Methotrexate is a type of drug called an antimetabolite. It treats rheumatoid arthritis by decreasing the activity of your immune system, treats psoriasis by slowing the growth of skin cells and treats cancer by slowing the growth of cancer cells.


What is this medication?

METHOTREXATE (METH oh TREX ate) treats inflammatory conditions such as arthritis and psoriasis. It works by decreasing inflammation, which can reduce pain and prevent long-term injury to the joints and skin. It may also be used to treat some types of cancer. It works by slowing down the growth of cancer cells.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

COMMON BRAND NAME(S): Rheumatrex, Trexall


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What should I tell my care team before I take this medication?

They need to know if you have any of these conditions:

  • Fluid in the stomach area or lungs
  • If you often drink alcohol
  • Infection or immune system problems
  • Kidney disease or on hemodialysis
  • Liver disease
  • Low blood counts, like low white cell, platelet, or red cell counts
  • Lung disease
  • Radiation therapy
  • Stomach ulcers
  • Ulcerative colitis
  • An unusual or allergic reaction to methotrexate, other medications, foods, dyes, or preservatives
  • Pregnant or trying to get pregnant
  • Breast-feeding

How should I use this medication?

Take this medication by mouth with a glass of water. Follow the directions on the prescription label. Take your medication at regular intervals. Do not take it more often than directed. Do not stop taking except on your care team's advice.

Make sure you know why you are taking this medication and how often you should take it. If this medication is used for a condition that is not cancer, like arthritis or psoriasis, it should be taken weekly, NOT daily. Taking this medication more often than directed can cause serious side effects, even death.

Talk to your care team about safe handling and disposal of this medication. You may need to take special precautions.

Talk to your care team about the use of this medication in children. While this medication may be prescribed for selected conditions, precautions do apply.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.


What if I miss a dose?

If you miss a dose, talk with your care team. Do not take double or extra doses.

What may interact with this medication?

Do not take this medication with any of the following:

  • Acitretin

This medication may also interact with the following:

  • Aspirin and aspirin-like medications including salicylates
  • Azathioprine
  • Certain antibiotics like penicillins, tetracycline, and chloramphenicol
  • Certain medications that treat or prevent blood clots like warfarin, apixaban, dabigatran, and rivaroxaban
  • Certain medications for stomach problems like esomeprazole, omeprazole, pantoprazole
  • Cyclosporine
  • Dapsone
  • Diuretics
  • Gold
  • Hydroxychloroquine
  • Live virus vaccines
  • Medications for infection like acyclovir, adefovir, amphotericin B, bacitracin, cidofovir, foscarnet, ganciclovir, gentamicin, pentamidine, vancomycin
  • Mercaptopurine
  • NSAIDs, medications for pain and inflammation, like ibuprofen or naproxen
  • Other cytotoxic agents
  • Pamidronate
  • Pemetrexed
  • Penicillamine
  • Phenylbutazone
  • Phenytoin
  • Probenecid
  • Pyrimethamine
  • Retinoids such as isotretinoin and tretinoin
  • Steroid medications like prednisone or cortisone
  • Sulfonamides like sulfasalazine and trimethoprim/sulfamethoxazole
  • Theophylline
  • Zoledronic acid

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.


What should I watch for while using this medication?

Avoid alcoholic drinks.

This medication can make you more sensitive to the sun. Keep out of the sun. If you cannot avoid being in the sun, wear protective clothing and use sunscreen. Do not use sun lamps or tanning beds/booths.

You may need blood work done while you are taking this medication.

Call your care team for advice if you get a fever, chills or sore throat, or other symptoms of a cold or flu. Do not treat yourself. This medication decreases your body's ability to fight infections. Try to avoid being around people who are sick.

This medication may increase your risk to bruise or bleed. Call your care team if you notice any unusual bleeding.

Be careful brushing or flossing your teeth or using a toothpick because you may get an infection or bleed more easily. If you have any dental work done, tell your dentist you are receiving this medication.

Check with your care team if you get an attack of severe diarrhea, nausea and vomiting, or if you sweat a lot. The loss of too much body fluid can make it dangerous for you to take this medication.

