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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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9,187 public posts

Newly diagnosed Rheumatoid Arthritis experiencing very bad pain

Started on 15mg of Methotrexate. I had no visible reaction to Methotrexate. About two weeks ago started to feel worse and started 20g course of prednisone. Over the weekend pain started suddenly in my hips for about four days before reducing.
Started on 15mg of Methotrexate. I had no visible reaction to Methotrexate. About two weeks ago started to feel worse and started 20g course of prednisone. Over the weekend pain started suddenly in my hips for about four days before reducing.
Yogachick2 profile image
Yogachick2
in NRAS
2 years ago

Unsympathetic Family

I was diagnosed with RA 2 years ago. I have felt ill for years but put it down to OA, Fibromyalgia and menopause. My consultant was of the opinion that I have had RA for a very long time. I was relieved to have a diagnosis but worried about how I would cope living alone. At present I am on two injections
I was diagnosed with RA 2 years ago. I have felt ill for years but put it down to OA, Fibromyalgia and menopause. My consultant was of the opinion that I have had RA for a very long time. I was relieved to have a diagnosis but worried about how I would cope living alone. At present I am on two injections
tazman3 profile image
tazman3
in FieryBones - RA Community
2 years ago

Covid Vaccine

I take methotrexate 20mgs and Benapali weekly and i am having the covid vaccine tomorrow. Has anyone else had the vaccine who is on these meds and if so did you have any adverse reactions?
I take methotrexate 20mgs and Benapali weekly and i am having the covid vaccine tomorrow. Has anyone else had the vaccine who is on these meds and if so did you have any adverse reactions?
sallyc profile image
sallyc
in NRAS
2 years ago
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Well, I just could not do methotrexate. It was awful. Started leflunomide yesterday. Have any of you used this drug? Side effects?

Leflunomide
Leflunomide
Interpreter profile image
Interpreter
in NRAS
2 years ago

Hydroxy

I have methotrexate injection once a week but nothing else It’s been a week now not really any changes except headaches . I was told there would be no side affects . Joints sort of ok What do you think ? By the way the tinnitus is still there !
I have methotrexate injection once a week but nothing else It’s been a week now not really any changes except headaches . I was told there would be no side affects . Joints sort of ok What do you think ? By the way the tinnitus is still there !
Liz018 profile image
Liz018
in NRAS
2 years ago

Methotrexate. How low should immune response be?

I wonder if anyone could help to answer this question. I will be contacting my GP, but with several of their staff off with covid the lines are busy. I've been on 20mg metoject pen for 8wks. My most recent bloods came back with several abnormal results. Most being the ones to do with immune response
I wonder if anyone could help to answer this question. I will be contacting my GP, but with several of their staff off with covid the lines are busy. I've been on 20mg metoject pen for 8wks. My most recent bloods came back with several abnormal results. Most being the ones to do with immune response
cakenomore profile image
cakenomore
in NRAS
2 years ago

Alcohol and methotrexate

None since starting methotrexate etc and am a little scared of truth be told 😳
None since starting methotrexate etc and am a little scared of truth be told 😳
Gottaloveastaffy profile image
Gottaloveastaffy
in NRAS
2 years ago

Update on my granddaughter

Hi all Our youngest granddaughter had her Ophthalmology appointment today and I'm very pleased to say it went very well and her eyes are good, the Humira and Methotrexate are working very well.
Hi all Our youngest granddaughter had her Ophthalmology appointment today and I'm very pleased to say it went very well and her eyes are good, the Humira and Methotrexate are working very well.
Hidden profile image
Hidden
in Positive Wellbeing During Self-Isolation
2 years ago

ACR: Vaccinate patients with musculoskeletal, inflammatory, autoimmune disease for COVID-19

“For example, an RA patient with well-controlled disease may benefit from holding a dose of methotrexate immediately following vaccination,” David Karp, MD, PhD, president of the ACR, said in the release.
“For example, an RA patient with well-controlled disease may benefit from holding a dose of methotrexate immediately following vaccination,” David Karp, MD, PhD, president of the ACR, said in the release.
lupus-support1 profile image
lupus-support1
Administratorin LUpus Patients Understanding and Support
2 years ago

Meds, chocolate and migraines

I’m kicking myself... I’ve always been a chocoholic, so in my 30’s (pre RA), I munched away merrily on chocolate, I suffered awful headaches really, really bad ones and they’d last for days, weeks even. I also had hay fever, so put these headaches down to allergic rhinitis. Took antihistamine and paracetamol
I’m kicking myself... I’ve always been a chocoholic, so in my 30’s (pre RA), I munched away merrily on chocolate, I suffered awful headaches really, really bad ones and they’d last for days, weeks even. I also had hay fever, so put these headaches down to allergic rhinitis. Took antihistamine and paracetamol
Brushwork profile image
Brushwork
in NRAS
2 years ago

