Methotrexate

Sounds like 'meth-o-trex-ate'

Methotrexate is used to treat some autoimmune conditions such as rheumatoid arthritis and psoriasis. Find out how to take it safely and possible side effects.

Type of medicine Also called
  • Immunosuppressive medicine (it weakens your body's immune response)
  • Chemotherapy (anti-cancer agent)
  • Methoblastin®
  • Trexate®
  • DBL-Methotrexate® 

What is methotrexate?

Methotrexate is an immunosuppressive medicine, which means it weakens your body's defence (immune) response. It is used to treat some autoimmune conditions related to an ‘overactive’ immune system, such as rheumatoid arthritis and psoriasis

Methotrexate is also used as an anti-cancer agent. It works by stopping the growth of cancer cells. Methotrexate is prescribed by a specialist doctor who is experienced in treating your condition. 

In New Zealand methotrexate is available as tablets (2.5 mg and 10 mg).

Watch a video about methotrexate for inflammatory disease such as arthritis.

Dose

  • The dose of methotrexate will be different for different people.
  • Your doctor will calculate your dose based on your condition, your blood test results and your response.
  • If methotrexate is being used for arthritis or psoriasis, it is usually taken once a week (every 7 days) as it lasts in your body much longer than most other medicines.
  • Take methotrexate on the same day each week.
  • If methotrexate is being used to treat cancers such as leukaemia or lymphoma, or for some people with psoriasis, the dosing may be daily, or a few days per week. 
  • Always take your methotrexate exactly as your doctor has told you. The pharmacy label on your medicine will tell you how much methotrexate to take, how often to take it and any special instructions.
  • You may be asked to take folic acid tablets while you are on methotrexate. This is to help reduce side effects. Take your folic acid on a different day from your methotrexate.
My dose Details
Choose the option that applies to you


I am taking methotrexate for:

□  arthritis
□  a skin condition
□ ________________
 My dose Take methotrexate ONCE a week.

______ tablets to be taken on _____________ (day of the week).

  • If your tablets look different to your last supply contact your pharmacist.
  • Take folic acid on a different day from your methotrexate.
  • Most people take their dose ONCE a week, but some people may need to take their dose more often. 
  • Do not take methotrexate every day.
Notes:


How to take methotrexate

  • Timing: If methotrexate is being used for arthritis or psoriasis, it is usually taken once a week (every 7 days). Take your dose on the same day each week. You can take methotrexate before or after food.
  • Swallow your tablets with a drink of water. Do not crush or chew them.
  • Limit or avoid alcohol. Heavy drinking can increase your risk of side effects, such as problems with your liver. 
  • Missed dose:
    • If you forget to take your weekly methotrexate dose, and it is within 2 days of when you should have taken it, take it as soon as you remember.
    • If you have missed your weekly dose by more than 2 days, contact your doctor for advice about what to do. Never take 2 doses together to make up for a missed dose. 

Extra care is needed when taking methotrexate

Make sure you take the right dose

When you collect your methotrexate prescription, check that your tablets are the right strength, the right frequency (once a week) and that you have the right number of tablets. Methotrexate tablets come in 2 strengths: 2.5 mg and 10 mg. If your tablets look different to your last supply, get advice from your doctor or pharmacist.

Blood tests

While you are taking methotrexate you will need to have regular blood tests to monitor for side effects and to work out whether the treatment is effective. 

Vaccines

Some vaccines should not be taken if you are taking methotrexate. Always check with your doctor or pharmacist first. It is safe for you to have the annual flu vaccine.

Sun protection

Methotrexate makes your skin more sensitive to the sun. Protect your skin when you are in the sun, especially between 10am and 3pm. If outdoors, wear protective clothing and use a high factor sunscreen (SPF 30+).

Pregnant or planning a pregnancy

Methotrexate should not be taken if you are pregnant. If either you or your partner are taking methotrexate talk to your doctor about contraception. If you or your partner wish to become pregnant, ask your doctor about stopping methotrexate. It should not be taken for at least 12 weeks before pregnancy.

Tell your healthcare providers 

Make sure you tell anyone providing you with health, dental or medical care that you are taking methotrexate

Precautions - before taking methotrexate

  • Are you pregnant or planning to have children in the future?
  • Are you breastfeeding?
  • Do you have stomach problems including a stomach ulcer?
  • Do problems with your liver or kidney?
  • Have you recently had or been in contact with people with chickenpox or shingles?
  • Are you taking any other medicines? This includes any medicines you buy without a prescription, such as herbal and complementary medicines and medicines for pain relief.

If so, it’s important that you tell your doctor or pharmacist before you start methotrexate. Sometimes a medicine isn’t suitable for a person with certain conditions, or it can only be used with extra care.

Side effects

Like all medicines, methotrexate can cause side effects, although not everyone gets them. Often side effects improve as your body gets used to the new medicine.

Side effects What should I do?

  • Feeling sick (nausea) 
  • Vomiting (being sick)
  • Diarrhoea (runny poo)

  • Take your methotrexate with food or in the evening.
  • Tell your doctor if troublesome.

  • Tiredness
  • Headache
  • Muscle and joint pains
  • These are quite common when you first start taking methotrexate and usually go away with time.
  • Tell your doctor if troublesome.
  • Signs of problems with your lungs such as dry cough, shortness of breath, difficulty breathing or chest pain.
  • Tell your doctor immediately or phone Healthline on 0800 611 116.
  • Signs of changes in your blood cells, such as a sore mouth, mouth ulcers, easy bruising, nosebleeds, bleeding gums, short of breath, fever or infection
  • Tell your doctor immediately or phone Healthline on 0800 611 116.
  • Signs of problems with your liver, such as sudden pains in your stomach, loss of appetite or yellowing of your skin and eyes
  • Tell your doctor immediately or phone Healthline on 0800 611 116.

Interactions

  • Methotrexate may interact with a number of medicines and herbal supplements, so check with your doctor or pharmacist before starting methotrexate and before starting any new medicines. 
  • Also check with a pharmacist before taking over-the-counter anti-inflammatories such as diclofenac (eg, Voltaren Rapid), ibuprofen (eg, Nurofen), naproxen (eg, Naprogesic). Taking these together with methotrexate may increase your risk of side effects.

Learn more

The following links have more information on methotrexate. Be aware that websites from other countries may contain information that differs from New Zealand recommendations:

Methotrexate RheumInfo
Methotrexate
 Medsafe Consumer Information Sheet, NZ
Methotrexate Australian Rheumatology Association
Methotrexate Arthritis Research, UK

References

  1. Methotrexate New Zealand Formulary
  2. Methotrexate safe prescribing Safe Rx
Credits: Sandra Ponen, Pharmacist. Reviewed By: Angela Lambie, Pharmacist, Auckland Last reviewed: 22 Apr 2021