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    Related terms
    • Brand Names: U.S.: Rheumatrex®;TrexallT
    • Brand Names: Canada: Apo-Methotrexate®;ratio-Methotrexate

    • It is used to treat arthritis.
    • It is used to treat cancer.
    • It is used to treat ectopic pregnancy.
    • It is used to treat leukemia.
    • It is used to treat psoriasis.
    • It is used to treat inflammatory bowel disease.
    • It is used to stop graft-versus-host-disease.
    • Methotrexate harms cancer cells causing their death.
    • It lowers swelling.
    • It lowers the body's harmful response to diseases of the immune system.


    How to take

    • Follow how to use as you have been told by your doctor or read the package insert.
    • When taken by mouth, this drug is most often only taken once a week. Talk with your doctor to make sure the dose is right.
    • How this drug is taken may change based on blood work results, side effects, and how well the drug is working.
    • Take on an empty stomach. Take 1 hour before or 2 hours after meals.
    • It may be given by mouth or as a shot into a muscle, vein, or the fatty part of the skin. A shot may be given into the spinal fluid.

    Missed Dose

    • Take a missed dose as soon as you think about it.
    • If it is close to the time for your next dose, skip the missed dose and go back to your normal time.
    • Do not take 2 doses at the same time or extra doses.
    • Do not change the dose or stop this drug. Talk with the doctor.


    • Store at room temperature.
    • Protect from light.
    • Protect tablets from water. Do not store in a bathroom or kitchen.



    • This drug may have unsafe effects on the bone marrow. The bone marrow may not be able to make cells found in the blood as well as it used to for a few weeks.
    • Very bad infections have happened in patients who take this drug. Talk with the doctor.
    • This drug may cause bad skin side effects or mouth sores.
    • This drug may cause very bad kidney and/or liver problems.
    • This drug may cause lung problems. Closely read the part in this leaflet which lists when to call your doctor.
    • This drug may cause very loose stools (diarrhea). Talk with the doctor.
    • This drug may add to your chance of getting lymphoma or other cancers.
    • Talk with your doctor if you are getting radiation. There may be more chance of harm to tissue and bone.
    • Do not take if you are pregnant.
    • Talk with your doctor before taking any pain drugs (eg, ibuprofen, ketoprofen, naproxen). Do not take this drug if you are pregnant and being treated for rheumatoid arthritis or psoriasis. The good effects and bad effects of other uses need to be compared in women of childbearing age.
    • Sometimes drugs are not safe when you take them with certain other drugs. Taking them together can cause bad side effects. This is one of those drugs. Be sure to talk to your doctor about all the drugs you take.


    • If you have an allergy to methotrexate or any other part of this drug.
    • Tell your doctor if you are allergic to any drugs. Make sure to tell about the allergy and what signs you had. This includes telling about rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs.
    • If you are breast-feeding.
    • Psoriasis or rheumatoid arthritis:
    • If you are pregnant or may be pregnant.
    • If you have any of these health problems: Bone marrow disease or very bad liver disease.


    • Talk with your doctor before getting any vaccines. Use with this drug may either raise the chance of an infection or make the vaccine not work as well.
    • If you have had hepatitis B or C, talk with your doctor.
    • If you have a drug or drinking problem, talk with your doctor.
    • If you have kidney disease, talk with your doctor.
    • If you have liver disease, talk with your doctor.
    • If you have a weak immune system, get infections easy, or are on antibiotics, talk with your doctor.
    • If you have mouth sores, stomach irritation or ulcers, talk with your doctor.
    • Have your blood work checked. Talk with your doctor.
    • Check all drugs you are taking with your doctor. This drug may not mix well with some other drugs.
    • Keep a list of all your drugs (prescription, natural products, vitamins, OTC) with you. Give this list to your doctor.
    • When taking methotrexate for a long time or at high doses, you may need closer watching of liver and bone marrow function. Talk with your doctor.
    • Do not donate blood while using this drug and for 1 month after stopping.
    • Talk with your doctor before using products that have aspirin, blood thinners, garlic, ginseng, ginkgo, ibuprofen or like products, pain drugs, or vitamin E.
    • Avoid beer, wine, or mixed drinks.
    • Take good care of your teeth. See a dentist often.
    • You may get sunburned more easily. Avoid sun, sunlamps, and tanning beds. Use sunscreen and wear clothing and eyewear that protects you from the sun. Keep protecting yourself from sunburn for at least 1 month after using this drug.
    • Use birth control that you can trust to stop pregnancy while taking this drug.

    Side Effects

    • Anemia, low white blood cell count, and low platelet count.
    • Chance of getting an infection. Wash hands often. Stay away from people with infections, colds, or flu.
    • Upset stomach or throwing up. Many small meals, good mouth care, sucking hard, sugar-free candy, or chewing sugar-free gum may help.
    • Not hungry.
    • Loose stools (diarrhea).
    • Mouth irritation or sores. Using a soft toothbrush or cotton swabs and rinsing the mouth may help. Do not use mouth rinses that have alcohol in them.
    • Sore throat.
    • Headache.
    • Hair loss. Hair most often grows back when this drug is stopped.
    • Kidney failure may rarely happen.
    • Harm to the liver may rarely happen.
    • Harm to the lungs may rarely happen.
    • Other kinds of cancer may rarely happen later in life.

    Contact a healthcare provider

    • If you think there was an overdose, call your local poison control center or ER right away.
    • Signs of a very bad reaction to the drug. These include wheezing; chest tightness; fever; itching; bad cough; blue or gray skin color; seizures; or swelling of face, lips, tongue, or throat.
    • Signs of infection. These include a fever of 100.5°F (38°C) or higher, chills, very bad sore throat, ear or sinus pain, cough, more sputum or change in color of sputum, pain with passing urine, mouth sores, wound that will not heal, or anal itching or pain.
    • Chest pain or pressure.
    • Trouble breathing.
    • Cough that does not go away.
    • Pinpoint red spots on your skin.
    • Very bad belly pain.
    • Very upset stomach or throwing up.
    • Very loose stools (diarrhea).
    • Not able to eat.
    • Any bruising or bleeding.
    • Dark urine or yellow skin or eyes.
    • Feeling very tired or weak.
    • For women, if you get pregnant while taking this drug.
    • Any rash.
    • Side effect or health problem is not better or you are feeling worse.

    General Statements

    • If you have a very bad allergy, wear an allergy ID at all times.
    • Do not share your drugs with others and do not take anyone else's drugs.
    • Keep all drugs out of the reach of children and pets.
    • Most drugs may be thrown away in household trash after mixing with coffee grounds or kitty litter and sealing in a plastic bag.
    • In Canada, take any unused drugs to the pharmacy. Also, visit to learn about the right way to get rid of unused drugs.
    • Keep a list of all your drugs (prescription, natural products, vitamins, OTC) with you. Give this list to your doctor.
    • Call your doctor for help with any side effects. If in the U.S., you may also call the FDA at 1-800-FDA-1088 or if in Canada, you may also call Health Canada's Vigilance Program at 1-866-234-2345.
    • Talk with the doctor before starting any new drug, including OTC, natural products, or vitamins.

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    Copyright © 2011 Natural Standard (

    The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.