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Methotrexate can treat a range of conditions, such as rheumatoid in humans or adults with cancer.

RA; a condition in which the body attacks its own joints, causing pain, swelling, and loss of function) that cannot be controlled by certain other medications.

Methotrexate works by reducing folic acid in the body, causing folic acid depletion.

The body needs folic acid for good digestive (GI) and liver health.

Methotrexate has the potential to cause nausea, vomiting, or nausea.

A person with rheumatoid arthritis can also use folic acid supplements in their diet to avoid side effects.

About methotrexate

Methotrexates are an immuno-blocking drug.

The medication reduces the amount of inflammation in the body and helps to prevent infections.

People take methotrexate to relieve pain in people intolerant to inflammatory diseases such as sarcoidosis and other forms of chronic inflammation.

Methotrexate is by prescription only.

The products come in methotrexate tablets, liquid drinks, and ready-to-inject syringes.

Your doctor will sometimes suggest injections to treat the pain.

It is administered by injection for cancer treatments.

Why is this medication prescribed?

Methotrexate is in a class of medications called antimetabolites.

It also can suppress the immune system. The drug makes your immune system less active.

Methotrexate treats cancer by slowing the growth of cancer cells. These include breast cancer, lung cancer, some cancers of the head and neck, leukemia, and certain types of lymphoma.

Methotrexate treats psoriasis by slowing the growth of skin cells to stop scales from forming.

Methotrexate may treat rheumatoid arthritis by decreasing the activity of the immune system.

Methotrexate is a medication that doctors prescribe to treat certain conditions, including adult rheumatoid arthritis, some cancers, and severe psoriasis.

Psoriasis is a skin disease that causes red, scaly, itchy patches to form on the body. Methotrexate slows the growth of skin cells which keeps scales from forming.

Methotrexate (brand names: Rheumatrex and Trexall) also can be used to treat Crohn’s disease, multiple sclerosis, and other autoimmune diseases.


Your physician should regularly check your progress, to ensure your medication is working properly and that you can prevent unwanted side effects.

Blood testing can be necessary as the test can reveal any undesirable side effects.

Some severe side effects can occur without causing any symptoms you would immediately notice.

Your physician will want to monitor you with blood tests more frequently early on in treatment.

Pregnancy and fertility

You will be tested for pregnancy if you have children before starting this treatment.

Using a pregnancy-related drug can lead to serious health consequences.

The medication can cause congenital disabilities if taken during pregnancy by an adult.

Female patients must use effective fertility control during treatment and within three months of receiving their first dose.


Your doctor may advise you not to use methotrexate if you drink or have ever consumed large amounts of alcohol, or have ever had liver disease because there is a higher risk of developing liver damage.

Your doctor will check your liver function regularly since methotrexate can sometimes cause toxic effects on the liver.


Taking a methotrexate pill for rheumatoid arthritis may cause recurrent pain and increases sensitivity.

Bad side effects to be reported

Check with your doctor right away if you have a rash, itching, dizziness, fainting, fast heartbeat, trouble breathing or swallowing, or chest tightness while you are using this medicine

How should this medicine be used?

Methotrexate can be administered in tablets, liquids or injectables.

Your doctor will tell you how long to use methotrexate.

This schedule may vary based on the condition or response of your body and will depend on the medication.

Protocol must be carefully supervised when taking methotrexate.

Taking a methotrexate pill for arthritis may cause recurrent pain and increases sensitivity.


Methotrexate can potentially be a life-long adverse reaction.

Methotrexate is recommended to treat severe diseases only.

Tell your doctor if you are taking any over the counter other medicines or nonsteroidal anti inflammatory drugs

Report to your physician if you have any of the following.

Kidney Failure

If your stomach was filled up and your lungs were enlarged or if you had renal failure.

Ulcerative colitis

If you have or have ever had stomach ulcers or ulcerative colitis (a condition that causes swelling and sores in the lining of the colon [large intestine] and rectum).

Report these symptoms

If you have difficulty breathing blistering, peeling, or loosening of the skin, blue-green to black skin discoloration, cough, cracks in the skin, diarrhea, itching, joint or muscle pain, loss of heat from the body, red, irritated eyes, red skin lesions, often with a purple center, sore throat, sores, ulcers, or white spots in the mouth or on the lips, fever or chills, or unusual tiredness or weakness while you are using this medicine.

Sun exposure

This medicine may make your skin more sensitive to sunlight. Wear sunscreen, eye protection, and a hat. Do not use sunlamps or tanning beds.

Infections and Bleeding

It is uncommon to get serious infections while taking methotrexate.

However, methotrexate does act on the immune system.

Signs of infection include:

  • Fever over 101 degrees.
  • Production of colored sputum.
  • Pain on passing your urine.
  • Development of a boil on the skin.


