Methotrexate
Methotrexate is used to treat rheumatoid arthritis, psoriasis, and certain cancers. It is available as Rheumatrex, Trexall and is commonly prescribed in the immunology category.
About Methotrexate
Methotrexate is an antimetabolite / conventional synthetic dmard (dihydrofolate reductase inhibitor) also sold under brand names including Rheumatrex and Trexall. It is primarily used to methotrexate is prescribed to treat: • Rheumatoid arthritis, psoriasis, and certain cancers • Various related conditions in the immunology category • Associated symptoms and complications It is an important medication that helps manage these conditions effectively. Methotrexate is available in oral tablet (2.5 mg, 5 mg, 7.5 mg, 10 mg, 15 mg), subcutaneous auto-injector — otrexup, rasuvo (7.5 mg, 10 mg, 12.5 mg, 15 mg, 17.5 mg, 20 mg, 22.5 mg, 25 mg), subcutaneous solution single-use vial (25 mg/ml), and injection solution — preservative-free (25 mg/ml) for iv/im/intrathecal use form. Healthcare providers commonly prescribe Methotrexate for conditions including Attention Deficit Hyperactivity Disorder (ADHD), Lupus Anticoagulant, and Vertigo.
Methotrexate at a Glance
- Brand names
- Rheumatrex, Trexall
- Drug class
- Antimetabolite / Conventional Synthetic DMARD (Dihydrofolate Reductase Inhibitor)
- Pregnancy category
- FDA Category Category X — Methotrexate is a known teratogen and abortifacient. It causes embryonic death, fetal malformations (craniofacial, limb, CNS), and intrauterine growth restriction. Pregnancy is contraindicated during use and for at least one ovulatory cycle (women) or 3 months (men) after discontinuation. Effective contraception is required for both sexes throughout treatment.
- Available forms
- Oral tablet (2.5 mg, 5 mg, 7.5 mg, 10 mg, 15 mg), Subcutaneous auto-injector — Otrexup, Rasuvo (7.5 mg, 10 mg, 12.5 mg, 15 mg, 17.5 mg, 20 mg, 22.5 mg, 25 mg), Subcutaneous solution single-use vial (25 mg/mL), Injection solution — preservative-free (25 mg/mL) for IV/IM/intrathecal use
- Therapeutic categories
- Immunology, Rheumatology, DMARDs
- Conditions treated
- 3 related conditions on this site
What Methotrexate Is Used For
Methotrexate is prescribed to treat:
• Rheumatoid arthritis, psoriasis, and certain cancers • Various related conditions in the immunology category • Associated symptoms and complications
It is an important medication that helps manage these conditions effectively.
Dosage Quick Reference
These are general dosage guidelines for Methotrexate. Your doctor will determine the appropriate dose for your specific situation.
| Condition | Starting Dose | Maintenance Dose |
|---|---|---|
| Rheumatoid arthritis | 7.5 mg once weekly (oral or SC) | 10–25 mg once weekly; with daily folic acid 1–5 mg |
| Severe psoriasis | 10–25 mg once weekly | 10–30 mg once weekly; lowest effective dose with folic acid |
| Polyarticular juvenile idiopathic arthritis | 10 mg/m² once weekly | 10–20 mg/m² once weekly with folic acid supplementation |
| Ectopic pregnancy (single-dose protocol) | 50 mg/m² IM once | Repeat hCG-guided dosing per protocol |
Side Effects
Common side effects may include:
• Nausea or stomach upset • Headache • Dizziness or lightheadedness • Fatigue or tiredness • Mild rash or itching
Serious side effects (seek immediate medical attention):
• Severe allergic reactions (rash, hives, swelling, difficulty breathing) • Unusual bleeding or bruising • Severe stomach pain • Signs of liver problems (yellowing of skin/eyes, dark urine) • Chest pain or irregular heartbeat • Severe dizziness or fainting • Signs of serious adverse effects
See also: Drug Interactions ↓
Drug Interactions
Methotrexate has a narrow therapeutic index, and many interactions can substantially raise toxicity risk through reduced renal clearance, displaced protein binding, or additive bone-marrow or hepatic toxicity.
