Methotrexate
Methotrexate (pronounced me-tho-trex-ate) is a chemotherapy drug that is given as a treatment for many types of cancer. This information describes methotrexate, how it is given and some of its possible side effects. It should ideally be read with our general information about chemotherapy and about your type of cancer.
If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.
- What methotrexate looks like
- How it is given
- Possible side effects
- Less common side effects
- Additional information
- Things to remember about methotrexate tablets
What methotrexate looks like
Methotrexate is a yellow fluid. It is also available as 2.5mg and 10mg yellow tablets.
How it is given
Methotrexate may be given:
- as an injection into a vein (intravenously) through a fine tube (cannula) inserted into the vein
- through a central line, which is inserted under the skin into a vein near the collarbone, or into a PICC line, which is inserted into a vein in the crook of the arm
- as a drip (infusion) into the vein through a cannula or line
- by injection under the skin (subcutaneously)
- by injection into a muscle (intramuscularly)
- by injection into an artery (intra-arterially)
- by injection into the fluid around the spinal cord through a lumbar puncture (intrathecally) or an ommaya reservoir (a device which has been inserted into an area beneath the scalp). Only specially trained doctors and nurses can give drugs in this way, and the procedure has to be carried out in a special area, so you may be given this treatment by different staff and in a different hospital from the rest of your chemotherapy
- as tablets that should be swallowed whole with plenty of water. It is important to take them as directed by your doctor.
Possible side effects
Each person's reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described in this information will not affect everyone who is given methotrexate, and may be different if you are having more than one chemotherapy drug.
We have outlined the most common and less common side effects, so that you can be aware of them if they occur. However, we have not included those that are very rare and therefore extremely unlikely to affect you. If you notice any side effects which you think may be due to the drug, but which are not listed in this information, please discuss them with your doctor or chemotherapy nurse.
Lowered resistance to infection Methotrexate can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given and your resistance to infection usually reaches its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily and will usually have returned to normal levels before your next cycle of chemotherapy is due.
Contact your doctor or the hospital straightaway if:
- Your temperature goes above 38ºC (100.5ºF)
- You suddenly feel unwell (even with a normal temperature).
You will have a blood test before having more chemotherapy to make sure that your cells have recovered. Occasionally it may be necessary to delay your treatment if the number of blood cells (the blood count) is still low.
If you are having methotrexate as a course of tablets, you may be given them every week for a number of weeks. Your blood cell count will be monitored throughout the course of treatment to make sure that the number of white blood cells does not get too low.
Bruising or bleeding Methotrexate can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, and bleeding gums.
Anaemia (low number of red blood cells) While having treatment with methotrexate you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if these are a problem.
Sore mouth and ulcers Your mouth may become sore, or you may notice small ulcers during this treatment. Drinking plenty of fluids and cleaning your teeth regularly and gently with a soft toothbrush can help to reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as special mouthwashes and medicines to prevent or clear any mouth infection can be prescribed.
Taste changes You may notice that your food tastes different. Normal taste will usually come back after the treatment finishes.
Diarrhoea This can usually be easily controlled with medicine, but let your doctor know if it is severe or if it continues. It is important to drink plenty of fluids if you have diarrhoea.
Tiredness and feeling weak You may feel very tired. It is important to allow yourself plenty of time to rest.
Skin changes Your skin may darken, due to excess production of pigment. This usually returns to normal a few months after the treatment finishes.
Your kidneys may be affected Methotrexate in very high doses can damage the kidneys. It is rare for this to happen when standard doses are given. To prevent this happening you may be given sodium bicarbonate, either as tablets or capsules or as an infusion into the vein, before and during the methotrexate treatment. Your kidney function will be checked by a blood test before each methotrexate treatment.
Gritty eyes due to inflammation of the cornea If this occurs it is important that you tell your doctor, who can prescribe soothing eye drops.
Less common side effects
Nausea (feeling sick) and vomiting If you do feel sick, it may begin soon after the treatment is given and can last for a few days. Your doctor can now prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting. If the sickness is not controlled or continues, tell your doctor, who can prescribe other anti-sickness drugs that may be more effective.
Blurred vision Methotrexate may affect your eyesight. Tell your doctor about any eye pain or vision changes.
Hair loss This is very rare at low doses but often happens when high doses are given. Hair may thin, or occasionally be lost completely. If this happens, it usually begins about 3-4 weeks after starting treatment, although it may occur earlier. You may also have thinning and loss of eyelashes, eyebrows and other body hair. Hair loss is temporary, and your hair will return to normal once the treatment is finished.
Sensitivity of the skin to sunlight During treatment with methotrexate, and for several months afterwards, you will be more sensitive to the sun and your skin may burn more easily than normal. You can still go out in the sun, but always wear a high protection suncream and protective clothing.
Skin changes Methotrexate can cause a rash, which may be itchy. Your doctor can prescribe medicine to help. Areas of skin that have previously been treated with radiotherapy may become red and sore. Let your doctor know if this happens.
Changes to lung tissue Tell your doctor if you notice any coughing or breathlessness.
Your liver may be temporarily affected Methotrexate may cause changes in the way that your liver works, though your liver will return to normal when the treatment is finished. This is unlikely to cause you any harm but your doctor will monitor this carefully. Samples of your blood will be taken regularly to check your liver is working properly.
Allergic reaction You will be monitored for any signs of an allergic reaction during the treatment. Signs include skin rashes and itching, a high temperature, shivering, redness of the face, a feeling of dizziness, headache, breathlessness, anxiety and a need to pass urine. Tell your doctor or nurse if you have any of these signs, as medicine can be given to reduce them.
Additional information
When methotrexate is given in high doses, or into the fluid around the spinal cord, or into the brain, it can cause headaches, dizziness, tiredness, blurred vision and loss of balance for a few hours. Tell your doctor if you have any of these effects.
Some medicines can be harmful to take when you are having chemotherapy. Let your doctor know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.
Methotrexate may be prescribed for conditions other than cancer, such as psoriasis and rheumatoid arthritis. If you are having methotrexate for conditions other than cancer, you should discuss the treatment and any possible side effects with your relevant specialist.
A drug called folinic acid may be given 24 hours after starting methotrexate treatment, to reduce the side effects. While you are attached to a drip, the folinic acid can be given into the vein (intravenously), otherwise it is given as tablets. It is very important that the folinic acid is taken on time and that all the tablets are taken as directed by your doctor. It is often called a 'rescue' when it is given in this way after methotrexate treatment.
Other medicines Some medicines can be harmful to take when you are having chemotherapy. Tell your doctor about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.
Fertility Your ability to become pregnant or father a child may be affected by taking this drug. Discuss fertility with your doctor before starting treatment.
Contraception It is not advisable to become pregnant or father a child while taking methotrexate, as the developing foetus may be harmed. It is important to use effective contraception while taking this drug, and for at least a few months afterwards. It is important to discuss this with your doctor.
Things to remember about methotrexate tablets
- It is important to take your tablets at the right times.
- You must take them as directed by your doctor.
- Keep the tablets in the original packaging and store them at room temperature, away from heat and direct sunlight.
- Keep tablets in a safe place where children cannot reach them, as methotrexate could harm them.
- If your doctor decides to stop the treatment, return any remaining tablets to the pharmacist. Do not flush them down the toilet or throw them away.
- If you are sick just after taking the tablet tell your doctor, as you may need to take another dose. Do not take another tablet without first telling your doctor.
- If you forget to take a tablet do not take a double dose. Tell your doctor and keep to your regular dose schedule.
