Methotrexate

Methotrexate is a medicine used to treat autoimmune conditions such as rheumatoid arthritis and severe psoriasis and, usually with other medicines, certain cancers. This guide covers methotrexate uses, how it works, dosage, side effects, precautions, drug interactions, use in pregnancy and breastfeeding and its approximate price in India.

At a Glance

What Is Methotrexate?

Methotrexate is a disease-modifying anti-rheumatic drug (DMARD) used to treat autoimmune conditions such as rheumatoid arthritis, pJIA and severe psoriasis. It is also used, usually with other medicines, in cancer treatment. The NHS also lists Crohn’s disease among the conditions it treats. Methotrexate can cause serious side effects, so it is used only under a doctor’s supervision.

Uses of Methotrexate

The US prescribing information for methotrexate tablets (revised 05/2026) lists these uses

• Rheumatoid arthritis (adults)
• Polyarticular juvenile idiopathic arthritis (pJIA) in children
• Severe psoriasis (adults)
• Cancer, as part of combination chemotherapy: acute lymphoblastic leukemia (maintenance), mycosis fungoides (a cutaneous T-cell lymphoma), and relapsed or refractory non-Hodgkin lymphomas

Crohn’s disease is not listed on the US tablet label, although the NHS includes it. Your doctor decides whether methotrexate is appropriate for your condition. Cancer treatment is planned and supervised by an oncologist.

How Methotrexate Works

Methotrexate inhibits dihydrofolic acid reductase, an enzyme needed to make the building blocks of DNA. This interferes with DNA synthesis, repair and cell replication. Actively dividing tissues, such as cancer cells, bone marrow and the lining of the mouth and gut, are more sensitive to this effect. That is why it can slow cancer growth, and also why it can cause side effects in the blood, mouth and digestive tract.

The US label states that the mechanism of action in rheumatoid arthritis and psoriasis is unknown.

Dosage and How to Take Methotrexate

For rheumatoid arthritis and psoriasis, methotrexate is taken once a week, not daily. Taking the weekly dose every day by mistake has caused fatal reactions. Take it on the same day each week, and confirm that day with your doctor or pharmacist.

If you have taken methotrexate daily, or more than your prescribed dose, call your doctor or emergency services immediately. Do not wait for symptoms.

US label examples (tablets). These are not universal recommendations or Indian prescribing guidance

• Rheumatoid arthritis: the recommended starting dose is 7.5 mg orally once weekly, with escalation to achieve the best response. Doses above 20 mg once weekly increase the risk of serious adverse reactions.
• Psoriasis: 10 to 25 mg orally once weekly. The label says not to exceed 30 mg per week.
• pJIA: dosing is based on body surface area and is set by a specialist.

Your doctor decides the dose and any changes based on your condition, age, body size, kidney function, other medicines and response. Cancer doses vary widely and are decided by the oncologist.

How long it takes to work: in rheumatoid arthritis, the US label says most responses occurred between 3 and 6 weeks from the start of treatment, and some occurred up to 12 weeks later.

Folic acid: for rheumatoid arthritis, pJIA and psoriasis, the US label says folic acid or folinic acid should be given to reduce the risk of side effects. If your doctor has prescribed folic acid, take it exactly as directed. It is not something to avoid. The NHS says it is usually taken once a week on a different day from methotrexate. What to avoid is adding extra folic acid or vitamin products on your own without your doctor’s advice. In cancer treatment, products containing folic acid may reduce methotrexate’s effectiveness, so follow your oncologist’s guidance.

Take this medicine only as advised by your doctor or healthcare professional. Do not start, stop, or change the dose on your own.

Side Effects of Methotrexate

Common side effects: nausea, vomiting, diarrhea, stomach pain, loss of appetite, mouth sores (stomatitis), headache, tiredness and hair loss. Your skin may become more sensitive to sunlight.

Serious side effects (US label)

• Liver toxicity, including fibrosis, cirrhosis and fatal liver failure
• Bone marrow suppression, which can cause life-threatening low blood counts
• Lung toxicity, including interstitial pneumonitis, which can be irreversible or fatal
• Serious infections, including life-threatening ones
• Gastrointestinal toxicity, including hemorrhagic enteritis and intestinal perforation
• Kidney toxicity, including acute kidney failure
• Severe skin reactions, such as toxic epidermal necrolysis and Stevens-Johnson syndrome
• Severe neurotoxicity, and secondary cancers

When to Get Urgent Help

Contact your doctor urgently for:

• Yellowing of the skin or eyes
• A persistent cough, chest pain or breathlessness
• Fever, chills or a sore throat, which can signal infection
• Bleeding gums, blood in the urine, vomiting blood or unexplained bruising
• Severe diarrhea or abdominal pain
• Mouth ulcers that do not settle

Seek emergency care for swelling of the lips, mouth or throat, difficulty breathing, or a severe blistering or peeling rash.

Methotrexate Precautions and Warnings

Formal contraindications (US label)

Pregnancy in patients treated for non-cancer conditions

• A history of severe hypersensitivity reactions, including anaphylaxis, to methotrexate

Warnings and precautions, which are not formal contraindications:

• Kidney impairment. Patients with reduced kidney function should be monitored closely for side effects, and the dose may be reduced or stopped.
• Methotrexate increases the risk of serious infections.
• Liver, lung, blood and gut problems (see Serious side effects above).
• Heavy alcohol use increases the risk of liver toxicity.
• Live vaccines are not recommended during treatment.
• Nitrous oxide anesthesia should be avoided. Tell any surgeon or anesthetist that you take methotrexate.

Monitoring: the label says to check blood counts, liver tests and kidney function at the start of treatment, periodically during treatment, and when clinically indicated. Your doctor decides the schedule.

Methotrexate should be used under the supervision of a healthcare provider, especially for long-term use, because of the potential for serious side effects.

Methotrexate Drug Interactions

This is not a complete list. Tell your doctor and pharmacist about all prescription and OTC medicines, supplements and herbal products you use.

Methotrexate in Pregnancy, Breastfeeding and Fertility

• Pregnancy: methotrexate can cause embryo-fetal toxicity, including fetal death, and is contraindicated in pregnant women with non-cancer conditions. The NHS also says it is not recommended in pregnancy because it can cause birth defects. If you want to become pregnant, speak to your doctor before stopping contraception.
• Contraception (US label): females of reproductive potential should use effective contraception during treatment and for 6 months after the final dose. Males with female partners should do the same during treatment and for 3 months after the final dose, because methotrexate can cause chromosomal damage to sperm cells.
• Breastfeeding: the sources differ. The US label says not to breastfeed during treatment and for 1 week after the final dose. The NHS says it may be possible to breastfeed if the weekly dose is 25 mg or less, but not for 24 hours after taking it. The right advice depends on your dose, your condition and the guidance your doctor follows, so ask your doctor before deciding.
• Fertility: the NHS says methotrexate may reduce fertility, and may damage sperm in men and egg production in women.

Methotrexate Brands, Strengths and Price in India

Common Indian brands are Folitrax (Ipca) and Biotrexate (Zydus). Prices below are retailer listings checked on 13 Oct 2026 (IST). They are not fixed official prices and vary by retailer, location, batch and date.

The two Biotrexate listings show different MRPs and should be verified before publishing.

How HealthPil Can Help

Medicines should be started, adjusted, or stopped only under the guidance of a qualified healthcare professional. If you have questions about this medicine, its side effects, or your treatment plan, you can consult a doctor through HealthPil.