- NSAIDs and salicylates (e.g., ibuprofen, naproxen, aspirin): Decrease renal clearance and displace methotrexate from albumin, increasing toxicity. Especially dangerous with high-dose methotrexate; with low-dose weekly therapy for arthritis the risk is generally manageable but requires monitoring.
- Trimethoprim-sulfamethoxazole and other folate antagonists: Additive myelosuppression — pancytopenia, sometimes fatal. This combination is generally avoided.
- Proton pump inhibitors (e.g., omeprazole, pantoprazole): Reduce methotrexate clearance, particularly with high doses. Consider using H2 blockers (e.g., famotidine) instead during high-dose courses.
- Penicillins, ciprofloxacin, probenecid: Reduce renal tubular secretion of methotrexate, increasing levels and toxicity risk. Monitor closely.
- Live vaccines: Contraindicated during methotrexate therapy due to immunosuppression and risk of disseminated vaccine infection. Update vaccinations before starting therapy when feasible.
- Alcohol and other hepatotoxic drugs (e.g., leflunomide, isotretinoin): Additive hepatotoxicity. Limit alcohol to no more than occasional moderate intake; many rheumatologists recommend complete avoidance.
- Nitrous oxide: Can precipitate severe, sometimes fatal methotrexate toxicity due to interference with folate metabolism. Avoid nitrous oxide during methotrexate therapy.
See also: Questions to Ask Your Doctor ↓
Key Considerations
Known drug interactions
Methotrexate has documented interactions with other medications, supplements, and certain foods. Review the Drug Interactions section below and tell your healthcare provider about every medication you take, including over-the-counter products. Jump to section →
Multiple forms available
Methotrexate comes in more than one form (Oral tablet (2.5 mg, 5 mg, 7.5 mg, 10 mg, 15 mg), Subcutaneous auto-injector — Otrexup, Rasuvo (7.5 mg, 10 mg, 12.5 mg, 15 mg, 17.5 mg, 20 mg, 22.5 mg, 25 mg), Subcutaneous solution single-use vial (25 mg/mL), Injection solution — preservative-free (25 mg/mL) for IV/IM/intrathecal use). The right form for you depends on your condition, ease of use, and your provider's recommendation.
Additional Information
What is Methotrexate?
Methotrexate (generic name: Methotrexate) is a medication primarily used to treat rheumatoid arthritis, psoriasis, and certain cancers. It is marketed under the brand name(s) Rheumatrex, Trexall and belongs to the Immunology category of medications.
How Does Methotrexate Work?
Methotrexate works through several mechanisms to provide therapeutic benefits:
- Acts on specific receptors or pathways in the body
- Modulates biological processes related to the treated condition
- Provides symptom relief and improves quality of life
- Helps manage the underlying condition effectively
- Works best when combined with appropriate lifestyle modifications
The medication is designed to target the specific pathways involved in rheumatoid arthritis, psoriasis, and certain cancers, making it an effective treatment option.
Common Uses
Primary Indications
Methotrexate is commonly prescribed for:
- Rheumatoid arthritis, psoriasis, and certain cancers: The main indication for this medication
- Related Conditions: Associated symptoms and complications
- Prevention: May help prevent progression of certain conditions
- Symptom Management: Reduces discomfort and improves daily function
Additional Uses
In some cases, Methotrexate may also be prescribed for:
- Off-label uses as determined by your healthcare provider
- Combination therapy with other medications
- Long-term management of chronic conditions
- Short-term treatment of acute symptoms
Dosage and Administration
Methotrexate dosing varies based on the specific condition being treated and individual patient factors.
Typical Dosing:
- Starting dose is typically determined by your healthcare provider
- May be adjusted based on response and tolerability
- Can be taken with or without food (follow specific instructions)
- Usually taken once or twice daily
Administration Tips:
- Take at the same time(s) each day for best results
- Swallow tablets/capsules whole unless instructed otherwise
- Don't skip doses
- Complete full course of treatment as prescribed
- Follow your doctor's specific instructions carefully
Important Safety Information
Who Should Not Take Methotrexate?
