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Methotrexate

Brand names: Trexall, Otrexup, Rasuvo, Xatmep

Methotrexate calms the immune system. Low doses taken once a week treat rheumatoid arthritis and psoriasis. Higher doses treat some cancers.

Brand namesTrexall, Otrexup, Rasuvo, Xatmep
Type of medicineDMARD (immune-calming medicine)
Prescription?Prescription
ImportantThis page is general information, not a prescription. Don't start, stop, or change a medicine without talking to your provider or pharmacist.

Overview

For arthritis and psoriasis it's taken ONCE A WEEK, not daily. Taking it daily by mistake has caused deaths.

Regular blood tests check blood counts, liver, and kidneys.

What it's used for

  • Rheumatoid arthritis
  • Psoriasis and psoriatic arthritis
  • Juvenile arthritis
  • Some cancers

How to take it

  • For arthritis or psoriasis, take it once a week on the same day. Mark the day on a calendar.
  • Your provider usually also prescribes folic acid to lower side effects.
  • Limit alcohol.
  • Keep all blood test appointments.

Your dose depends on your health and other medicines. Always follow your prescription label, and ask your pharmacist if anything is unclear.

Side effects

Common side effects

  • Nausea
  • Mouth sores
  • Tiredness the day after
  • Hair thinning
Call 911Dry cough with shortness of breath or fever (lung inflammation)
Call 911Took it daily instead of weekly by mistake. Call Poison Control at 1-800-222-1222 or 911.
Call your provider todayFever, chills, sore throat, or other signs of infection
Call your provider todayUnusual bruising or bleeding, or very pale skin
Call your provider todayYellow skin or eyes or dark urine
Call 911A blistering, peeling, or widespread red rash, especially with fever

Warnings

  • Boxed warnings: serious harm to the liver, lungs, blood, kidneys, and skin; serious infections; and severe birth defects or miscarriage.
  • Avoid live vaccines while taking it.

Other medicines, foods, and alcohol

  • Bactrim (sulfamethoxazole-trimethoprim), penicillins, NSAIDs, and PPIs can raise methotrexate levels.
  • Alcohol raises liver damage risk.

Tell your provider and pharmacist about every medicine, vitamin, and supplement you take.

Pregnancy and breastfeeding

Methotrexate causes miscarriage and birth defects. Don't take it during pregnancy. Use birth control during and after treatment for as long as your provider says. This also applies to men whose partner could get pregnant.

Missed doses, overdose, and storage

If you miss a dose

This is a weekly medicine. Call your provider or pharmacist for advice. Never take it two days in a row and never double up.

If someone takes too much

Call Poison Control at 1-800-222-1222 or get help online at poison.org. Call 911 if the person collapses, has a seizure, has trouble breathing, or can't be woken.

Storing it

Store at room temperature, away from heat and moisture (not in the bathroom), and out of reach of children and pets.

Conditions it's used for

Sources

Last updated 2026-11-13.