Methotrexate (Rheumatrex, Trexall, Otrexup, Rasuvo)

Methotrexate is one of the most effective and commonly used medications in the treatment of rheumatoid arthritis and other forms of inflammatory arthritis. It may also be used to treat lupus, inflammatory myositis, vasculitis, psoriasis, scleroderma, and some forms of childhood arthritis. It is known as a disease-modifying anti-rheumatic drug (DMARD), because it not only decreases the pain and swelling of arthritis, but it also can decrease damage to joints and long-term disability.

How To Take It

Methotrexate comes either as pills or as a subcutaneous injection. Methotrexate is usually taken as a single dose once per week, although occasionally the dose is split into two to improve absorption or avoid side effects. Your doctor also may prescribe a folic acid (or folate) supplement to decrease the chance of side effects. Alcohol should be avoided as it can significantly increase the risk for liver damage while taking methotrexate.

Contraception is highly encouraged while on methotrexate as this medication can cause fetal abnormalities. Regular laboratory monitoring is required while taking methotrexate. Symptomatic improvement can be noted within three to six weeks of initiating therapy, but full benefit of this drug may take up to 12 weeks.

Side Effects

Methotrexate can lower the ability of your immune system to fight infections. If you develop an infection while using this medication, you should stop it and contact your doctor. The most common side effects are gastrointestinal upset and elevations of liver function tests.

The most common side effects are nausea and diarrhea. Mouth sores, rash, dizziness, and abnormalities in blood counts can also be seen but are less common.

Methotrexate rarely can cause liver issues, most likely to occur in patients who already have liver problems or are using alcohol or taking other drugs that are toxic to the liver. Slow hair loss is seen in some patients but reverses once medication is stopped. This can often be managed by taking folic acid. It is important to remember that most patients do not experience side effects.

Tell Your Rheumatology Provider

You should contact your rheumatology provider if you develop symptoms of an infection, such as a fever or cough, or if you think you are having any side effects. Be sure to let your rheumatology provider know if you are pregnant, planning to get pregnant, or if you are breastfeeding. Methotrexate treatment should be discontinued for at least three months before attempting to become pregnant. Men taking methotrexate should talk to their physician prior to attempts to conceive. If you are planning on having surgery or will be receiving chemotherapy or radiation therapy, talk to your rheumatology provider first.

Updated February 2024 by Bhakti Shah, MD, and reviewed by the American College of Rheumatology Committee on Communications and Marketing.

This patient fact sheet is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis, and treatment of a medical or health condition.