Learn More About Methotrexate!

How do I take methotrexate?

You should always follow the dosage prescribed by your doctor. Your dose may be adjusted until your doctor finds the best dose for you. This may take several months.

Remember: methotrexate is always taken once a week and never daily. 

The optimal dose is at least 20 mg per week. Methotrexate can be administered either orally (tablets) or by subcutaneous injection (usually given by the patient themself). Many doctors and patients usually prefer to start with the tablets. Tablets should be taken with a glass of water with food or at the end of a meal.

Sometimes folic acid is prescribed with methotrexate to reduce side effects but it is not always necessary. Because methotrexate is not a painkiller but an antimetabolite, so it can be combined with anti-inflammatory drugs and other pain relievers. It should also be noted that since methotrexate is eliminated by the kidneys, the dose should be reduced in cases of renal failure.

How long does it take to work?

Because it is slow acting it may be several weeks before you begin to feel the benefit of the drug so don’t be discouraged. Provided the drug is working, you may well continue to take it for months or even years.

Are there any side effects I should know about?

Like all medicines, methotrexate may cause side effects in a small number of people. The most frequent is the “feeling of sickness” and very occasionally vomiting, which occurs a day or so after taking the tablets. These can disappear with continued treatment or can be alleviated by other simple measures. Other side effects could include skin rashes or mouth ulcers. If these occur, you should contact your doctor and not wait until the next visit. If you should suffer from a persistent fever, dry cough or shortness of breath, you should stop your methotrexate, tell your doctor and report the side effect on the Yellow Card website. 

At the beginning of the treatment, you will have a chest x-ray and urinalysis. Then you will need a blood test either weekly or every two weeks for the first month and then once a month after that. This is to make sure that the methotrexate is not suppressing your bone marrow and to ensure that it is not harming the liver, kidneys and blood cells. All these side effects are reversible, so by having blood tests regularly it is possible to stop the medication before you are even aware of a problem. I have been taking methotrexate for my condition for nineteen years, the only side effect has been a very low immune system.

Interactions with other medicines

Some drugs will affect the way methotrexate works:

• Non-steroidal anti-inflammatories (NSAIDs) like IBUPROFEN or cough and cold remedies containing NSAIDs
• CO-TRIXOMAZOLE, TRIMETHOPRIM or other antibiotics for bacterial infections
• Diuretics (medicines that make you urinate more) such as INDAPAMIDE and BENDROFLUMETHIAZIDE
• Epilepsy medicines such as PHENYTOIN or levetiracetam
• Theophylline used to treat asthma
• Medicines used to treat indigestion such as OMEPRAZOLE

You also should not take medicines, vitamin or mineral supplements that contain folic acid if you are already taking folic acid prescribed by your doctor. Check the ingredients on the labels. 

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. 

Additional information 

It is important that you drink very little or no alcohol while on treatment, just a few units each week, because the risk of toxicity on your liver is very high. You should also know that methotrexate contains gluten, if you have an intolerance, ask your doctor. 

Pregnancy should be avoided whilst taking methotrexate and for six months after stopping the drug. Men should not father a child for six months after stopping the drug.

What do Carenity members think?

Our community is generally satisfied with the effectiveness of methotrexate but many have experienced side effects.  

“I have been using methotrexate for 7 years now. I started on 10mg/week. In the beginning I caught every virus/bug going around but this has settled now. I am now on 15mg/week. Before using this drug, I was in a lot of pain and could barely walk upstairs or dress myself. Now I am pain free and living a normal life. Working full time and having an active social life.”

“In the beginning when I first started taking Methotrexate I had niggling ailments like thrush, iritis, ear infections, chest infections anything that was 'doing the rounds' really. I have been taking this drug since 2005, and after initial side effects I have no problems with it for the last 10 years or so. I value its reaction to my AS. Brilliant, pain is now under control.”

Read Carenity's medication fact sheet on METHOTREXATE

Article written in collaboration with Richard Eaton (richard0804), Carenity Ambassador, UK. Richard has been suffering from ankylosing spondylitis for twenty years and has been on methotrexate long term, nineteen years.

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