Methotrexate

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 and 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. 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. Phone lines are open Monday to Friday between 8.30am and 4pm.

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.

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 methotrexate day

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

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.

Limit alcohol and avoid binge drinking. Do you know your safe limits? Learn more on NHS.UK – Alcohol units.

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.

Read more about vaccinations (Versus Arthritis).

Avoid contact with chickenpox. (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.

Sunburn 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 on NHS.UK – Sunscreen and sun safety.

• 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