About this leaflet

This information leaflet has been written to help you to understand more about your Methotrexate medication and to help answer some of your questions. We also recommend you reading the information leaflet enclosed with your medication for more detail.

What is Methotrexate and why am I taking it?

Methotrexate is a medication that helps to reduce inflammation in the body. It works by calming down an overactive immune system and is known as an immunosuppressant.

You have been prescribed Methotrexate to treat inflammation caused by your immunotherapy treatment. It can help relieve symptoms such as joint pain, swelling, and skin issues linked to an overactive immune response.

How do I take Methotrexate?

  • Methotrexate is taken once a week – it’s important to take it on the same day each week.
  • It can come as a tablet, liquid, or injection.
  • Tablets should be swallowed whole with or after food.

You may also be prescribed Folic Acid (5 mg) to take six days a week (not on the same day as Methotrexate). Folic acid helps reduce some side effects and supports healthy cells.

Important: Do not take folic acid on the same day as Methotrexate – it can make Methotrexate less effective.

You might start on a low dose of methotrexate, which may be increased depending on how well you tolerate the medication.

If you need more Methotrexate, please contact your healthcare team – your GP may not be able to prescribe it. If you're unsure who to contact, call our 24-hour Patient Hotline: 0800 169 5555.

Monitoring while on Methotrexate

You’ll need regular blood tests to check your blood count, liver, and kidney function:

  • Weekly blood tests for the first 8 weeks
  • Then, less often once your results are stable

Your dose may be adjusted depending on your test results or any side effects.

Are there any possible side effects to Methotrexate?

Like all medications, Methotrexate can cause side effects, although not everyone will experience them.

Common side effects may include:

  • Nausea or vomiting
  • Diarrhoea
  • Headaches
  • Loss of appetite
  • Stomach pain or indigestion
  • Hair thinning or loss

More side effects – You should contact your healthcare team for advice if you experience any of the following:

  • Fever, chills, or signs of infection
  • Yellowing of the skin or eyes (jaundice)
  • Ongoing cough, chest pain, or trouble breathing
  • Swelling in the hands, feet, or ankles
  • Easy bruising or unexplained bleeding

For full details on possible side effects, please refer to the manufacturer's patient information leaflet provided with your medication.

Important information about taking Methotrexate

If you feel unwell at any time while taking Methotrexate, please contact the The Clatterbridge Cancer Centre's 24-hour Patient Hotline on 0800 169 5555 for support and advice.

How long until it starts working?

It can take up to 12 weeks for Methotrexate to have an effect, though some people feel better sooner.

Don’t stop taking Methotrexate without speaking to your healthcare team first.

Vaccination advice

While taking Methotrexate, you can safely receive the following recommended vaccines:

  • Flu vaccine
  • COVID-19 vaccine
  • Pneumococcal vaccine

These vaccines help protect you from serious infections and are recommended during your treatment.

However, you should avoid live vaccines, as these may not be safe while your immune system is suppressed. Live vaccines can include but are not limited to:

  • BCG Vaccine
  • Measles, Mumps and Rubella (MMR) vaccine (Priorix, MMRVaxPro)
  • Rotavirus vaccine (Rotarix)
  • Shingles vaccine (Zostavax)
  • Oral typhoid vaccine (Ty21a)
  • Varicella vaccine (Varilrix and Varilvax)
  • Yellow fever vaccine

If you are offered any vaccine, it is important to inform the vaccinator that you are taking Methotrexate, so they can ensure the vaccine is suitable for you.

Pregnancy and fertility?

Methotrexate is not recommended if you are pregnant, planning a pregnancy, or breastfeeding. If any of these apply to you, please speak to your healthcare team before starting or continuing this medication.

If you are sexually active, it is important to use effective barrier contraception (e.g. condoms) while taking Methotrexate to avoid becoming pregnant during treatment. 

Things to remember while taking Methotrexate

  • Take it once a week on the same day each week – not daily.
  • Do not take your Folic Acid on the same day as Methotrexate.
  • Always take Methotrexate with or after food to reduce stomach upset.
  • Wash your hands regularly – Methotrexate can lower your immunity and increase your risk of infections.
  • Keep up with your blood tests – these help monitor your liver, kidneys, and blood cells.
  • Avoid alcohol or limit your intake, as both alcohol and Methotrexate can affect your liver.
  • Do not take any over-the-counter or herbal medicines without checking with your healthcare team.
  • Tell any doctor, dentist or healthcare provider that you are taking Methotrexate – especially before procedures or vaccinations.
  • Use reliable contraception while taking Methotrexate – it can harm an unborn baby.
  • Do not share your medication – Methotrexate is prescribed specifically for you.
  • Read the information leaflet enclosed with your medication for more detail
  • Store Methotrexate safely – keep it out of sight and reach of children.

If you feel unwell or have concerns, call the 24-hour Patient Hotline: 0800 169 5555.

Cancer Voices logo

This information has been reviewed by Cheshire and Merseyside Cancer Voices to check it is easy to understand. Cheshire and Merseyside Cancer Voices is a panel of cancer patients who volunteer to read NHS information to make sure it makes sense to people. They have been brought together by Cheshire and Merseyside Cancer Alliance.