Methotrexate
Description
Methotrexate is used to treat rheumatoid arthritis, psoriasis, and certain othe
r autoimmune or inflammatory conditions. As an antimetabolite, Methotrexate blocks the activity of an enzyme required for cell growth, especially in rapidly dividing immune cells. Slowing down this abnormal immune activity helps reduce inflammation, joint pain, swelling, and skin plaque formation. Methotrexate is a prescription-only medicine and should be taken strictly under medical supervision. The dosage and weekly schedule are carefully determined by the doctor based on the patient’s condition, body response, and other ongoing treatments. It is extremely important to follow the exact dosing instructions, as exceeding the prescribed dose can lead to serious side effects. Before starting Methotrexate, patients must inform their doctor if they are pregnant, planning pregnancy, or breastfeeding, as this molecule is unsafe in these situations. It is also essential to share details about all current medicines, supplements, and any existing medical problems such as liver or kidney disorders. Regular monitoring through blood tests may be required during long-term therapy.
Uses
- To treat psoriasis
- To treat rheumatoid arthritis
- To treat various types of cancers such as breast and lung cancers
- Also used as a single agent or in combination with anti-cancer medications
Contraindications
When should one not use Methotrexate
- Allergic reaction to this medicine
- Pregnancy and breastfeeding
- Severe liver or kidney disease
- Decreased platelets and white blood cells
- If you have recently received a live vaccine
- If you have ulcers in the mouth
- If you have fever, joint pain
Side effects
Common side effects of this drug are:
- Diarrhea
- Mouth ulcers
- Weakness
- Menstrual problems
- Skin rash
- Persistent cough
- Joint pain, muscle pain
- Stomach pain
- Swelling of feet
- Dizziness
- Yellowing of the skin (liver damage)
- Fever with chills
- Unusual bleeding
- Blurred vision
- Temporary hair Loss
- Loss of appetite
- Difficulty in passing urine
- Nausea or vomiting
- Decrease white blood cells
Precautions and Warnings
Pregnancy
Q:
Can I take Methotrexate during pregnancy?
A:
It is highly unsafe to use during pregnancy. Human and animal studies have shown significant side effects on fetus like birth defects or miscarriage. If you are a woman of childbearing age, strictly use contraception and avoid pregnancy.
Breast Feeding
Q:
Can I take Methotrexate while breastfeeding?
A:
Methotrexate is strictly not to be taken during breastfeeding.
Driving
Q:
Can I drive if I have consumed Methotrexate?
A:
Do not drive until your vision is clear. It may cause dizziness, drowsiness.
Alcohol
Q:
Can I consume alcohol with Methotrexate?
A:
Alcohol should be avoided while receiving Methotrexate as it increases the chances of damaging your liver.
Other General Warnings
Talk to your doctor if
- You have kidney disease, ulcers in the stomach, diabetes mellitus or any infections
- You have received any live vaccines
- You should avoid having a baby at least 6 months after stopping Methotrexate as this medicine affects sperm and egg production
- If you experience cough with blood or pink color sputum immediately inform your doctor
- Taking more medicine than what is prescribed by your doctor can be very harmful and should be avoided
- If you are on this medicine for the long term, regular health check-ups are required
Mode of Action
How Does It Work?
It works by stopping or slowing down the growth of cancer cells and suppress the immune system. In rheumatoid arthritis, it works by decreasing the activity of the body's immune system. This decrease swelling, pain and stiffness, and improves function. It also works by slowing down the rapid growth of skin cells....
Interactions
Interactions with other medicines
- Using Methotrexate with individual Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) such as Ibuprofen, Aceclofenac, Acemetacin and Diclofenac can cause severe and sometimes fatal bone marrow suppression, aplastic anemia (in which the body stops making new blood cells), and gastrointestinal toxicity...
- When used along with radiotherapy, Methotrexate may increase the risk of cell death in soft tissues and bones
- Live vaccines
- Cyclosporin’s (used in transplantation)
Interactions with food items
No information is available on interactions of Methotrexate when taken with food, consult your doctor or pharmacist for further details.
Dietary Restrictions
No information is available on dietary restrictions while you are taking Methotrexate, consult your doctor or pharmacist for further information.
Dosage
Overdose
In overdose, vomiting, diarrhea and gastrointestinal bleeding may occur. Severe bone marrow suppression may occur. Liver toxicity is more likely in patients with pre-existing risk factors for liver disease. Patients may see symptoms like sudden shortness of breath and a dry, persistent cough and also fever. A single overdose also has shown this fatal side effect. Another cause of death is bone marrow suppression. Several deaths have been reported all over the world from Methotrexate overdose. Because they had been accidentally taking medicine daily instead of once a week dose as prescribed. This grave mistake should be avoided on part of the prescriber, pharmacist, patient and a caregiver....
Missed a Dose
If you missed any dose, take it as soon as you remember. Skip the missed dose if it is time for your next dose. Do not take an extra dose of medicine to make up the missed dose. Be very careful with the dosage in terms of strength and duration spacing with this medicine. Strictly adhere to your prescribed dose of medicine....
Content Details
WRITTEN BY
Dr. Nikita Toshi
BDS (Bachelor of Dental Surgery), WHO FIDES member
REVIEWED BY
Dr. Ritu Budania
MBBS, MD (Pharmacology)
Frequently Asked Questions (FAQs)
Q: What precautions should I take before treatment with Methotrexate?
A: Prolonged use of Methotrexate may cause liver damage, including cirrhosis (irreversible scarring of the liver), which may be fatal. High doses of Methotrexate can also damage the kidneys and cause kidney failure. People with psoriasis or rheumatoid arthritis may not be suitable for Methotrexate if they have alcoholism, alcoholic liver disease or other chronic liver diseases, have an immunodeficiency syndrome, have a blood deficiency disorder such as anemia (low red blood cell count), leukopenia (low white blood count) or thrombocytopenia (low blood platelet count).
Q: What is Methotrexate used for?
- Methotrexate is used to treat rheumatoid arthritis and psoriasis by reducing inflammation and slowing the overactive immune response.
Q: How often should I take Methotrexate?
- Methotrexate is usually taken once a week, not daily. Always follow your doctor’s exact instructions to avoid harmful side effects.
Q: Can I take Methotrexate if I am pregnant?
- No. Methotrexate is unsafe during pregnancy and breastfeeding. Inform your doctor immediately if you are pregnant or planning to conceive.
Q: Do I need regular tests while taking Methotrexate?
- Yes. Your doctor may advise regular blood tests to monitor liver function, kidney health, and blood cell levels to ensure safe treatment.
References
View All
- Webmed.methotrexate. 2025 [Cited 5th Dec 2025]
- Ema.methotrexate. 2025 [Cited 5th Dec 2025]
- Lactmed.methotrexate. 2025 [Cited 5th Dec 2025] Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-. Methotrexate. [Updated 2018 Oct 31]
- Dailymed.methotrexate. 2025 [Cited 5th Dec 2025]
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