Methotrexate – your safety tips

Methotrexate is a drug that we commonly use in Rheumatology. Many people are understandably concerned and apprehensive when it comes to considering taking this medication. It has as we say got a ‘bad rep’ (aka bad reputation….), with many people afraid of the possible side effects. But in my practice having used it for more than a decade I have seen it to be on the whole a very well tolerated and very effective drug, helping people more than it harms. Of course, this is all a personal matter as there is no way of predicting what will happen to each person on methotrexate.

Taking correct steps with methotrexate can minimise a lot of side effects.

My top 7 tips for taking Methotrexate to stay safe and well 🙂

1: Take it only once a week.

Even if there may one day be an instruction on your script that says daily, IGNORE it. If this ever  happens, this will be a prescribing error. Let your doctor know ASAP! Methotrexate is only taken once a week.

Methotrexate is unlike other drugs which are usually taken daily. Methotrexate is not taken every day.

Taken once a week the medication is very safe. Taken daily, it has serious problems, one of them being death… so please never take it every day!!

The Rule of Rheumatology is:


To help you taking it only once a week:

Choose a regular day

Make sure you know which tablets are the methotrexate: look at the shape size and colour, familiarise yourself with it to make sure you don’t mix it up with other tablets.

Use a dosette box if you have memory issues.

Your pharmacist can help you with this.

and as a recap… DON’T take it every day!

2: Take it at night.

Methotrexate can cause some nausea. Taking it at night lessens the possibility of you feeling the impact of this. Sometimes in some people nausea persists but I have found taking it at night to be helpful for many people.

3: Get regular blood tests

I know. Having regular blood tests is not pleasant and it is not something that we dream about as kids. However, with methotrexate its part of what I call ‘defensive driving for drugs’! We learn how to drive to minimise potential harm, and it’s the same with drugs. Regular blood tests can pick up changes in the bloods before we get really sick with the medication.

4: If you are sick, stop Methotrexate until you get better

If you have a fever, or a serious cold, or other infection, it’s important to STOP the methotrexate until you get better. Methotrexate can lower your immune system and make you more likely to get more serious infections and delaying your healing. To support yourself, it’s important to stop the methotrexate and:

Check in with your doctor if you are feeling unwell.

5: If you have a cough which doesn’t go away – let your doctor know

In rare cases methotrexate can affect the lungs. Sometimes it just causes a cough and other times it can causing breathing problems. If you have any of these problems it’s important to let your doctor know. Often we ignore things like this as they can creep up on us, but when you are on a medication like methotrexate it is important to communicate with your doctor how you are feeling, otherwise they won’t know if they need to take action to keep you healthy.

6: Take folic acid at least twice a week.

But don’t take it at the same time as Methotrexate.

Why not?

Because if you do it interferes with the absorption of the methotrexate which means the drug won’t work – because it’s not being absorbed!

7: Have regular visits with your Rheumatologist

Especially in the early stage of your treatment. This can help with identifying potential side effects. It also gives your Rheumatologist the opportunity to tailor your treatment to your medical condition to make sure you are getting the right doses, and the best treatment.

If you have any questions or concerns, write them down and ask your doctor. You don’t have to wait for your next appointment if it is scheduled for a few months.

If there is a problem now, see your doctor sooner.