Methotrexate tablets for inflammatory conditions

In Aotearoa New Zealand methotrexate is available as tablets in 2 strengths – 2.5 mg and 10 mg.

• The dose of methotrexate is different for different people, depending on what it's being used for, your weight and how well it's working.
• Take methotrexate tablets once a week on the same day each week
• Always take your methotrexate exactly as your doctor has told you. The pharmacy label on your medicine will tell you how much to take, how often to take it and any special instructions. If it looks different to what you were expecting, ask your pharmacist to check.

Folic acid

Note: You may be asked to take folic acid tablets while you're taking methotrexate.

• Folic acid is a type of B vitamin that you need for your cells to divide and grow normally. Folic acid is also needed for your body to make red blood cells.
• Methotrexate blocks some of the actions of folic acid, which can lead to side effects such as mouth sores, stomach pain, liver problems, hair loss and anaemia.
• Taking folic acid supplements can help offset methotrexate side effects.  
• Take your folic acid on a different day from your methotrexate.

Image credit: Healthify He Puna Waiora

• Timing of your doses: Take methotrexate tablets once a week on the same day each week. Methotrexate is best taken on an empty stomach, but if it makes you feel nauseous or sick, try taking it with food. 
• Swallow your tablets with a drink of water: Don't crush or chew them.
• Limit or avoid alcohol: Limit alcohol to 1 to 2 standard drinks once or twice a week. Avoid heavy or binge drinking because it can increase your risk of side effects, such as problems with your liver. Learn more about what a standard drink is.
• Missed dose: If you forget to take your dose on the right day, you can take the missed dose up to a day later. Otherwise, skip the dose and continue next week. Don't take 2 doses at the same time.
• Folic acid: You may be asked to take folic acid tablets while you're on methotrexate. This is to help reduce side effects. Take your folic acid on a different day from your methotrexate.
• Keep taking methotrexate regularly. Methotrexate doesn't work straight away. It usually takes a few weeks or months before you notice the full benefits. If you stop methotrexate treatment for more than a few weeks your condition may get worse.  

Here are some things to know when you're taking methotrexate. Other things may be important as well, so ask your healthcare provider what you should know about.

Make sure you take the right dose

Methotrexate tablets come in 2 strengths: 2.5 mg and 10 mg. When you collect your methotrexate prescription, check that your tablets are the right strength, and that you have the right number of tablets. If your tablets look different to your last supply, get advice from your doctor or pharmacist. There isn’t a big difference between a safe dose of methotrexate and a harmful dose, so it’s important to double check your dose and ask if it's not what you were expecting.

Tests and monitoring

Methotrexate weakens your immune system, making it harder for your body to fight infections. Before you start methotrexate, you may need tests to make sure you don't have any infections such as tuberculosis (TB)(external link), HIV(external link), hepatitis B(external link) or hepatitis C(external link).

While you're taking methotrexate, you'll need regular blood tests to monitor for side effects and to check whether the treatment is working. Blood tests are very important during the first few months of treatment. Over time, these tests are needed less often.

Risk of infections

Methotrexate weakens your body’s defence (immune) system, so you're more likely to pick up infections. It's important to avoid anyone who has chickenpox, shingles or measles.

Vaccinations

Methotrexate makes your immune system weaker, putting you at increased risk of infections. Vaccines are a good way to prevent some infections. You should have all the vaccinations you need before you start treatment with methotrexate, because some vaccines shouldn't be taken while you're taking methotrexate. Always check with your doctor or pharmacist first. It's safe for you to have the annual flu vaccine. Keep your flu vaccinations up to date to reduce your risk of getting the flu.

Other medicines

Methotrexate may interact with a few medicines and herbal supplements, so check with your doctor or pharmacist before starting methotrexate or before starting any new medicines, including those you may buy over the counter.

Sun protection

Methotrexate makes your skin more sensitive to the sun. Protect your skin when you are in the sun, especially between 10am and 3pm. If outdoors, wear protective clothing and use a high factor sunscreen (SPF 30+).

Pregnant or planning a pregnancy

Methotrexate shouldn't be taken if you're pregnant. If you're taking methotrexate, talk to your healthcare provider about contraception. If you wish to become pregnant, ask your doctor about stopping methotrexate. It shouldn't be taken for at least 3 months before pregnancy.

Like all medicines, methotrexate can cause side effects, although not everyone gets them. Often side effects improve as your body gets used to the new medicine.