You should promptly evaluate abnormal bleeding, such as from the gums or in the urine, or material that looks like coffee grounds. Purple spots on the legs could signify slight bleeding into the skin.

If the infection is severe, you will probably need to have your blood count checked since a low white blood cell count could worsen the problem.

If anyone experiences severe side effects, such as bleeding, they may require hospitalization to check blood levels and for other treatments.


The medicine may also cause congenital disabilities if it is used by the father when his sexual partner becomes pregnant.

If you are a woman who can bear children, your doctor may give you a pregnancy test before you start using this medicine to make sure you are not pregnant.

Tell your doctor immediately if pregnancy occurs while using this medicine.


It is advisable to significantly limit drinking alcohol, while taking methotrexate can be harmful. At times the doctor might choose to avoid methotrexate if you aren’t going to limit alcohol.

Alcohol will increase the risk of liver problems.

Kidney disease

Tell your doctor if you have or have ever had excess fluid in your stomach area or the space around your lungs and if you have or have ever had kidney disease.

Allergic Reaction

If: you get a skin rash that may include itchy, red, swollen, blistered, or peeling skin, you’re wheezing, and you get tightness in the chest or throat, you have trouble breathing or talking your mouth, face, lips, tongue or throat start swelling You could be having a severe allergic reaction and may need immediate treatment in hospital.

Warning Signs

Call your doctor right away if you have: A fever or feel as if you have the flu, diarrhea, a nagging cough. Shortness of breath. Any unusual bruising or bleeding (including blood in the stool or black, tarry stools). Blurred vision or loss of sight. Confusion. Weakness or difficulty moving one or both sides of your body.


If you experience a severe side effect, you or your doctor may send a report to the Food and Drug Administration (FDA)

20 mg methotrexate Side effects

The drugs also have unwanted side effects. Although not every possible side effect is likely, they will need treatment.

Hair loss

Thinning hair- hair loss is a relatively uncommon side effect.

Mouth ulcers

Up to one-third develop mouth ulcers or mouth sores.

Brain fog

Many also complain of headaches, fatigue, and an overall “blah” feeling, which is sometimes called “methotrexate fog” and can occur a day after receiving a dose of methotrexate (which is taken in pill form or injected once a week).

Stomach upset

Common problems to be aware of while taking methotrexate are stomach upset and stomach pain. Take methotrexate after meals, which may reduce the risk of stomach upset.

If you develop nausea or vomiting, report it promptly because another medication may be prescribed to control these symptoms. Some people feel some nausea and fatigue the day after taking methotrexate.

Dizziness, headaches, loss of appetite

The most common include dizziness, drowsiness, headache, loss of appetite, nausea (and sometimes vomiting), red eyes, swollen, tender gums, stomach pain, yellow eyes or sore throat.


Call your doctor right away if you have: A fever or feel as if you have the flu. Diarrhea. A nagging cough. Shortness of breath. Any unusual bruising or bleeding (including blood in the stool or black, tarry stools.


Other side effects include anemia or low red blood cell counts, changes in mood, gastrointestinal bleeding, headaches, increased risk for stress fractures, leukopenia, and low white blood cell counts, non-productive dry cough, pancreatitis rashes, trouble thinking clearly or vomiting blood.

Tell your doctor if you have or have ever had a low number of blood cells or any other problem with your blood cells.


Check with your doctor immediately if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.

Sun sensitivity

Methotrexate can cause sun sensitivity and sunburn much more quickly than you might have in the past. After starting methotrexate, be especially careful the first time in the sun, perhaps staying no more than five minutes.


This medicine may cause serious allergic reactions, including anaphylaxis, which may be life-threatening and require immediate medical attention. Check with your doctor if you have a rash, itching, dizziness, or fainting.

Rheumatoid Arthritis

Severe rheumatoid arthritis (RA) – is an autoimmune disease in the body that attacks its joints.

Doctors who prescribe methotrexate for arthritis say that following a few simple steps can make it even safer and reduce potential side effects.

People with RA or psoriasis often take it once a week. It’s strong medicine, so it’s essential to take it exactly as your doctor tells you.


If any of the following occur, they should report them to your physician at your next appointment: mouth sores or hair loss (both of which can be dose-related and appear to happen less when you take folic acid vitamin supplements, which is routinely advised along with methotrexate).

People with GI problems such as nausea and vomiting. 79%: RA patients on methotrexate took folic acid supplements and lowered the risk of GI problems and mouth sores.

Tell your doctor immediately if you’re taking any other medicines, including herbal pills, vitamins, or supplements.

How to reduce sides effects

Learn more about how methotrexate affects folic acid, as well as about the other possible side effects.

How does methotrexate affect folic acid?

Folic acid is a B vitamin.

An enzyme in the liver converts folic acid into folate, which plays many essential roles in the body, including helping with cell division and DNA replication.

Methotrexate works by reducing the amount of folic acid in the body, which means that harmful cells cannot replicate.

