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Methotrexate is available as a 2.5 mg oral tablet.

Methotrexate is an antimetabolite that is used to treat:
Acute lymphoblastic leukemia (ALL) in adults and children; given with other chemotherapy Cutaneous T-cell lymphoma in adults; given by itself or with other chemotherapy Advanced non-Hodgkin lymphoma in adults; given with other chemotherapy Rheumatoid arthritis (RA) in adults
Polyarticular juvenile idiopathic arthritis (pJIA) in children Severe psoriasis in adults

Methotrexate is an antimetabolite medication that treats many types of cancers and non-cancer conditions (like arthritis and psoriasis). For cancer: Methotrexate works by blocking dihydrofolate reductase, a protein in your body that’s important for making DNA in cells and for cell growth. Since cancer cells grow much more quickly than healthy cells, the medication helps slow down cancer growth so the cancer can’t spread as well.

For non-cancer conditions: We don’t know exactly how Methotrexate works to treat non-cancer conditions such as rheumatoid arthritis and psoriasis. But research suggests that, at lower doses, it blocks the immune system from becoming too active. For psoriasis, the medication might also help slow down the growth of skin cells.

The dose of Methotrexate varies depending on what condition you’re taking the medication for. Sometimes, the dose depends on your body size or body surface area (BSA) in m2 units. It is typically taken by mouth up to 4 times a week.

Methotrexate is a safe and effective treatment when used for FDA licensed indications. However, like all medications, they may give you unwanted side effects. You should always discuss potential side effects with your physician to ensure the medication is suitable and right for you. You should not use this medication if you are pregnant or breastfeeding, have alcoholic liver disease, bone marrow hypoplasia, leukopenia, thrombocytopenia or
significant anemia.

Common side effects of Methotrexate:

• Mouth sores
• Nausea or vomiting
• Diarrhea
• Stomach upset
• Dizziness
• Tiredness
• Chills
• Fever
• Infection
• Higher liver enzyme levels in the blood
• Low white blood cells
• Low platelet levels

Serious side effects are rare with Methotrexate. Contact your healthcare provider immediately if you experience any of the following.

• Serious infections (from having low white blood cell counts): temperature of 100.4 degrees Fahrenheit, with or without other symptoms, such as chills, cough, muscle aches, very fast heartbeat, confusion
  Low platelets: blood in urine or stool, nosebleeds, unexplained bruising or bleeding, bruising or bleeding that doesn’t go away
• Serious lung problems: sudden cough, fever, difficulty breathing
• Serious liver problems: nausea, vomiting, tiredness, stomach pain or swelling, pale-colored stool, dark-colored urine, yellowing of the whites of the eyes or skin
  Serious nervous system problems: headache, confusion, vision changes, difficulty talking, difficulty moving one side of the body, seizure, coma
• Serious skin reactions: painful blisters, skin wounds, peeling skin, fever, sore throat, body aches
  Allergic reaction: rash, difficulty breathing, swelling of the mouth or around the eyes

The following medications may interact with Methotrexate:

• Concomitant administration of some NSAIDs with high dose Methotrexate therapy has been reported to elevate and prolong serum Methotrexate levels, resulting in deaths from severe hematologic and gastrointestinal toxicity
• Methotrexate is partially bound to serum albumin, and toxicity may be increased because of displacement by certain drugs, such as salicylates, phenylbutazone phenytoin, and sulfonamides. Renal tubular transport is also diminished by probenecid; use of Methotrexate with this drug should be carefully monitored
• Oral antibiotics such as tetracycline, chloramphenicol, and nonabsorbable broad spectrum antibiotics, may decrease intestinal absorption of Methotrexate or interfere with the enterohepatic circulation by inhibiting bowel flora and suppressing metabolism of the drug by bacteria
• Penicillins may reduce the renal clearance of Methotrexate; increased serum concentrations of Methotrexate with concomitant hematologic and gastrointestinal
• toxicity have been observed with Methotrexate. Use of Methotrexate with penicillins should be carefully monitored

Various FDA-approved generic manufacturers

Methotrexate can cause embryo-fetal toxicity, including fetal death. For non-neoplastic diseases, Methotrexate is contraindicated in pregnancy. For neoplastic diseases, advise patients of reproductive potential of the potential risk to a fetus and to use effective contraception.

• Rheumatrex
• Trexall