Methotrexate

Examples

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Brand Name	Chemical Name
Trexall	methotrexate

How It Works

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Methotrexate is similar to the vitamin called folic acid. It works by competing with folic acid in cells. This blocks the way the cell is able to make genetic material, and the cell dies.

Methotrexate may be given as a pill or as a shot in the vein (intravenously, or IV) or in the muscle (intramuscularly, or IM).

Why It Is Used

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Methotrexate can be used to treat several conditions and diseases, including:

• Cancer. Methotrexate slows or stops the growth of cancer cells in the body. It may be given with other medicines.
• Autoimmune diseases, such as:
  • Rheumatoid arthritis. Methotrexate may be used alone or with other medicines to control the progression of rheumatoid arthritis.
  • Juvenile rheumatoid arthritis (JRA). Methotrexate is safe and effective for children with JRA. It is generally used for children who do not respond to nonsteroidal anti-inflammatory drugs. It is also used to treat resistant chronic uveitis in children with JRA.
  • Psoriasis. Methotrexate slows the rapid growth of skin cells in psoriasis.
  • Sjögren's syndrome. Methotrexate is generally used for people who do not respond to other medicine for Sjögren's syndrome.
• Ectopic pregnancy. Methotrexate is used with leucovorin to end an ectopic pregnancy or to prevent the growth of any fetal cells that are left behind after surgery to end an ectopic pregnancy.
• Medical abortion. Methotrexate is used with misoprostol in early pregnancy for medical abortion.

How Well It Works

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Methotrexate effectively treats many conditions and diseases, including:

• Cancer. The type and extent of a cancer will determine whether methotrexate is used. It is commonly used in combination with other chemotherapy medicines.
• Autoimmune diseases. Methotrexate relieves joint pain and other symptoms and helps to control diseases such as rheumatoid arthritis, juvenile rheumatoid arthritis, psoriasis, and Sjögren's syndrome.^{1, 2}
• Ectopic pregnancy. Methotrexate is used to end an ectopic pregnancy in early pregnancy. It is not used to treat a ruptured ectopic pregnancy.

Side Effects

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Side effects from methotrexate are usually temporary and occur more often with long-term use. Side effects may include:

• Nausea, vomiting, and loss of appetite.
• Fatigue and sleep disturbances.
• Reduced white blood cell count.

Less common side effects include:

• Sun sensitivity and easy sunburning.
• Diarrhea or blood in the stool.
• Mouth sores.
• Easy bruising and bleeding.
• Skin rash or sores.
• Headaches.
• Chills and fever.
• Lightheadedness.

Long-term side effects may include:

• Liver damage. The risk of liver damage is increased in people who have other problems, such as diabetes, liver disease, or a history of alcohol abuse.
• Lung problems.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

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Methotrexate can cause birth defects. Do not use this drug if you are pregnant or wish to become pregnant or father a child while you are taking it.

Many antibiotics can increase the level of methotrexate in your blood. Make sure your doctor knows that you are taking methotrexate if you need to take an antibiotic for another problem.

You will have your blood drawn often while you are taking methotrexate.

Do not drink alcoholic beverages, including beer and wine, while you are being treated with methotrexate.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

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Citations

1. Jonsson R, et al. (2005). Sjögren's syndrome. In WJ Koopman, LW Moreland, eds., Arthritis and Allied Conditions: A Textbook of Rheumatology, 15th ed., vol. 2, pp. 1681–1705. Philadelphia: Lippincott Williams and Wilkins.

2. Fox RI (2000). Sjögren's syndrome: Current therapies remain inadequate for a common disease. Expert Opinion on Investigational Drugs, 9(9): 2007–2016.

Credits

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Author	Kathe Gallagher, MSW
Editor	Kathleen M. Ariss, MS
Editor	Cynthia Tank
Associate Editor	Michele Cronen
Associate Editor	Pat Truman
Primary Medical Reviewer	Joy Melnikow, MD, MPH - Family Medicine
Specialist Medical Reviewer	Douglas A. Stewart, MD - Medical Oncology
Last Updated	August 31, 2007