How does methotrexate work?
Methotrexate calms your immune system, to help stop it attacking your body's cells. This helps reduce the swelling (inflammation) that causes swollen and stiff joints in rheumatoid arthritis, thickened skin in psoriasis or damage to your bowel in Crohn's disease.
Methotrexate is not a painkiller. However, by reducing the inflammation caused by the condition, you may notice you have less pain as your symptoms improve.
When used in cancer treatments, methotrexate stops cancer cells reproducing. This helps prevent them growing and spreading in your body.
When will I feel better?
Once your dose of methotrexate has been increased to a full dose, it may take up to 12 weeks before you notice any benefits.
It's important to keep taking methotrexate. The medicine is working, even if you do not feel any different for a few months.
Are there any long-term side effects?
Methotrexate may increase the risk of problems with your liver or lungs, especially if you take a high dose.
However, your doctor will monitor you very closely while you're taking methotrexate. Any concerns or problems will be found during routine check-ups.
Speak to your doctor or specialist nurse if you're worried about taking methotrexate.
Can you get more than a week's supply at a time?
When you start your treatment, your hospital consultant will usually give you the first few prescriptions for methotrexate. You'll get 1 week's supply at a time.
They'll monitor you closely to make sure that the medicine is working properly, the dose is at the correct level and you're not having too many side effects.
Once the dose is right and your condition is stable, the consultant may ask your GP to continue your treatment. Your GP will also decide where you'll go for blood tests and how often.
Once this is agreed, and if your blood results are OK, your GP will usually give you 1 month's supply of methotrexate at a time (or 4 doses).
Do I need to avoid people with viruses while I'm taking it?
Methotrexate may lower the number of white cells in your blood. This can make you more likely to get an infection.
It's important to reduce your risk of getting an infection. When possible, avoid close contact with people who you know are unwell.
Tell your doctor if you think you're getting a sore throat, if you have a high temperature or if you have symptoms or test positive for coronavirus (COVID-19).
It's important to have any vaccinations that you're invited for. Tell the person giving the vaccine that you take methotrexate, as some types of vaccine may not be suitable for you.
People who live with you can reduce the risk of passing on an infection by also having vaccinations.
Are there other treatments for inflammatory conditions?
There are several different treatments that can help the symptoms of inflammatory conditions. These include medicines, other types of therapy and even surgery.
Your doctor will be able to recommend the best treatment for you, based on your condition and your symptoms.
Other treatments for rheumatoid arthritis include:
- other medicines similar to methotrexate, such as sulfasalazine
- biological medicines (made from proteins and other substances produced by the body), such as adalimumab
- steroids
- painkillers, including non-steroidal anti-inflammatory drugs (NSAIDs)
- supportive treatments, including physiotherapy
- surgery, including joint replacement
Other treatments for psoriasis include:
- creams and ointments that you put on your skin
- ultraviolet light (phototherapy)
- other tablets or injections, like methotrexate, that work throughout your entire body
Other treatments for Crohn's disease include:
- steroids such as prednisolone
- other immunosuppressants such as azathioprine
- biological medicines such as adalimumab
- surgery to remove an inflamed section of bowel
- a liquid diet (enteral nutrition), suitable for children and young adults
Will it affect my contraception?
Methotrexate does not affect any type of contraception, including the combined pill, progestogen-only pill or emergency contraception.
However, if methotrexate makes you sick (vomit) or have severe diarrhoea for more than 24 hours, your contraceptive pills may not protect you from pregnancy. Look on the pill packet to find out what to do.
Find out more:
Can I drive or ride a bike?
Methotrexate may sometimes make you feel tired, or dizzy and light-headed.
If you're feeling tired or dizzy, do not drive, ride a bike or use tools or machinery until you feel better.
It's an offence to drive a car if your ability to drive safely is affected. It's your responsibility to decide if it's safe to drive. If you're in any doubt, do not drive.
Talk to your doctor or pharmacist if you're unsure whether it's safe for you to drive while taking methotrexate. GOV.UK has more information on the law on drugs and driving.
Can I drink alcohol while taking methotrexate?
It's usually OK to drink alcohol if you take a low weekly dose of methotrexate (25mg or less) for the long-term treatment of an inflammatory condition.
If you're taking high doses of methotrexate, ask your doctor for advice about drinking alcohol.
Are there any foods or drinks I need to avoid?
There are no specific foods that you need to avoid while taking methotrexate. However, methotrexate may reduce your ability to fight infection, so it's best to avoid unpasteurised milk and soft cheeses.
It's also best to avoid having too much caffeine, contained in coffee, tea, cola, energy drinks and chocolate. This is because caffeine can stop methotrexate from working as well as it should.