Methotrexate | Side Effects, Dosage, Uses & More
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Generic Name:

methotrexate, Injectable solution

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SECTION 1 of 5

Highlights for methotrexate

Injectable solution
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Methotrexate is used to treat certain types of cancer, psoriasis and joint inflammation in rheumatoid arthritis.

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This drug comes as a solution for intravenous (IV) injection. A healthcare provider will inject this drug into your vein. You won’t give this drug to yourself at home. This medication is also available as an oral tablet.

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The IV form of methotrexate is only available as a generic drug.

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The more common side effects of this drug include mouth sores, nausea, chills, and an increased risk of infections.

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In some cases, methotrexate can cause serious, life-threatening side effects. These include bleeding and liver, kidney, and bone marrow damage. Your doctor may do tests to monitor for these side effects.

IMPORTANT INFORMATION

FDA warning

This drug has a black box warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients to potentially dangerous effects.

Diarrhea warning. Tell your doctor right away if you develop diarrhea during treatment. This can be fatal. Your doctor may have you stop taking this drug.

Liver problems warning. This drug can cause serious liver problems, including fibrosis and cirrhosis. Your risk goes up the longer that you take this drug.

Lung problems warning. This drug can cause lung lesions. These can occur at any time while you’re taking the drug and at any dose. Stopping the medication may not cause the lesions to go away. Call your doctor right away if you have signs of a lung lesion. These include trouble breathing, shortness of breath, chest pain, or a dry cough.

Lymphoma warning. This drug can increase your risk of malignant lymphoma (lymph node cancer). This risk may go away when you stop taking the drug.

Skin reactions warning. This drug can cause life-threatening skin reactions. These may go away when you stop receiving the drug. Call your doctor or go to the emergency room right away if you have:

  • a rash
  • red, swollen, blistered, or peeling skin
  • fever
  • red or irritated eyes
  • sores in your mouth, throat, nose, or eyes

Infections warning. This drug can decrease your body's ability to fight an infection. If you have an infection, get treatment from your doctor before you start taking methotrexate. People who receive this drug also have a higher chance of serious, life-threatening infections.

Harmful buildup warning. Certain health problems may slow your body’s ability to clear out this drug. This can increase your risk of side effects. Your doctor may decrease your dose or have you stop taking this drug.

Cancer warning. If you have a rapidly growing tumor, this drug may increase your risk of tumor lysis syndrome. This syndrome occurs from the fast breakdown of cancer cells. This condition is serious and may be fatal (cause death).

Treatments that increase side effects warning. Some drugs and treatments can increase the side effects of methotrexate. These include radiation therapies and nonsteroidal anti-inflammatory drugs (NSAIDs). These effects can be fatal.

Pregnancy warning. You shouldn’t use this drug if you’re pregnant or plan to become pregnant. This drug may harm or even end a pregnancy. If you get pregnant while taking this drug, call your doctor right away.

This drug can also affect sperm. Both men and women should use effective birth control during treatment.

Drug features

Methotrexate is a prescription drug. It’s available in an intravenous (IV) solution, which is only given by a healthcare provider. You won’t give this drug to yourself at home. This medication is also available as an oral tablet.

The IV form of methotrexate is only available as a generic drug.

Methotrexate may be used as part of a combination therapy. This means you may need to take it with other medications.

Why it's used

Methotrexate is used to treat certain cancers, psoriasis, and rheumatoid arthritis. This includes active rheumatoid arthritis and polyarticular juvenile idiopathic arthritis.

More Details

How it works

Methotrexate belongs to a class of drugs called metabolites. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

More Details

Why it's used

Methotrexate is used to treat certain cancers, psoriasis, and rheumatoid arthritis. This includes active rheumatoid arthritis and polyarticular juvenile idiopathic arthritis.

Treatment with this drug can be fatal (cause death). You should only take this drug if you have life-threatening cancer or disabling psoriasis or rheumatoid arthritis that hasn’t responded to other treatment.

How it works

Methotrexate belongs to a class of drugs called metabolites. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

This drug works differently to treat each condition:

Cancer: This drug works by making it harder for your body to make or repair DNA. Cells in your body that grow rapidly react to this effect. When cancer cells grow more than normal cells, this drug harms the cancer cells.

Psoriasis: This drug works by slowing down how fast the top layer of your skin is produced. This helps to treat the symptoms of psoriasis.

