate and Benepali. I always slap on sunscreen when playing golf but am not so careful when out and about or gardening.I shall now go for long sleeves but just wonder if anyone else has experienced the same and what have you found best to relieve the symptoms?
Pythagorus profile image
Pythagorus
in NRAS
2 years ago

Low CRP

I have been on Methotrexate for years and Benepali for quite a few My CRP is under 1 can anyone explain how this can be please ?
I have been on Methotrexate for years and Benepali for quite a few My CRP is under 1 can anyone explain how this can be please ?
vonniesims profile image
vonniesims
in NRAS
2 years ago

Mtx

Hi hope everyone is keeping as well as they can Does anyone find that the day or even 2 after taking their dose of MTX that they have more then usual visits to the loo?
Hi hope everyone is keeping as well as they can Does anyone find that the day or even 2 after taking their dose of MTX that they have more then usual visits to the loo?
Hidden profile image
Hidden
in NRAS
2 years ago

Massive flair

Here I go again!PMR since May 2018.Have flared several times ,the pain just creeps up on you- I have hip bursitis, a painful knee which am having MRI for ,and the usual aching buttocks,shoulders,ache in sternum ,aching behind knees and can’t walk v far mainly cos of hip pain So went from Pred 2 mg to
Here I go again!PMR since May 2018.Have flared several times ,the pain just creeps up on you- I have hip bursitis, a painful knee which am having MRI for ,and the usual aching buttocks,shoulders,ache in sternum ,aching behind knees and can’t walk v far mainly cos of hip pain So went from Pred 2 mg to
bakingD profile image
bakingD
in PMRGCAuk
2 years ago

Amoxicillin and MTX

Hi all. You may remember my post about having a cold a little while back. Well this has developed into a chest infection and my GP had insisted I take two weeks off work even though I work from home and has advised I shield for the two weeks as well due to high covid cases in my area, which is fair enough
Hi all. You may remember my post about having a cold a little while back. Well this has developed into a chest infection and my GP had insisted I take two weeks off work even though I work from home and has advised I shield for the two weeks as well due to high covid cases in my area, which is fair enough
Pink75928 profile image
Pink75928
in NRAS
2 years ago

Probiotics when on metal and biologics for RA?

Hi I was wondering if it would be safe to take a probiotic tablet as I’m on methotrexate and tocilizumab for RA? I have had chest infection and heard probiotic good after them but just wondering if anyone would know if they were ok to take it on this treatment for RA?
Hi I was wondering if it would be safe to take a probiotic tablet as I’m on methotrexate and tocilizumab for RA? I have had chest infection and heard probiotic good after them but just wondering if anyone would know if they were ok to take it on this treatment for RA?
Florida100 profile image
Florida100
in NRAS
2 years ago

Shin and forearm pains??

I have RA and on methotrexate and hydroxychloroquine sulphate, officially ‘in remission’, but fatigues always! In the last two weeks one ankle has swollen painfully, and the knee on the other leg....
I have RA and on methotrexate and hydroxychloroquine sulphate, officially ‘in remission’, but fatigues always! In the last two weeks one ankle has swollen painfully, and the knee on the other leg....
girli1111 profile image
girli1111
in NRAS
2 years ago

MTX holiday

Have any of you temporarily paused methotrexate? I have a family trip planned which will involve a long drive and a week visiting people etc. I can't imagine me coping with this as well as MTX side effects, particularly brain fog and nausea. I wondered whether I could skip that weeks dose.
Have any of you temporarily paused methotrexate? I have a family trip planned which will involve a long drive and a week visiting people etc. I can't imagine me coping with this as well as MTX side effects, particularly brain fog and nausea. I wondered whether I could skip that weeks dose.
HallySim profile image
HallySim
in NRAS
2 years ago

Chrons and MTX tablets

Has anyone on here who suffers from mild Chron's Disease with a lot of dietary issues taken MTX tablets? I ask because, from next week, I am going to be switching from pens to tablets. Due to side affects I sometimes have to lower my dose for a couple of weeks and it is such a waste of pens doing
Has anyone on here who suffers from mild Chron's Disease with a lot of dietary issues taken MTX tablets? I ask because, from next week, I am going to be switching from pens to tablets. Due to side affects I sometimes have to lower my dose for a couple of weeks and it is such a waste of pens doing
Knip profile image
Knip
in NRAS
2 years ago
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