Methotrexate and Dosing

Dr. John Wade, MD, FRCPC, Rheumatologist, talks about what Methotrexate is typically used for and the standard dosing schedules commonly used.

ethotrexate is a disease-modifying anti-rheumatic drug (DMARD). It is commonly used to treat inflammatory conditions including rheumatoid arthritis (RA), psoriatic arthritis, vasculitis and systemic lupus erythematosus. It reduces pain and swelling and may slow joint damage and disease progression.

Methotrexate Dosage & Side Effects

There are two ways to take methotrexate. One is to take a pill or a number of pills once a week. Or, you can auto-inject a dose under the skin once a week. The dose may start at 7.5 milligrams a week, up to a dose of 25 milligrams once a week. Methotrexate won’t relieve your symptoms right away – that’s why it’s called a slow disease-modifying agent. Typically, you’ll notice the effects between 6 and 12 weeks, and a maximum effect may take up to 52 weeks.

Side effects of methotrexate include:

• Fatigue
• Stomach upset
• Small ulcerations in the nose or mouth
• Liver inflammation
• Thinning of the hair

Some methotrexate side effects can be decreased or prevented by taking folic acid. You can get enough folic acid if you eat lots of green vegetables. If you don’t eat a lot of green vegetables you can take folic acid supplements.

Methotrexate Considerations

Methotrexate is usually the first line treatment for rheumatoid arthritis and other types of inflammatory arthritis, but there are several other disease modifying agents that one can use either alone or in conjunction with methotrexate. Those medications include:

• Anti-malarials
• Sulfasalazine
• Prednisone
• Leflunomide
• Ciclosporin
• Azathioprine
• Biologics

Methotrexate, like other medications, will often interfere with metabolism or interact with other drugs you’re taking. If you are going to go on methotrexate or you’re going to start new medications, it’s always a good idea to talk to your doctor or your pharmacist about these possible interactions. If you take methotrexate, your rheumatologist or doctor will want to do regular blood test monitoring. If you’re pregnant or planning to become pregnant, methotrexate is not an option for you.

Talk to your rheumatologist if you’d like more information on methotrexate. 

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Print this Action Plan and check off items that you want to discuss with your healthcare provider

  • Methotrexate is a disease-modifying anti-rheumatic drug (DMARD). It is commonly used to treat inflammatory conditions including rheumatoid arthritis (RA), psoriatic arthritis, vasculitis and systemic lupus erythematosus.
  • There are two ways to take methotrexate. One is to take a pill or a number of pills once a week. Or, you can auto-inject a dose under the skin once a week.
  • Methotrexate won’t relieve your symptoms right away – that’s why it’s called a slow disease-modifying agent. Typically, you’ll notice the effects between 6 and 12 weeks, and a maximum effect may take up to 52 weeks.
  • Side effects of methotrexate include fatigue, stomach upset, small ulcerations in the nose or mouth, liver inflammation and thinning of the hair.
  • If you take methotrexate, your rheumatologist or doctor will want to do regular blood test monitoring. If you’re pregnant or planning to become pregnant, methotrexate is not an option for you.

 

 

Dr John Wade Patient Education Platform