Methotrexate is used to treat inflammatory conditions such as rheumatoid arthritis, psoriasis and Crohn's disease. Find out how to take it safely and possible side effects.
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What is methotrexate?
Methotrexate is used to treat inflammatory conditions such as rheumatoid arthritis, psoriasis and Crohn's disease. These conditions are also called autoimmune conditions because they are related to an ‘overactive’ immune system. Methotrexate is an immunosuppressive medicine, which means it interrupts the activity of your immune system, slowing the disease and reducing inflammation. Watch a video about methotrexate for inflammatory disease such as arthritis.
Credits: RheumInfo, 2019
Note: this video is from Canada so may have information that differs from New Zealand recommendations.
- In New Zealand methotrexate is available as tablets in 2 strengths – 2.5 mg and 10 mg.
- The dose of methotrexate is different for different people.
- Your doctor will calculate your dose based on your condition, your blood test results and your response.
- 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.
How to take methotrexate
- Timing: Take methotrexate tablets once a week on the same day each week. Methotrexate is best taken on an empty stomach, but if it makes you feel nauseous or sick, try taking it with food.
- Swallow your tablets with a drink of water. Do not crush or chew them.
- Limit or avoid alcohol. Limit your alcohol intake to 1–2 standard drinks once or twice a week. Avoid heavy or binge drinking because it can increase your risk of side effects, such as problems with your liver.
- Missed dose: If you forget to take your dose, take the missed dose up to a day later. Otherwise, skip the dose and continue next week. Do not take 2 doses at the same time.
- Folic acid: 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.
- Keep taking methotrexate regularly. Methotrexate does not work straight away. It usually takes a few weeks or months before you notice the full benefits. If you stop methotrexate treatment for more than a few weeks there is a risk that your condition may worsen.
Extra care is needed when taking methotrexate
Make sure you take the right dose
Methotrexate tablets come in 2 strengths: 2.5 mg and 10 mg. When you collect your methotrexate prescription, check that your tablets are the right strength, and that you have the right number of tablets. If your tablets look different to your last supply, get advice from your doctor or pharmacist.
While you are taking methotrexate you will need to have regular blood tests. These check the treatment is working and monitor for side effects, measure kidney and liver function, and do a full blood count. Over time, these tests are needed less often.
It is safe for you to have the annual flu vaccine. Keep your flu vaccinations up to date to reduce your risk of getting the flu. Some vaccines should not be taken if you are taking methotrexate. Always check with your doctor or pharmacist first.
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 3 months 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 of methotrexate
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.
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- 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 cause side effects.
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, NZ
Methotrexate Australian Rheumatology Association
Methotrexate Arthritis Research, UK
- Methotrexate New Zealand Formulary
- Methotrexate safe prescribing Safe Rx
Additional resources for healthcare professionals
Methotrexate NZ Formulary
DBL methotrexate Medsafe, NZ
Methoblastin Medsafe, NZ
Safer prescribing of high-risk medicines – methotrexate – potentially fatal in overdose BPAC, NZ, 2014
Methotrexate prescribing errors can be fatal BPAC, NZ, 2011
Rheumatoid arthritis – monitoring of DMARDs BPAC, NZ, 2008
Methotrexate – safe prescribing – once a week SafeRx, NZ
Reducing harm from high-risk medicines – oral methotrexate HQSC, NZ