Do not take Methotrexate if you:
- Are allergic to Methotrexate or any ingredients
- Have certain medical conditions (discuss with your doctor)
- Are taking medications that interact with Methotrexate
- Have severe liver or kidney disease (without dose adjustment)
Drug Interactions
Inform your doctor about all medications you take, including:
- Prescription medications
- Over-the-counter drugs
- Vitamins and supplements
- Herbal products
Some medications may interact with Methotrexate, affecting its efficacy or increasing side effect risk.
Pregnancy and Breastfeeding
Pregnancy:
- Discuss risks and benefits with your doctor if pregnant or planning pregnancy
- May require special monitoring or dose adjustments
- Some medications should be avoided during pregnancy
Breastfeeding:
- Consult your doctor about safety while breastfeeding
- May pass into breast milk
- Benefits and risks should be carefully considered
Monitoring and Follow-Up
While taking Methotrexate, your doctor may monitor:
- Effectiveness of treatment (symptom improvement)
- Side effects or adverse reactions
- Laboratory values if applicable
- Blood pressure, heart rate, or other vital signs as appropriate
- Overall response to therapy
Regular follow-up appointments are important to ensure the medication is working properly and to make any necessary adjustments.
Managing Side Effects
Most side effects are mild and improve with time. Here are strategies for common side effects:
Gastrointestinal Upset
- Take with food if allowed
- Stay well hydrated
- Eat smaller, more frequent meals
- Report persistent nausea or vomiting
Dizziness
- Rise slowly from sitting or lying positions
- Avoid sudden movements
- Stay hydrated
- Avoid alcohol
- Report severe or persistent dizziness
Fatigue
- Get adequate rest
- Maintain regular sleep schedule
- Exercise as tolerated
- Report excessive tiredness that interferes with daily activities
Lifestyle Considerations
To maximize the benefits of Methotrexate:
- Follow a healthy, balanced diet
- Exercise regularly as recommended by your doctor
- Maintain a healthy weight
- Avoid alcohol or limit consumption
- Don't smoke
- Manage stress through relaxation techniques
- Get adequate sleep
- Stay well hydrated
- Keep all follow-up appointments
- Take medication consistently as prescribed
When to Contact Your Doctor
Seek immediate medical attention if you experience:
- Signs of severe allergic reaction (difficulty breathing, severe rash, swelling)
- Chest pain or rapid heartbeat
- Severe dizziness or fainting
- Unusual bleeding or bruising
- Signs of liver problems (yellowing of skin/eyes, dark urine, severe fatigue)
- Severe stomach pain
- Any symptoms that concern you
Contact your doctor for non-emergency issues:
- Mild to moderate side effects that persist
- Questions about your medication
- Concerns about effectiveness
- New medications prescribed by another doctor
- Scheduled surgery or dental procedures
- Planning pregnancy
Storage
Store Methotrexate at room temperature (68-77°F or 20-25°C) away from light, heat, and moisture. Keep in original container. Keep out of reach of children and pets. Do not use past expiration date.
Important Reminders
- Take exactly as prescribed by your doctor
- Don't stop suddenly without medical advice
- Keep all follow-up appointments
- Report any unusual symptoms
- Don't share medication with others
- Store safely away from children
- Check expiration dates
- Ask your pharmacist if you have questions
Clinical Benefits
When used appropriately, Methotrexate provides several benefits:
- Effective management of rheumatoid arthritis, psoriasis, and certain cancers
- Improvement in quality of life
- Reduction in symptoms
- Prevention of complications
- Generally well-tolerated when used as directed
- Backed by clinical research and extensive use
Disclaimer: This information is for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Always consult your physician or other qualified healthcare provider with any questions about a medical condition or medication.
Frequently Asked Questions
Questions to Ask Your Doctor About Methotrexate
Consider discussing these topics at your next appointment:
- How often will I need blood tests, and what results would change my dose?
- What are the warning signs of liver, lung, or bone marrow toxicity that should prompt me to call you immediately?
- Are my vaccinations — including pneumococcal and shingles — up to date before we start?
- How will methotrexate interact with the other medications and supplements I take?
- What is the long-term plan, and at what point would we consider adding or switching to a biologic?
Medical Disclaimer: This information is for educational purposes only and should not be considered medical advice. Always consult with your healthcare provider before starting, stopping, or changing any medication. Your doctor can provide personalized recommendations based on your specific health condition and medical history.