Taking folic acid

You may be prescribed folic acid tablets while taking methotrexate, a manufactured 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.

You may be wary of the side effects of methotrexate.

A drop in white blood cells could cause infections—a dip in the production of blood platelets, which could cause abnormal bleeding. Still, most people tolerate the drug quite well, especially if they take folic acid, follow doctor’s instructions and practice other good health habits.

The only way to reduce the side-effect is to reduce the dose of the drug. However, taking folic acid on non-methotrexate days usually helps with the other side effects. If you’re currently on folic acid just once a week, it might be worth taking it on the six non-methotrexate days.

In addition to taking folic acid supplements, a person can also reduce the side effects of methotrexate by talking to a doctor about dosage.

Because methotrexate also depletes folic acid levels, it can cause various side effects, including mouth ulcers, headaches, and fatigue. Taking a folic acid supplement can reduce the risk of these side effects.


According to the Arthritis Foundation, some doctors suggest taking 1 milligram (mg) of folic acid daily.

Other doctors may recommend taking a single 5-mg dose weekly.

Some people will take the folic acid supplement 24 hours after a methotrexate dose.

In a multi-study review of placebo-controlled clinical trials on the effects of folic acid supplementation, the authors made several conclusions: Folic acid reduced the risk of methotrexate side effects, such as nausea, vomiting, and stomach pain by 26 percent.

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 consequences of your blood tests.

You must be aware of any symptoms or possible side effects to report them to your doctor promptly − and appropriate action can be taken if necessary.

Some serious side effects can occur without causing any symptoms you would immediately notice.

Before Using

When a drug is used, it must balance its potential danger with its benefits.

It is vital that your doctor may check your progress at regular visits to make sure this medicine is working correctly and to check for unwanted effects.

May need blood and urine tests to check for unwanted effects.

Who can and cannot take methotrexate?

Methotrexates are sometimes used in children.

Methotrexate is not recommended in pregnancy or while trying for a baby.

This medicine can stay in a woman’s body for six months after stopping taking it.

For men, there is a risk that methotrexate can damage sperm.

Alcohol abuse, or history of Anemia or Leukopenia (low white blood cells), Liver disease, severe or Thrombocytopenia (low platelet blood level), or Weak immune system—Methotrexate tablets should not be used.

Whether male or female, you must use birth control while taking methotrexate. You can take birth control pills, use a condom plus a spermicidal foam, or not have sex.

After stopping methotrexate, women must continue to use birth control or not have sex until they have had at least one menstrual period after their last dose.

Men should use birth control or not have sex for three months after their last dose of methotrexate.

If you have a young baby before taking methotrexate, don’t breastfeed them while taking this drug.

Proper use

It would be best if you only took it according to the doctor or pharmacist’s directions.

  • Avoid using the drug for longer than prescribed.
  • Don’t use it daily if your doctor says you have any health issues or cancer.
  • Measure oral medication using an identifying spoon, syringe, or medicine mug.
  • Take out all the tablets altogether. Avoid tearing it down.
  • Avoid taking any tablets if you can’t swallow.
  • Pain medicines can increase the effects of methotrexate, which can be bad for you.
  • Don’t take any vitamins, supplements, or herbal products without talking to your doctor first. These can cause serious damage to your body.
  • Don’t get any vaccines (shots) while you’re taking methotrexate. If you’ve stopped taking methotrexate, talk to your doctor to ensure that it’s okay to get a vaccine. Taking methotrexate can make it easier for you to get an infection. Try to avoid people who are sick.
  • The researchers did not find a link between taking folic acid and the effectiveness of methotrexate for treating RA.


While you are being treated with methotrexate, and after you stop treatment with it, do not have any immunizations (vaccines) without your doctor’s approval. Methotrexate may lower your body’s resistance. The vaccine may not work as well, or you might get the infection the immunization is meant to prevent.

How and when to take methotrexate?

Take methotrexate liquid Always use the oral syringe that comes with your medicine to measure your dose. It’s essential to use this syringe to get the right amount. It’s a good idea to have a drink of water after taking your medicine.

What should I know about the storage and disposal of this medication?

Keep this medication inside its container tightly closed and away from kids.

Conserve in a cool, damp place (not in the bathroom).

Unneeded medication must be disposed of to ensure animals or children do not consume the drug whenever possible.

It is more efficient to get a medically correct prescription by going on the take-aways.

Ask your physician to discuss the available programs for take-back to your community.

What should I do if I forget a dose?

You can take your missed dose immediately.

When you have missed your next dose, stop taking it.

Do not take double doses.

In case of emergency/overdose

For overdose calls, please get help from a poison control hotline 1300 220 2222.

Immediately contact 911 for assistance.

Other uses for this medicine include:

Methotrexate can also treat multiple sclerosis, a condition where immune cells attack nerves.

Consult a doctor if you are taking the drug for serious medical problems.




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