Methotrexate tablets are taken by mouth on a prescribed schedule for inflammatory disease or selected cancers. They are used for conditions such as rheumatoid arthritis and severe psoriasis when…
Methotrexate tablets are taken by mouth on a prescribed schedule for inflammatory disease or selected cancers. They are used for conditions such as rheumatoid arthritis and severe psoriasis when immune activity needs to be reduced. Methotrexate changes folate-dependent cell activity, helping control inflammation and abnormal cell growth.
Methotrexate is an antimetabolite and an immunosuppressant with disease-modifying activity. In rheumatology, it is one of the principal disease-modifying antirheumatic drugs, commonly abbreviated as DMARDs.
Methotrexate tablets contain methotrexate as the active substance. Methotrexate sodium is another pharmaceutical form used in some preparations, especially injectable products.
The European Medicines Agency describes methotrexate as a medicine used in inflammatory disease and oncology, with the appropriate dose depending on the condition being treated [1].
Methotrexate tablets contain methotrexate as the active substance. Methotrexate sodium is another pharmaceutical form used in some preparations, especially injectable products.
Methotrexate is prescribed for selected autoimmune diseases, severe inflammatory skin disease, and certain cancers. The treatment plan depends on the diagnosis, kidney and liver function, blood counts, previous therapies, and the patient’s response.
| Clinical use | Main treatment goal | Typical specialist setting |
|---|---|---|
| Rheumatoid arthritis | Reduce inflammation and slow joint damage | Rheumatology |
| Severe psoriasis | Reduce excessive skin-cell activity and inflammation | Dermatology |
| Selected cancers | Disrupt rapidly dividing malignant cells | Oncology |
In rheumatoid arthritis, methotrexate can reduce swollen joints, morning stiffness, and inflammatory activity after treatment has had time to build its effect. The American College of Rheumatology places methotrexate among the key conventional DMARD options for rheumatoid arthritis [2].
Severe psoriasis involves accelerated skin-cell turnover and immune-mediated inflammation. Methotrexate can reduce this activity and may improve plaques, scaling, and inflammation when topical therapy or other approaches are insufficient.
The British Association of Dermatologists includes methotrexate among systemic options for selected patients with significant psoriasis [3].
Methotrexate is contraindicated during pregnancy for many treatment purposes because it can harm fetal development.
Methotrexate is not suitable for every inflammatory condition. Its use requires a clear diagnosis and an assessment of organ function because the same mechanism that suppresses abnormal immune activity can also affect healthy tissues.
NOT for you if a clinician has identified pregnancy, severe liver disease, significant blood-count abnormalities, or an inability to follow the weekly schedule and monitoring plan.
Methotrexate can be well tolerated when the regimen is correct and monitoring is maintained. It can also cause serious toxicity, especially after an excessive dose, an interaction, dehydration, impaired kidney function, or delayed recognition of infection or blood abnormalities.
| Possible problem | Symptoms requiring attention | Clinical monitoring |
|---|---|---|
| Liver injury | Yellowing of the skin, dark urine, severe abdominal discomfort | Liver blood tests |
| Bone marrow suppression | Fever, sore throat, unusual bruising, marked fatigue | Full blood count |
| Lung inflammation | New dry cough or breathlessness | Clinical assessment and investigations |
Common adverse effects include nausea, reduced appetite, mouth ulcers, headache, tiredness, and temporary changes in liver blood tests. Hair thinning and skin sensitivity can occur.
Hepatotoxicity means liver injury. Methotrexate can raise liver enzymes and, with cumulative exposure or additional risk factors, can contribute to more serious liver damage.
Bone marrow suppression reduces the production of blood cells. A low white-cell count can increase infection risk, while a low platelet count can cause easy bruising or bleeding. Anaemia may cause unusual tiredness, dizziness, or breathlessness.
Methotrexate can also cause serious lung inflammation. New breathlessness or a persistent dry cough requires prompt assessment, even without fever.
Methotrexate resembles folate, a vitamin required for the production of DNA and other cellular components. It interferes with folate metabolism by inhibiting enzymes involved in the pathway. Cells that divide rapidly need this pathway continuously, so they are more vulnerable to folate disruption.
Dihydrofolate reductase converts dihydrofolate into tetrahydrofolate, an active folate form required for several biochemical reactions. Methotrexate inhibits dihydrofolate reductase and reduces the availability of active folate inside cells.
At lower doses used for inflammatory disease, additional effects on adenosine signalling and immune-cell activity also contribute to the anti-inflammatory response. At higher doses used in oncology, folate-pathway inhibition becomes a major part of the cytotoxic effect.