Talk to your care team about your risk of cancer. You may be more at risk for certain types of cancers if you take this medication.

Do not become pregnant while taking this medication or for 6 months after stopping it. Women should inform their care team if they wish to become pregnant or think they might be pregnant. Men should not father a child while taking this medication and for 3 months after stopping it. There is potential for serious harm to an unborn child. Talk to your care team for more information. Do not breast-feed an infant while taking this medication or for 1 week after stopping it.

This medication may make it more difficult to get pregnant or father a child. Talk to your care team if you are concerned about your fertility.

What side effects may I notice from receiving this medication?

Side effects that you should report to your care team as soon as possible:

  • Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
  • Blood clot—pain, swelling, or warmth in the leg, shortness of breath, chest pain
  • Dry cough, shortness of breath or trouble breathing
  • Infection—fever, chills, cough, sore throat, wounds that don't heal, pain or trouble when passing urine, general feeling of discomfort or being unwell
  • Kidney injury—decrease in the amount of urine, swelling of the ankles, hands, or feet
  • Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing of the skin or eyes, unusual weakness or fatigue
  • Low red blood cell count—unusual weakness or fatigue, dizziness, headache, trouble breathing
  • Redness, blistering, peeling, or loosening of the skin, including inside the mouth
  • Seizures
  • Unusual bruising or bleeding

Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):

  • Diarrhea
  • Dizziness
  • Hair loss
  • Nausea
  • Pain, redness, or swelling with sores inside the mouth or throat
  • Vomiting

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medication?

Keep out of the reach of children and pets.

Store at room temperature between 20 and 25 degrees C (68 and 77 degrees F). Protect from light. Get rid of any unused medication after the expiration date.

Talk to your care team about how to dispose of unused medication. Special directions may apply.

NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.

Additional Common Questions

Does methotrexate cause weight gain?

Methotrexate is a kind of drug called a disease-modifying antirheumatic drug (DMARD). DMARDs can cause gradual and modest weight gain in some people with rheumatoid arthritis. But studies show that other drugs used to treat rheumatoid arthritis may cause more weight gain. Weight gain is also more likely to affect people who have underweight (BMI less than 18.5) before treatment began.

Is methotrexate a steroid?

No, DMARDs aren’t steroids. DMARDs are steroid-sparing drugs, harnessing a lot of the immunomodulatory properties of steroids but without the systemic side effects of corticosteroids. These side effects include weight gain, easy bruising, increased blood sugar and increased blood pressure.

How long does methotrexate stay in your system?

The amount of time it takes for methotrexate to leave your system varies. Taking certain medications may affect the amount of time it takes. Also, if you have reduced kidney function or a disease that causes extra body fluid, it may take longer for the drug to leave your system. However, for most people, the drug will be eliminated within one week of taking your last dose. More specifically, when taken in low doses, it can stay in your system for 16 to 55 hours after your last dose. When taken in high doses, it can stay in your system for 44 to 83 hours after your last dose.

How long does it take for methotrexate to work?

It depends on many factors, including what health condition you’re treating with methotrexate. If you’re taking it to treat rheumatoid arthritis, it won’t begin working immediately. It can take three to six weeks for your symptoms to begin to improve. It may take up to 12 weeks before you notice complete benefits.

If you’re taking methotrexate for psoriasis, you may see improvements in your symptoms in four to six weeks. But it may take up to six months to get complete clearing.

If you’re taking the medication for cancer, it should start working immediately. The methotrexate will help slow down the growth of quickly dividing cancer cells. But it’s hard to say how rapidly it’ll shrink your tumor because everyone responds to medications differently.

A note from Cleveland Clinic

Methotrexate is a medication that treats inflammatory arthritis, psoriasis and other inflammatory conditions. It decreases inflammation in your body. This can reduce pain and prevent long-term damage to your joints and skin. It can also slow down the growth of cancer cells to treat cancer. Taking medications can be stressful, but your healthcare provider is there to answer your questions and talk to you about your concerns.

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Note: Introduction and Additional Common Questions written and medically approved by Cleveland Clinic professionals.

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