methotrexate disodium at a glance
Medicine class
Folate antagonist, antimetabolite and immunosuppressant.
Main roles
Severe inflammatory disease and selected haematological or trophoblastic cancers.
Available oral forms
Tablets and an oral solution measured with the supplied oral syringe.
Critical safety point
A frequency error, particularly accidental daily use for inflammatory disease, can cause fatal toxicity. Check the named treatment day before administration.
What is methotrexate disodium used for?
Selected oral products cover inflammatory and oncological indications. Licensing differs between formulations.
Active rheumatoid arthritis in adults.
Severe psoriasis that has not responded adequately to established treatments, including severe psoriatic arthritis.
Severe active polyarticular juvenile idiopathic arthritis in children and adolescents when response to non-steroidal anti-inflammatory medicines has been inadequate; this indication is represented by the oral solution.
Acute lymphoblastic leukaemia as part of maintenance therapy.
Malignant trophoblastic tumours; this indication is represented by the oral solution.
Well-established non-licensed context: methotrexate is also used by specialists for inflammatory bowel disease, including Crohn’s disease, although this is not licensed for the selected products.
How does methotrexate disodium work?
Methotrexate blocks folate-dependent cellular processes, reducing DNA synthesis and cell proliferation. This limits rapidly dividing cancer cells and modifies immune and inflammatory activity in conditions such as rheumatoid arthritis and psoriasis.
methotrexate disodium preparations and strengths
Oral solution
Route: Oral
Strengths: 2 mg/mL
Tablet
Route: Oral
Strengths: 2.5 mg, 10 mg
How to take methotrexate disodium
Follow the prescription and patient card exactly, checking the named treatment day before each administration. Methotrexate may be taken with or without food.
Swallow tablets with water. The score line on the selected tablet helps swallowing but does not divide the tablet into equal amounts.
Measure oral solution only with the supplied oral syringe; its markings are in millilitres, not milligrams. Drink water afterwards to clear residue from the mouth.
Wash hands after handling. Caregivers should use disposable gloves for the oral solution, clean spills promptly and avoid skin or mucosal contact.
Keep methotrexate securely out of children's reach, preferably in a locked cupboard.
methotrexate disodium side effects
Common or expected effects
- Nausea, vomiting, reduced appetite or abdominal discomfort
- Sore mouth, mouth inflammation or diarrhoea
- Headache, dizziness, tiredness or drowsiness
- Mild hair loss, rash, itching or increased sensitivity to sunlight
- Changes in liver blood tests
Get urgent medical advice
- Fever, chills, sore throat or other signs of infection
- Mouth ulcers, unexplained bruising, bleeding or marked breathlessness suggesting blood-cell toxicity
- Persistent dry cough, chest pain or difficulty breathing suggesting lung inflammation
- Jaundice or other evidence of liver injury
- Reduced urination, swelling or other evidence of kidney injury
- Severe blistering or peeling skin reactions
- Anaphylaxis, including throat swelling or severe breathing difficulty
methotrexate disodium in pregnancy
Methotrexate is contraindicated during pregnancy for the selected non-cancer indications because exposure can cause miscarriage, impaired fetal growth and congenital abnormalities. Anyone planning pregnancy or who becomes pregnant during or soon after treatment should contact the specialist promptly; cancer treatment requires an individual specialist risk–benefit decision.
methotrexate disodium while breastfeeding
The selected oral product information contraindicates breastfeeding because methotrexate enters breast milk and may cause toxicity in the infant. Discuss feeding plans with the specialist before breastfeeding or changing treatment.
methotrexate disodium interactions
Methotrexate has clinically important interactions, particularly with medicines that affect folate, blood-cell production, the liver or renal clearance. Check with a prescriber or pharmacist before starting prescribed, pharmacy or complementary products.
Trimethoprim or co-trimoxazole
The combination can cause severe bone-marrow suppression through additive antifolate effects and altered methotrexate handling; concurrent use should generally be avoided.
NSAIDs, including ibuprofen, naproxen and aspirin used for pain
These may reduce renal clearance and increase renal or methotrexate toxicity; over-the-counter use should be checked first.
Penicillin antibiotics, including amoxicillin
Reduced renal clearance may increase methotrexate toxicity, requiring clinical review and vigilance for mouth ulcers, sore throat, bruising or bleeding.
Common questions about methotrexate disodium
Answers are fully visible for fast scanning and source review.
What should I do if I take too much methotrexate?
Contact NHS 111 immediately, even if you feel well. Take the medicine packet, patient card and details of other medicines with you if assessed.
Why does my methotrexate prescription name a treatment day?
It helps prevent dangerous frequency errors. Accidental daily administration for inflammatory disease can cause severe or fatal blood and gastrointestinal toxicity.
Can methotrexate be taken with food?
Yes. The selected oral products can be taken with or without food unless the treatment team gives different product-specific instructions.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.