Thursday, November 7, 2013



Methotrexate is used for a variety of disorders. While it is used to treat some types of cancer, in lower doses, it is used to treat autoimmune diseases. 

For autoimmune diseases, methotrexate may be taken orally or as an intramuscular injection. The normal dose for rheumatoid arthritis is 7.5mg per week. It may be given in one dose or in divided doses.

Some patients have side effects to oral methotrexate that can be decreased by switching to the injectable form.

Before you start methotrexate, your physician will do routine lab tests to check blood counts and to ensure your liver is healthy enough for the medication. Tell your physician if you are an alcoholic, have liver or kidney disease, stomach ulcers, or an infection.

It's very important that you provide your physician with a list of all the medications, even over the counter medicines, that you are taking. Your doctor also needs to know about any other types of treatments you may be taking - like radiation therapy.

Methotrexate can cause birth defects in a baby when taken by the mother or father. Don't use it if you (or your wife) are pregnant or planning to become pregnant. Notify your physician as soon as you suspect that you might be pregnant if you are on therapy.

Side effects can include serious, life threatening side effects.

Call 9-1-1 if you experience the following:

  • Swelling of the mouth, throat, tongue or other signs of severe allergic reaction

If you experience any of the following, call your physician right away:
  • Very dark urine or blood in your urine
  • Vomiting coffee ground or bloody emesis
  • Bloody, black, or tarry stools
  • Diarrhea
  • Changes in vision
  • Confusion
  • Seizures
  • Coughing
  • Swelling of legs or feet
  • Red dots on the skin
  • Shortness of breath
  • Any unexpected bleeding or bruising
  • Sores in mouth and lips - can lead to dehydration if it interferes with drinking
  • Back pain
  • Signs of infection - fever, cough, chills
  • Dizziness
  • Drowsiness
  • Headache
  • Painful or difficult urination
  • Unusual tiredness or weakness
  • Yellow discoloration of the skin or eyes
Common side effects:
  • Loss of appetite
  • Nausea and vomiting
  • Acne
  • Boils
  • Skin Rash or Itching
  • Hair loss
It is important to avoid alcohol while taking methotrexate due to the increased risk of liver damage. Also, be sure to keep your follow-up appointments with your physician, including those for lab work only.

Routine labs are needed to monitor liver function and to ensure your blood counts are adequate to continue the medicine.

For more information on rheumatology, visit the International Foundation for Autoimmune Arthritis.

  1. Drugs .com
  2. Harrison's Rheumatology 2nd Edition - Anthony S. Fauci, MD - Editor


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