Rheumatoid arthritis (RA): It isn’t exactly known how this drug works to treat RA. This drug affects your immune system. This may help reduce pain, swelling, and stiffness from RA.

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methotrexate Side Effects

Injectable solution

More common side effects

The more common side effects of methotrexate can include:

  • mouth sores

  • reduced number of white blood cells, which can increase your risk of infections

  • nausea

  • stomach pain

  • tiredness

  • chills

  • fever

  • dizziness

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 9-1-1 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • Bleeding. Symptoms can include:

    • vomit that contains blood or looks like coffee grounds
    • coughing up blood
    • blood in your stool or black tarry stools
    • bleeding from your gums
    • unusual vaginal bleeding
    • bruises
  • Liver problems. Symptoms can include:

    • dark-colored urine
    • vomiting
    • stomach pain
    • yellowing of your skin or the whites of your eyes
    • tiredness
    • loss of appetite
    • light-colored stools
  • Kidney problems. Symptoms can include:

    • not being able to urinate
    • changes in the amount of urine you pass
    • sudden, unexplained increase body weight
    • blood in your urine
  • Pancreas problems. Symptoms can include:

    • severe stomach pain
    • severe back pain
    • upset stomach
    • vomiting
  • Lung lesion. Symptoms can include:

    • a dry cough
    • fever
    • shortness of breath
  • Lymphoma (lymph node cancer). Symptoms can include:

    • tiredness
    • fever
    • chills
    • weight loss
    • loss of appetite
  • Skin reactions. Symptoms can include:

    • rash
    • redness
    • swelling
    • blisters
    • peeling skin
  • Infections. Symptoms can include:

    • fever
    • chills
    • sore throat
    • cough
    • ear or sinus pain
    • saliva or mucus that is a different color than normal
    • pain when urinating
    • mouth sores
    • wounds that won’t heal
  • Bone damage and pain

  • Tumor lysis syndrome. Symptoms can include:

    • fast or irregular heart rate
    • passing out
    • trouble urinating
    • muscle weakness or cramps
    • upset stomach, vomiting, or lack of appetite
    • loose stools
    • tiredness
Pharmacist's Advice
Healthline Pharmacist Editorial Team

Methotrexate may cause drowsiness.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.
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methotrexate May Interact with Other Medications

Injectable solution

Methotrexate can interact with other medications, herbs, or vitamins you might be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well. Your healthcare provider will look out for interactions with your current medications. Always be sure to tell your doctor about all medications, herbs, or vitamins you’re taking.

Alcohol interaction

Drinking alcohol raises your risk of liver side effects from methotrexate. You shouldn’t drink alcohol while you’re taking this drug. Alcohol may cause liver damage or make existing liver problems worse.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

People with liver disease

You shouldn’t take this drug if you have a history of liver problems or alcohol-related liver issues. This medication can make your liver function worse.

People with a weakened immune system

You shouldn’t take this drug. This medication can make your condition worse.

People with low blood cell counts

Your doctor will monitor you more closely while you take this medication. This drug can reduce your number of blood cells. If your blood cell counts drop too low, your doctor will stop giving you this drug.

People with kidney disease

This drug can make kidney function worse. It may even cause your kidneys to fail. Your doctor may decrease your dose or have you stop taking this drug.

People with ulcers or ulcerative colitis

You shouldn’t use this drug. This medication can make your condition worse. It increases the chance of ulcers of your gastrointestinal tract.

People with fluid around their abdomen or lung

This drug may stay in your body longer. This can increase your chance of side effects. Your doctor may decrease your dose or have you stop taking this drug.

People undergoing radiation therapy

This drug can increase your risk of skin and bone problems if you take it while undergoing radiation therapy for cancer. Your doctor will monitor you closely during treatment. They may have you stop taking this drug if your skin problems get worse.

People with psoriasis

If your psoriasis gets worse with ultraviolet (UV) radiation or sunlight, this drug may also cause your psoriasis to get worse. Your doctor will monitor you closely during treatment. They may have you stop taking this drug if your skin problems get worse.

Pregnant women

Methotrexate is a category X pregnancy drug. That means two things:

  1. Category X drugs should never be used during pregnancy.
  2. Women of childbearing age should use reliable birth control while taking this drug.

