Methotrexate

Understanding Methotrexate

Methotrexate is one of the most commonly used DMARD’s in rheumatology. It is classed as “gold standard” for treating inflammatory arthritis, by the National Institute for Health and Care Excellence in the UK. It is used to treat a wide variety of autoimmune conditions such as Rheumatoid Arthritis, Psoriatic Arthritis, Lupus (SLE), Vasculitis, Myositis, Scleraderma, Sjogren’s, Sclerosis and as well as a variety of other connective tissue diseases.

Before starting medication
Please read the written information and watch the video’s on methotrexate before starting this medication. It is important you understand how this medications works and why it is being prescribed; as well as how to take the medication correctly.

Answering some of your questions about Methotrexate

Methotrexate and pregnancy

Seek advice from your consultant or nurse before planning a family.

  • Methotrexate is toxic to unborn babies and can cause birth defects.  It must be avoided in pregnancy and therefore should be stopped at least 3 months prior to attempting to get pregnant.
  • Women taking methotrexate must use contraception.  Your individual condition and circumstances need to be looked at when planning contraception.  It needs to be reliable – condoms, withdrawal or rhythm method are not reliable methods of contraception.  Implants, contraceptive pills or coils are the recommended forms.
  • In men, the recent guidelines from the British Society of Rheumatology state there is no evidence of paternal exposure but the evidence is limited. We would still recommend the use of contraception.
  • More information on contraception can be found at the NHS website
When to attend for blood monitoring

We monitor to can pick up changes at an early stage. It is important to attend for blood tests to ensure it is safe to continue the drug.

When you start methotrexate attend for your first bloods test 2 weeks after then

  • Every 2 weeks x 4  (in total)
  • Monthly x 3
  • Then every 3 months
  • We will monitor & prescribe methotrexate for the first 3 months. Once stable this is then handed over to your GP to prescribe.
  • We will only contact you if the results are abnormal.
  • It is important to attend for blood tests to ensure it is safe to continue the drug. We will only contact you with the results if there are any abnormalities.
  • No bloods, no medication.  Safe prescribing is a priority.
  • You will have to book your own blood test.
  • To book a blood test at St Luke’s Hospital, please ring 01274–365056 or 01274-365170 to make an appointment. Alternatively, you can book your own blood test appointment by clicking here
  • Phone lines are open Monday to Friday between 8.30am and 4.00pm
Other useful links

National Rheumatoid Arthritis Society (NRAS) Freephone: 0800 298 7650

Versus Arthritis Freephone: 0800 5200 520

Lupus UK Telephone number: 01708 731251

National Axial Spondylarthritis Society Helpline and all enquiries: 020 8741 1515

Vasculitis UK Helpline number: 0300 365 0075

Scleroderma & Raynaud’s UK Helpline number: 0800 311 2756

For patients with ankylosing spondylitis

For patients with scleroderma

For patients with vasculitis

How to take methotrexate

Methotrexate should only be dispensed in 2.5mg tablets.  Please double-check the strength of the drug on the packet you are given to make sure this is correct.

  • ONCE A WEEK:
  • It is taken once a week on the SAME DAY every week.
  • Week 1: 10mg = 4 x 2.5mg tablets
  • Week 2: 15mg = 6 x 2.5mg tablets
  • Week 3: 20mg = 8 x 2.5mg tablets
  • Week 4: 25mg = 10 x 2.5mg tablets. This will then be your ongoing long-term dose
  • Folic acid 5mg daily except MTX day

Not all patient are prescribed the full dose of 25mg, please always check what is written on your box/bottle of methotrexate.

General advice
  • Alcohol no more than 14 units a week, limit the amount & avoid binge drinking.  Do you know your safe limits? Found out here
  • Avoid live vaccines.  This includes, but is not limited to, rabies, MMR, yellow fever and some forms of shingles vaccine.  You should advise any travel clinic that you are taking immunosuppression.
  • Flu, Covid and Pneumonia vaccines are inactive vaccines – this means they are not live vaccines.  Your GP will call you for these vaccines and we strongly advise that you have these. More information can be found here
  • Avoid contact with chicken pox. (As adults we tend to develop shingles rather than chicken pox, you may require anti-viral treatment from your GP).
  • Prevent sunburn. (Check for changes in the skin and monitor freckles and moles for such as changes in size, shape, colour and weeping). Have any changes checked with your GP.

Sun burn can lead to skin damage which increases the risk of developing skin cancers.  We recommend “slip, slap, slop” – slip on a shirt to cover up, slap on a hat, slop on the sunscreen. Find out more here