Methotrexate

Sounds like 'meth-o-trex-ate'

Easy-to-read medicine information about methotrexate – what it is, how to take methotrexate safely and possible side effects.

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

What is methotrexate?

  • Methotrexate is an immunosuppressive medication, which means that it weakens the body's defense system or immune response. It is used to treat some auto-immune conditions related to an 'over-active' 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 will be prescribed for you by a specialist doctor who is experienced in treating your condition. 

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 for much longer than most other medicines.
  • Take methotrexate on the same day each week.
  • Note: 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 methotrexate dose:

My dose Details
I am taking
methotrexate for:

Choose the option that applies to you:


□  Arthritis
□  Skin condition
□  _________________________
 My dose is: 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

  • Swallow the tablets with a drink of water.
  • You can take methotrexate before or after food.
  • Avoid or limit drinking alcohol while you are taking methotrexate.  
  • 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 two doses together to make up for a missed dose. 

Special instructions

  • Extra care is needed when taking methotrexate.
  • Double-check your prescription: is it the right strength, the right number of tablets and the right frequency (once a week)?
  • There are two strengths available (2.5 mg and 10 mg), make sure you take the right dose.
  • If your tablets look different to your last supply speak with your doctor or pharmacist for advice.
  • While you are taking methotrexate you will need to have regular blood tests to monitor for side effects and to determine if the treatment is effective. 
  • Methotrexate makes your skin more sensitive to the sun. Protect your skin when you are in the sun, especially between 10 am and 3 pm. If outdoors, wear protective clothing and use a high factor sunscreen (SPF 30+).
  • Make sure you tell anyone providing you with health, dental or medical care that you are taking methotrexate
  • 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.

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.

Possible 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
  • Diarrhoea

  • 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, short of breath, difficulty breathing, chest pain.
  • Tell you doctor immediately or ring Healthline on 0800 611 116
  • Signs of changes in your blood cells such as sore mouth, mouth ulcers, easy bruising, nosebleeds, bleeding gums, short of breath, fever, infection.
  • Tell you doctor immediately or ring Healthline on 0800 611 116
  • Signs of problems with your liver such as sudden pains in your stomach, loss of appetite, yellowing of the skin and eyes.
  • Tell you doctor immediately or ring Healthline on 0800 611 116

Interactions

  • Methotrexate may interact with a number of medications and herbal supplements so check with your doctor or pharmacist before starting methotrexate or before starting any new medicines. 
  • Also check with a pharmacist before taking over-the-counter anti-inflammatories such as diclofenac (e.g. Voltaren Rapid), ibuprofen (e.g. Nurofen), naproxen (e.g. 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 Medsafe Consumer Information Sheet

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: 12 Jul 2018