Methotrexate is given weekly either as a shot (injection)
or by mouth (orally).
How It Works
Methotrexate interferes with the
production and maintenance of DNA, the genetic material in the cells of your
body. It is not known exactly how methotrexate works in
rheumatoid arthritis, but it can reduce inflammation
and slow the progression of the disease. Methotrexate is considered a
disease-modifying antirheumatic drug (DMARD). DMARDs are also called
immunosuppressive drugs or slow-acting antirheumatic drugs (SAARDs).
Why It Is Used
Methotrexate reduces inflammation
caused by rheumatoid arthritis. It is the most common DMARD used to treat
rheumatoid arthritis.1 Methotrexate may be
In the early stages of rheumatoid arthritis to
prevent disease progression.
In combination with other medicines
such as other DMARDs.
How Well It Works
Methotrexate is effective in
relieving joint inflammation and pain, slowing disease progression, and
preventing disability by delaying joint destruction.2
People with rheumatoid arthritis may be more likely to continue treatment with
methotrexate than with other DMARDs because of favorable results and tolerable
Methotrexate is often the first DMARD prescribed
for rheumatoid arthritis and usually provides relatively fast relief of at
least some symptoms. If you can tolerate methotrexate, but it is not effective,
your rheumatologist will recommend that you take another DMARD along with
methotrexate (combination therapy). For example, methotrexate may be combined with leflunomide or with a biologic medicine.
Combination therapy may allow for lower doses of an individual drug to be used,
which may reduce the risk of adverse effects that can occur with higher doses.
In one large review of studies, various combinations of DMARDs plus
methotrexate were more effective than either methotrexate or another DMARD
All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.
Here are some important things to think about:
Usually the benefits of the medicine are more important than any minor side effects.
Side effects may go away after you take the medicine for a while.
If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.
Call 911 or other emergency services right away if you have:
Swelling of your face, lips, tongue, or throat.
Call your doctor if you have:
Signs of an infection, such as a sore throat, fever, sneezing, or coughing.
Signs of unusual bleeding or bruising, such as black and tarry stools or blood in the urine.
Sores in the mouth or on the lips.
Common side effects of this medicine include:
Nausea, vomiting, or loss of appetite.
See Drug Reference for a full list of side effects.
(Drug Reference is not available in all systems.)
What To Think About
These medicines can stop your immune system from fighting infection. When you are taking this medicine (and even when you have finished taking it), try not to be around people who are sick. And make sure you talk to your doctor before you get any vaccinations.
These medicines may increase your risk of getting cancer, including lymphoma.
Do not drink alcohol when you are taking these medicines. Combining alcohol with these medicines can increase your risk for liver damage.
If you are taking
methotrexate, talk to your doctor before taking any other
While it is generally safe to take nonsteroidal
anti-inflammatory drugs (NSAIDs), such as ibuprofen, with methotrexate, it is
best to talk with your doctor if you plan to do so. Methotrexate
is eliminated by the kidney, and NSAIDs could decrease kidney function, so it
is possible that clearance of methotrexate from the body could be affected by
If you have a history of liver
disease, such as viral or alcoholic hepatitis, talk with your rheumatologist
before taking methotrexate.
Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.
There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.
Advice for women
Do not use this medicine if you are pregnant or planning to get pregnant. If you need to use this medicine, talk to your doctor about how you can prevent pregnancy.
Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.
Drugs for rheumatoid arthritis (2009). Treatment Guidelines From The Medical Letter, 7(81): 37–46.
Walker-Bone K, Fallow S (2007). Rheumatoid arthritis,
search date June 2005. Online version of BMJ Clinical Evidence. Also available online:
Donahue KE, et al. (2008). Systematic review:
Comparative effectiveness and harms of disease-modifying medications for
rheumatoid arthritis. Annals of Internal Medicine,
How this information was developed to help you make better health decisions.