Methotrexate is a disease-modifying antirheumatic drug (DMARD). At the low doses used in rheumatology it calms the overactive immune response that drives joint inflammation. It is the first-choice treatment for rheumatoid arthritis worldwide, and it often stays the foundation even when other drugs are added.
How long it takes
Usually 6 to 12 weeks before the full effect. Early tiredness or nausea is not a sign that it has failed.
How to take it
- Once a week, on the same day every week. Writing the day on the strip helps.
- Never daily. Taking it every day by mistake is a recognised cause of serious, sometimes fatal, poisoning. If you are unsure, do not take a dose until you have checked with the clinic.
- Folic acid is prescribed alongside it, on a different day, to reduce side effects. Keep taking it.
- Some patients take it as a weekly injection under the skin instead of tablets. It often causes less nausea and can work better.
Common side effects
Most are mild and many settle. Mention them at your next visit; there is often a simple fix.
- Nausea or feeling washed-out for a day after the dose
- Mouth ulcers
- Mild hair thinning
- Mildly raised liver tests on monitoring bloods
Call the clinic the same day if you have
- Fever, sore throat, chills or any sign of infection
- A new dry cough or breathlessness
- Unexplained bruising, bleeding or severe mouth ulcers
- Yellowing of the eyes or skin, or dark urine
- You realise you have been taking it more than once a week
Clinic: +91 70571 19999. If you are very unwell, go to the nearest emergency department and take your medicine strip with you.
Blood tests & checks
- Blood count, liver and kidney tests every 2 to 4 weeks for the first three months, and after any dose increase
- Then every 8 to 12 weeks once the dose is stable
- A chest X-ray before starting is usual
Pregnancy & family planning
- Methotrexate can harm a developing baby and cause miscarriage. Use reliable contraception while taking it.
- Women: it is stopped before trying to conceive, usually one to three months ahead. Plan this with your rheumatologist so the disease stays controlled on a pregnancy-safe alternative.
- Men: current guidance generally allows low-dose methotrexate to continue when planning a family. Discuss it at your next visit.
- It is not used while breastfeeding.
Alcohol, infections, vaccines & other medicines
Alcohol
Both alcohol and methotrexate are processed by the liver. Keep alcohol to a minimum; the clinic will advise a limit based on your liver tests.
Antibiotics
Co-trimoxazole and trimethoprim (Septran, Bactrim) interact dangerously with methotrexate. Tell every doctor and pharmacist that you take it.
Infections
If you have a fever or are on antibiotics, the weekly dose is usually skipped until you are better. Call the clinic rather than guessing.
Vaccines
Inactivated vaccines (flu, pneumococcal, COVID-19) are safe and recommended. Live vaccines need to be discussed first.