NZ Formulary

Methotrexate (for inflammatory conditions)


What does it do?

Methotrexate is an immunosuppressant medicine used to treat inflammatory conditions such as rheumatoid arthritis, inflammatory bowel disease and psoriasis.

Before you start

  • Tell your doctor if you have liver, kidney, blood, lung, stomach or gut problems, or diabetes.
  • Tell your doctor if you are pregnant or breastfeeding. If you or your partner are planning to become pregnant, or find you are pregnant, discuss this with your doctor. Both men and women should use reliable contraception while taking methotrexate, and for 3 months after stopping.
  • Methotrexate weakens your immune system, making it harder for your body to fight infections. You may need tests before you start to make sure you don't have any infections like tuberculosis (TB), HIV, or hepatitis B and C.
  • Ask your doctor what vaccines you might need before you start and while you are taking methotrexate. You should not have a live vaccine while taking methotrexate.

How should you take it?

Take methotrexate tablets once a week, on the same day each week. The tablets come in 2.5 mg and 10 mg strengths – make sure you take the right strength. Swallow the tablets whole, with food and a glass of water. Do not break, crush or chew the tablets.
Methotrexate may also be injected under the skin or into a muscle.

Wash your hands after handling methotrexate.

What if you forget a dose?

The missed dose can be taken up to a day later. Otherwise, skip the dose and carry on as normal next week. Do not take two doses at the same time.

Can you take other medicines?

Some medicines available without a prescription may react with methotrexate including:

  • anti-inflammatories, such as diclofenac (e.g. Voltaren®), ibuprofen (e.g. Nurofen®), or aspirin (e.g. Disprin®, in doses used for pain relief). These can also be found in some cold and flu medicines (e.g. Nurofen Cold and Flu®).
  • trimethoprim

Tell your pharmacist or doctor about all medicines or treatments that you may be taking, including vitamins (e.g. folic acid), herbal products (e.g. echinacea) or recreational drugs.

Important information continues on next page.

What side effects might you notice?

Side EffectsRecommended action

Reduced number of blood cells that fight infections or help your blood to clot - symptoms include: fever, chills, sore throat or generally feeling unwell, or easy or unusual bruising or bleeding

Short of breath, persistent dry cough

Symptoms of liver problems including: yellow skin or eyes, itching, dark urine, pale bowel motions, abdominal pain

Tell your doctor immediately

Pain, sores, or redness in mouth or on lips

Tell your doctor

Headache, dizziness, changes in vision

Hair loss or thinning, skin changes including; rash, itching, lumps or discolouration

Nausea, vomiting, diarrhoea

Tell your doctor if troublesome

If you notice any other effects, discuss them with your doctor or pharmacist.

Other information:

  • You will need regular blood tests while taking methotrexate to monitor its effects.
  • Protect yourself from too much sunlight while being treated with methotrexate. Always cover up and apply a thick layer of broad spectrum sunscreen (at least SPF 30) when outside. Do not use sunbeds.
  • Women using methotrexate for a long time may need cervical screening more often. Discuss with your doctor.
  • It is important to tell anyone who gives you medical or dental treatment that you are taking methotrexate.
  • Limit your alcohol intake while taking methotrexate – discuss this with your doctor.
  • You may not notice the effects of methotrexate straight away – it can take several weeks before you start to feel better.