What does it do?

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

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.

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.

What side effects might you notice?

Side Effects	Recommended action
Increased risk of infection - symptoms may include: fever, chills, sore throat, aches and pains, tiredness, pain when peeing, mouth ulcers Short of breath, persistent dry cough Easy/unusual bruising or bleeding Symptoms of liver problems including: yellow skin or eyes, itching, dark urine, pale bowel motions, abdominal pain	Tell your doctor immediately
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:

• Tell your doctor if you have liver, kidney, blood, lung, stomach or gut problems, or diabetes.
• Tell your doctor if you have a long-term infection e.g. tuberculosis, HIV or hepatitis B or C.
• Both men and women should use reliable contraception while taking methotrexate, and for 3 months after stopping. If you or your partner are planning to become pregnant, or find you are pregnant, discuss this with your doctor. Tell your doctor if you are breastfeeding.
• 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.
• Methotrexate affects your immune system. Before you start and while you are using it, check with your doctor what vaccines you might need. You should not have a live vaccine while using it.
• You have an increased risk of getting an infection while taking methotrexate. Discuss with your doctor.
• 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.
• It is important to tell anyone who gives you medical or dental treatment that you are taking methotrexate.