Your doctor will likely give you a pregnancy test to make sure you aren’t pregnant before you start this drug. Women shouldn’t become pregnant while taking this drug and for at least one menstrual cycle after stopping treatment.

This drug can also affect sperm. Men shouldn’t father a child during treatment with this drug and for at least 3 months after stopping it.

Both men and women who take this drug should use effective birth control during treatment.

Women who are breast-feeding

Methotrexate passes into breast milk and may cause side effects in a child who is breastfed.

Talk to your doctor if you breastfeed your child. You should not breastfeed while taking this medication.

For seniors

The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects.

Seniors are also more likely to have liver problems and low folic acid levels. These can increase your risk of side effects.

For children

This drug has only been studied in children for the treatment of cancer and polyarticular juvenile idiopathic arthritis.

The safety and effectiveness of this drug in children hasn’t been established for the treatment of psoriasis.

Allergies

Methotrexate can cause a severe allergic reaction. Symptoms can include:

  • trouble breathing
  • swelling of your throat or tongue
  • hives

If you have an allergic reaction, call your doctor or local poison control center right away. If your symptoms are severe, call 9-1-1 or go to the nearest emergency room.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

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How to Take methotrexate (Dosage)

Injectable solution

Your doctor will determine a dosage that’s right for you based on your individual needs. Your general health may affect your dosage. Tell your doctor about all health conditions you have before your healthcare provider administers the drug to you.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.
Pharmacist's Advice
Healthline Pharmacist Editorial Team

Methotrexate comes with risks if you don’t receive it as prescribed.

If you stop receiving the drug suddenly or don’t receive it at all

Cancer: Your cancer may get worse.

Psoriasis: Your symptoms may not go away.

Rheumatoid arthritis: Your inflammation and pain may not go away or it could get worse.

If you miss doses or don’t receive the drug on schedule

Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

What to do if you miss a dose

Call your doctor right away if you miss the appointment to receive your scheduled dose.

How to tell if the drug is working

Cancer: If your cancer causes symptoms, they should start to get better. Your doctor will also check your levels of certain hormones and do other blood tests to see if this drug is working.

Psoriasis: Your symptoms of psoriasis should get better.

Rheumatoid arthritis: You should have less pain and swelling. People often see improvements starting 3–6 weeks after starting the drug.

Methotrexate is used for long-term or short-term treatment.

Your length of treatment depends on the condition being treated.

Important considerations for taking methotrexate

How long does it take?

The time it takes to receive this drug depends on your condition. Ask your doctor how long it will take to receive your dose.

Can I drive home after?

Methotrexate may make you dizzy or sleepy. You may need someone to help take you home after your infusion. You shouldn’t drive or use machinery while you’re on this medication until you know you can function normally.

Travel

Talk to your doctor if you plan to travel. You must receive this drug on a set schedule. You may need to plan your travel around your treatment schedule.

Clinical monitoring

While you’re taking this drug, your doctor may check the following to make sure the drug isn’t harming your body:

  • Signs of severe side effects. Your doctor may do blood tests to check for tumor lysis syndrome.
  • Blood cell counts. Your doctor will do blood tests to check your red and white blood cell counts and platelet counts. If your blood cell counts drop too low, your doctor will stop giving you this drug.
  • Liver function. Your doctor will do blood tests to check how well your liver is working. If your liver isn’t working well, your doctor may have you stop taking this drug.
  • Kidney function. Your doctor will do blood tests to check how well your kidneys are working. If your kidneys aren’t working well, your doctor may decrease your dose or have you stop taking this drug.
  • Lung function. Your doctor will do tests to check your lung function during treatment with this drug. These may include a chest x-ray. If your lungs aren’t working well, your doctor may have you stop taking this drug.

Your diet

Make sure you drink enough water and stay hydrated while taking this medication. If you’re dehydrated, this drug could build up in your body and cause more side effects. This may cause dizziness, low blood pressure, and weakness.

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How Much Does methotrexate Cost?

Injectable solution

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Lowest price for methotrexate

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These prices represent the lowest priced national pharmacies for methotrexate on GoodRx. They may be lower than your insurance.

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These prices represent the lowest priced national pharmacies for methotrexate on GoodRx. They may be lower than your insurance.

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Content developed in collaboration with University of Illinois-Chicago, Drug Information Group

Medically reviewed by Creighton University, Center for Drug Information and Evidence-Based Practice on February 18, 2016

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
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