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Updated October 2021
Methotrexate (brand name Methoblastin or injectable methotrexate (Hospira, Methacord, Methotrexate Accord & Trexject) is a well-established, effective treatment for several different types of inflammatory diseases such as rheumatoid arthritis, psoriatic arthritis, Crohn’s disease, SLE (Systemic Lupus Erythematosus) and severe psoriasis. It may also be used for other conditions.
It can reduce damage to joints, skin and other tissues so it belongs to the group of medicines called disease modifying antirheumatic drugs (DMARDS). It is not a painkiller.
Low dose methotrexate (5mg-30mg once per week) has been used to treat rheumatoid arthritis for more than 25 years. Most, but not all, patients will benefit from this medicine. It is also used at very high doses (1000mg-5000mg a day) to treat some cancers.
Methotrexate has been shown to prolong life and can reduce the risk of heart disease in rheumatoid arthritis.
It may be 4 to 12 weeks after reaching the best dose for your condition before you notice any benefits. Many of the conditions that are treated with methotrexate are long term and methotrexate may need to be taken for several years or in some people, indefinitely. Some other DMARDs are taken with methotrexate for added benefit.
Methotrexate may be taken by mouth as a tablet or given by injection either into the muscle or under the skin (subcutaneously). For more information on the injections see Injectable methotrexate.
Methotrexate is taken ONCE A WEEK, on the same day each week. If you are taking the tablets, it is a good idea to specify the day of the week that you will take your tablets to avoid making mistakes.
Methotrexate tablets are best taken on an empty stomach. However if nausea is a problem, taking them at mealtime can help to reduce this side effect and does not reduce the benefits too much.
Tablets come in 2.5mg or 10mg strengths. If you have two strengths ensure you CHECK THE STRENGTH each time you take it. Treatment may start low at 5mg or 10mg a week, increasing to an average dose of 20mg a week, and sometimes 30mg/week.
The dose is usually taken all at once on a single day. It may be divided into separate doses taken during that day if necessary.
If you stop methotrexate treatment for more than a few weeks there is a risk that your condition may worsen. Continue with your treatment unless advised by your doctor or unless side effects develop.
If you have an illness that makes you unwell enough to change plans for the day (e.g. gastroenteritis or fever), it is reasonable to miss the weekly dose until you have recovered.
In order to reduce side effects, it is recommended that you also take folic acid or folinic acid. Your doctor will explain how much of the folic/folinic acid to take and when to take it.
Methotrexate is often taken in combination with other arthritis medicines, including:
Some people experience side effects so tell your doctor if you are concerned about possible side effects. A reduction in dose may minimise these so you may be able to continue it. Your doctor will advise on any dose changes that are necessary.
Long term side effects:
Methotrexate may be taken for long periods (more than 25 years). The following are rare but possible long-term issues:
Information that comes with your methotrexate medicine describes in detail potential serious side effects that may occur with methotrexate. Many of those side effects relate to high dose methotrexate used for the treatment of cancer. These may not be applicable to the much lower doses that are prescribed for the treatment of rheumatoid arthritis.
Because your immune system may be depressed, there is an increased risk of developing some infections, especially Herpes zoster (chicken pox and shingles).
You should try to avoid contact with people who have these infections. If you have an infection or persistent fever, tell your doctor straight away.
Methotrexate can interact with other medicines. You should tell your doctor (including your GP, rheumatologist and others) about all medicines you are taking or plan to take. This includes over the counter, herbal or naturopathic medicines. You should also mention your treatment when you see other health professionals.