Without adequate active folate, cells cannot produce DNA building blocks normally. Cell replication slows or stops. This can reduce the expansion of activated immune cells in autoimmune disease and can damage rapidly dividing cancer cells in oncology.
Several practical errors can make methotrexate treatment less safe or less useful:
Methotrexate tablets are an oral, single-ingredient antimetabolite and immunosuppressant treatment. Unlike topical approaches, they act systemically and are used to reduce immune activity or disrupt rapidly dividing abnormal cells, with the regimen selected according to the condition.
In clinical practice, doctors usually set three expectations before starting methotrexate. First, improvement in inflammatory disease is gradual. Second, laboratory monitoring is part of treatment, not an optional extra. Third, the weekly schedule must be understood by the patient and by anyone helping with medicines. These discussions support safer prescribing.
A rheumatologist may continue methotrexate when joint symptoms are improving but not yet fully controlled, because disease activity can fall progressively over time. A dermatologist may assess plaque thickness, scaling, body-surface involvement, and relapse pattern rather than relying on one day of visible improvement.
Prescribers also review vaccinations, infection history, pregnancy plans, alcohol intake, kidney health, liver disease, and all other medicines.
Methotrexate treatment for rheumatoid arthritis or psoriasis may continue for months or years when it controls disease activity and monitoring remains satisfactory. The American College of Rheumatology guidance available in 2021 supports ongoing DMARD treatment when the clinical response and safety profile justify continuation [2]. Duration depends on disease control, blood results, liver and kidney function, infections, and treatment goals. Stopping suddenly can allow inflammatory disease to return, so dose reduction or discontinuation follows a planned clinical decision.
Methotrexate may take several weeks to show its full anti-inflammatory effect, and incomplete improvement does not automatically mean treatment has failed. NICE guidance published in 2020 for rheumatoid arthritis recommends assessing disease activity and adjusting treatment when the response is inadequate [4]. Do not increase the dose, shorten the interval, or take extra tablets independently. Persistent inflammation may lead the clinician to review adherence, folic acid timing, diagnosis, blood results, or combination DMARD treatment.
Older adults can receive methotrexate, but reduced kidney function, liver disease, dehydration, frailty, and multiple medicines can increase toxicity risk. HPRA safety information published in 2024 emphasises the importance of correct weekly dosing and monitoring, including in patients more vulnerable to adverse effects. A lower starting dose or slower adjustment may be selected according to kidney function and general health. Fever, mouth ulcers, bruising, breathlessness, or sudden weakness require prompt assessment.
There is no universal best time of day for oral methotrexate. A consistent weekly time can make missed doses less likely, and some people choose an evening because nausea or tiredness may be easier to manage while asleep. The EMA product information published in 2018 for methotrexate specifies that the regimen depends on the indication and must follow the prescribed schedule. Taking it on the wrong day is more dangerous than taking it in the morning rather than at night.
Before treatment, discuss pregnancy or breastfeeding, liver disease, kidney problems, blood disorders, lung disease, recurrent infections, alcohol intake, and recent vaccinations. The WHO medication-safety framework published in 2017 identifies medication reconciliation as a key step when starting or changing treatment. Provide a complete list of prescriptions, painkillers, antibiotics, supplements, and herbal products. Trimethoprim, co-trimoxazole, some anti-inflammatory medicines, and other immunosuppressants require specific review.
Do not take two doses together. The correct action depends on how much time has passed and whether the next weekly dose is approaching, so the prescriber or medicines service should give the specific instruction for that situation. NHS medicines-safety advice published in 2024 stresses that accidental daily dosing is an emergency because serious toxicity may initially have few symptoms. If methotrexate was taken more often than prescribed, seek urgent medical help immediately rather than waiting for symptoms.
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Based on 3 reviews
I used weekly methotrexate for rheumatoid arthritis for several months. My hands became less stiff, but the first weeks brought nausea and a couple of mouth ulcers. Folic acid helped after my prescribing team adjusted the schedule, and I became much more careful about blood-test appointments.
Several months 8 Nov 2026Methotrexate reduced the swelling in my knees, although the improvement was slower than I expected. I initially thought a missed tablet should be replaced the next morning, but the weekly dosing rule was explained again and I stopped making that mistake. Fatigue remained an issue after some doses.
10 Oct 2026I took methotrexate for severe psoriasis and saw less scaling after several treatment cycles. My liver tests needed closer monitoring after another medicine was added. The skin improvement was worthwhile, but the treatment required more organisation than I had expected.
Several treatment cycles 23 Oct 2026
