Methotrexate

About methotrexate

Methotrexate is a type of medicine called an immunosuppressant. It slows down your body's immune system and helps reduce inflammation.

It is used to treat inflammatory conditions, including:

It can also be prescribed for other autoimmune conditions such as sarcoidosis.

Methotrexate is available on prescription only.

It comes as tablets, a liquid that you drink, and pre-filled injection pens or syringes that you inject into your skin. Your specialist doctor may recommend injections if the tablets or liquid are not working for you.

It can also be given as an injection to treat some types of cancer. This is usually done in hospital.

Key facts

Who can and cannot take methotrexate

Methotrexate can be used by adults and children.

Methotrexate is not suitable for some people. Tell your doctor before taking methotrexate if you:

How and when to take methotrexate

Doses for inflammatory conditions

If you take methotrexate once a week, take it on the same day each week. There's usually a reminder on your pill packet and patient card, telling you which day to take your medicine.

For inflammatory conditions such as psoriasis, rheumatoid arthritis and Crohn's disease, the dose will vary. This depends on your condition and blood test results. Always follow the instructions from your doctor.

For rheumatoid arthritis, the usual starting dose is 7.5mg, taken once a week. This can be slowly increased up to 20mg (tablets) or 25mg (pre-filled injection pen or syringe) once a week.

For psoriasis, the usual starting dose is 2.5mg to 10mg, taken once a week. It can be slowly increased up to 30mg once a week.

For Crohn's disease, the usual dose to prevent flare-ups is 10mg to 25mg, taken once a week. This is often called a "maintenance" dose.

If your child is prescribed methotrexate, the doctor will use their height and weight to work out the right dose.

Taking methotrexate tablets

Swallow the tablets whole with a drink of water. You can take your tablets before or after food. Wash your hands after touching the tablets.

Your doctor will tell you how many tablets to take each time. You may have to take up to 10 tablets to make up your dose.

Taking methotrexate liquid

Always use the oral syringe that comes with your medicine to measure your dose. It's important to use this syringe so that you get the right amount.

It's a good idea to have a drink of water after taking your medicine.

Having methotrexate injections

You will usually go to your GP surgery or a hospital outpatient clinic once a week to have your injection.

Alternatively, you may get a pre-filled injection pen or syringe for you to use at home. Your doctor or nurse will show you how to use this.

Methotrexate treatment for cancer

If you're having methotrexate treatment for cancer, a doctor or nurse will usually give you an injection. You may need to have treatment more than once a week and this will be done in hospital.

What if I take too much?

Taking too much methotrexate can cause serious side effects. In some cases it can be fatal.

Store your weekly methotrexate separately, away from any other medicines that you take daily.

Contact 111 or advice if:

  • you have taken more than your prescribed dose of methotrexate
  • you have taken your methotrexate daily instead of weekly

Go to 111.nhs.uk or call 111

If you need advice for a child under the age of 5 years, call 111.

Taking folic acid

If you need to go to A&E, do not drive yourself. Get someone else to drive you or call for an ambulance.

Take the methotrexate packet, or the leaflet inside it, plus any remaining medicine with you.

You may be prescribed folic acid tablets while you're taking methotrexate. This is a man-made 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. It can make you less likely to be sick (vomit) or get diarrhoea.

Your doctor will usually start you on one 5mg folic acid tablet, taken once a week. Take it the day after your methotrexate.

If you are still bothered by side effects, your doctor may increase the dose of folic acid. You may need to take 1 tablet 6 times a week, starting the day after you take your methotrexate.

Important

Do not take folic acid on the same day as your methotrexate. It can stop your medicine from working properly.

Tests during treatment

When you first start treatment, you'll have a check-up and blood tests every 1 to 2 weeks. This is to check if the methotrexate is working and if it's causing any side effects.

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 results of your blood tests. You'll usually get a booklet for this.

Once you and your doctor have found the right dose and your treatment is working well, you'll have a check-up and blood tests every 2 to 3 months.

What if I forget to take it?

If you forget to take a dose, take it as soon as you remember the next day or the day after.

If your dose is more than 2 days late, contact your doctor or the clinic for advice about what to do.

Never take 2 doses together to make up for a missed dose.

Side effects

Common side effects

Like all medicines, methotrexate can cause side effects, although not everyone gets them.

Common side effects may happen in more than 1 in 100 people.

Speak to your doctor if these side effects bother you or do not go away:

Serious side effects

Serious side effects are rare and happen in less than 1 in 10,000 people.

Tell your doctor immediately if you get:

Serious allergic reaction

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to methotrexate.

These are not all the side effects of methotrexate. For a full list see the leaflet inside your medicines packet.

How to cope with side effects of methotrexate

What to do about:

Pregnancy and breastfeeding

Methotrexate and pregnancy

Methotrexate is not recommended in pregnancy.

If you are taking methotrexate and planning a pregnancy in the future, speak to your doctor. They will discuss whether you need to switch to a different medicine before stopping your contraception. Methotrexate can stay in your body for some time, so you need to stop taking methotrexate at least 6 months before trying for a baby.

If you become pregnant while taking methotrexate, do not stop taking your medicine and speak to your doctor as soon as possible. They’ll review your treatment and help you decide what to do next. Your doctor will only prescribe methotrexate for you while you're pregnant if the benefits of the medicine outweigh the chances of it being harmful.

Methotrexate and breastfeeding

Methotrexate passes into breast milk in very small amounts.

If your weekly dose of methotrexate is 25mg or less, it may be possible to breastfeed. However, you must not breastfeed for 24 hours after taking your medicine. Your midwife or health visitor can give you advice about how to feed your baby while you wait 24 hours.

If your weekly dose is more than 25mg, your doctor will talk to you about what’s best for you and your baby. You may still be able to breastfeed if your doctor says it is OK. However it depends on your dose of methotrexate and any other medicines you are taking.

If you breastfeed while taking methotrexate, your baby will have blood tests to check for any side effects.

If you notice that your baby isn't feeding as well as usual, or if you have any other concerns about your baby, talk to your health visitor, midwife or doctor as soon as possible.

For more information about how this medicine could affect you and your baby, read the leaflet on methotrexate on the Best Use of Medicines in Pregnancy (BUMPs) website.

Cautions with other medicines

Mixing methotrexate with herbal remedies and supplements

There are many medicines that affect the way methotrexate works.

Children taking methotrexate must not have a "live" flu vaccine (this usually applies to children aged 2 to 17 years). Adults are given an "inactivated" flu vaccine and this usually does not cause problems with methotrexate.

Tell your doctor if you're taking these medicines before you start methotrexate:

These are not all the medicines that may affect methotrexate.

Do not take vitamin and mineral supplements or any other products that contain folic acid (folate) if you are already taking folic acid prescribed by your doctor. Check the ingredients on the labels of any supplements.

There is not enough information to say whether it's safe to take other herbal remedies or supplements together with methotrexate. They are not tested in the same way as medicines.

Common questions about methotrexate

How does methotrexate work? How long does it take to work? How long will I take it for? Is it safe to take long-term? Does methotrexate increase the risk of cervical cancer? Can you get more than a week's supply at a time? Do I need to avoid people with viruses while I'm taking it? Are there other treatments for inflammatory conditions? Can I drink alcohol with it? Are there foods and drinks I need to avoid? Will it affect my contraception? Will it affect my fertility? Can I drive or ride a bike?