Blood test result worried

Hi everyone, can you help, I'm a bit worried :( My GP rang me about my regular MTX blood test.. He is concerned it shows anaemia and inflammation, which I've shown before, nothing new He said it's probably just from the RA, or the MTX. (I'm on Metaject 15mg for 3 years now ) -But he said to let
Hi everyone, can you help, I'm a bit worried :( My GP rang me about my regular MTX blood test.. He is concerned it shows anaemia and inflammation, which I've shown before, nothing new He said it's probably just from the RA, or the MTX. (I'm on Metaject 15mg for 3 years now ) -But he said to let
jimmx profile image
jimmx
in NRAS
2 years ago

Hydroxychloraquine

Hello, has anyone had itchy eyes while on hydroxy? I’m also on mtx. It’s driving me mad! 😁TIA
Hello, has anyone had itchy eyes while on hydroxy? I’m also on mtx. It’s driving me mad! 😁TIA
gilox profile image
gilox
in NRAS
2 years ago

Leg Muscle Aches after not taking MTX

I was diagnosed with some form of RA about 4 years ago, they were not sure what form I had but because there is a history of psoriasis in my family it could be the psoriatic type. I was put on MTX which appears to have been fairly successful. I was so scared of catching Covid that I stopped the MTX for
I was diagnosed with some form of RA about 4 years ago, they were not sure what form I had but because there is a history of psoriasis in my family it could be the psoriatic type. I was put on MTX which appears to have been fairly successful. I was so scared of catching Covid that I stopped the MTX for
mole147 profile image
mole147
in NRAS
2 years ago

Some better new

So I should take methotrexate as well. I got some bloods done there today as well. I really hope now that if he writes to my local hospital they will take up his recommendation for it. I never get my hopes up for these London appointments as they always seem to go badly.
So I should take methotrexate as well. I got some bloods done there today as well. I really hope now that if he writes to my local hospital they will take up his recommendation for it. I never get my hopes up for these London appointments as they always seem to go badly.
LouLamb profile image
LouLamb
in LUPUS UK
2 years ago

HRT & Methotrexate

I’m Perimenopause and I might be starting combined HRT patches soon and I’m taking methotrexate injections. Any one on here on these medications and how are they working together? I will be talking options with my dr soon. Thanks
I’m Perimenopause and I might be starting combined HRT patches soon and I’m taking methotrexate injections. Any one on here on these medications and how are they working together? I will be talking options with my dr soon. Thanks
Muds68 profile image
Muds68
in NRAS
2 years ago

HRT & METHOTREXATE

I’m Perimenopause and I might be starting combined HRT patches soon and I’m taking methotrexate injections. Any one on here on these medications and how are they working together? I will be talking options with my dr soon. Thanks
I’m Perimenopause and I might be starting combined HRT patches soon and I’m taking methotrexate injections. Any one on here on these medications and how are they working together? I will be talking options with my dr soon. Thanks
Muds68 profile image
Muds68
in Arthritis Action
2 years ago

MTX bloods

The results of my blood tests have been open for me to see on my GPS website until yesterday. It's now blocked together with my health record. Has anyone had this, please?
The results of my blood tests have been open for me to see on my GPS website until yesterday. It's now blocked together with my health record. Has anyone had this, please?
Whitegate profile image
Whitegate
in NRAS
2 years ago

Don't be like Garnacha - Follow own advice

Don't be like Garnacha, last week Garnacha was very pleased with herself that the advice given by the consultant to take cyclazine an hour before MTX and the next morning worked and she didn't feel sick for 5 - 6 days, she was so pleased with herself that she couldn't wait to tell everyone how much better
Don't be like Garnacha, last week Garnacha was very pleased with herself that the advice given by the consultant to take cyclazine an hour before MTX and the next morning worked and she didn't feel sick for 5 - 6 days, she was so pleased with herself that she couldn't wait to tell everyone how much better
Garnacha profile image
Garnacha
in NRAS
2 years ago

Hi Everyone, i'm new here.

My medication journey to date: Methotrexate. 2 weeks. Started on this as tablets. My body couldn't tolerate it, in fact it made the pain excruciating to the point of tears when i got to 6 tablets a day on a steadily ramped dose. Had to come of it. I had no bad side effects as listed.
My medication journey to date: Methotrexate. 2 weeks. Started on this as tablets. My body couldn't tolerate it, in fact it made the pain excruciating to the point of tears when i got to 6 tablets a day on a steadily ramped dose. Had to come of it. I had no bad side effects as listed.
CRich58 profile image
CRich58
in NRAS
2 years ago

operation and stopping MTX

I am due to have an elbow release operation on 8th April which is a Thursday and inject on a Friday but I am not sure whether to stop MTX week before then not have it on that Friday or say the 9th then the following Friday. Do I stop the folic acid daily or carry on with that. The nurse at pre op said
I am due to have an elbow release operation on 8th April which is a Thursday and inject on a Friday but I am not sure whether to stop MTX week before then not have it on that Friday or say the 9th then the following Friday. Do I stop the folic acid daily or carry on with that. The nurse at pre op said
Flor1rence profile image
Flor1rence
in NRAS
2 years ago
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