Methotrexate – Frequently asked Questions & Answers
This information has been provided with kind permission from Crohn’s and Colitis UK - a nationwide charity committed to providing information and support, funding crucial research and working to improve healthcare services for anyone affected by Inflammatory Bowel Disease.
For further information please download the full patient publication from Crohn’s and Colitis UK
How long will it take to work?
Methotrexate does not work immediately. It can take up to 3 months before your symptoms improve. Although you may not feel the benefit for some time, it does not mean that the methotrexate is not working.
How long will I be taking methotrexate?
If you respond to methotrexate you will usually remain on it for many months and perhaps several years, providing your blood tests are satisfactory.
When do I take methotrexate?
Methotrexate should be taken as a single ONCE A WEEK dose on the same day each week.
If you forget to take your methotrexate on your normal day, ask your doctor for advice. You may be able to take it up to two days later, but should not take it if you are three or more days late. If this happens, take your next dose on your usual day the following week. Do not double up your dose.
How is it taken?
Weekly, in tablet form or by injection.
You should take the tablets by mouth, after food. Swallow the tablets whole with a glass of water while sitting upright or standing. Do not crush or chew them.
Your nurse may train you to inject the methotrexate yourself. Alternatively the nurse may give you the injection each week.
Why am I prescribed folic acid?
Folic acid is a vitamin which can help your body cope with methotrexate and help reduce some of the possible side effects, such as nausea and vomiting. Usually it is taken once a week, but not on the same day as methotrexate. However, a number of different regimes may be used and some people are asked to take folic acid several times a week or every day except the methotrexate day.
How effective and safe is methotrexate?
Methotrexate has been used to treat Crohn’s Disease for some 20 years and has been successful in treating Rheumatoid Arthritis for over 50 years. A review of these studies found that a weekly dose of 25mg by injection may induce remission in Crohn’s, while a lower dose of 15mg per week can maintain remission. Some milder side effects, such as nausea and vomiting, were common in these studies, but generally there were no severe side effects. Approximately three out of ten people with IBD stop taking methotrexate due to side effects.
There is some evidence that taking methotrexate tablets is not as effective as having an injection. However, some people prefer to use oral preparations because they are more convenient.
Research on the use of methotrexate for Ulcerative Colitis is limited. However, medical experience suggests that it can be beneficial for some people with UC.
Will I need any special checks?
Before you start treatment you will need to have blood tests, including liver and kidney tests, as methotrexate can affect the blood count and sometimes cause liver problems. Your doctor may also request a chest x-ray, lung function tests, or liver scans. If your bone marrow, liver or kidney function is not working properly, methotrexate may not be suitable for you.
You will need to have regular blood counts and liver tests while you are on methotrexate to check that the treatment is working and that it is not affecting your blood or liver. A typical approach may be to have tests every 1-2 weeks for the first 2 or 3 months, and then every 1-3 months thereafter.
Your treatment monitoring may be managed by your hospital team or shared between the hospital and your GP. You may be given a booklet to record your test results. Take this with you every time you see your GP, hospital doctor, specialist nurse or pharmacist, as it helps them to share information.
Will I need to take any special precautions while on methotrexate?
Try to avoid close contact with people with infections. Methotrexate affects the way the body’s immune system works, which can make you more prone to infections. Even a mild infection such as a cold or sore throat could develop into a serious illness. Contact your doctor if you begin to feel unwell and think you have developed an infection, or are experiencing any other side effects (see What are the possible side effects?)
You may also be at greater risk of becoming more seriously ill from the viruses which cause chickenpox and shingles, measles and pneumococcal disease. If you are not already immune you may be able to be vaccinated before starting treatment. Otherwise, tell your doctor or nurse as soon as possible if you come into contact with anyone who has any of these conditions as you may be able to have a protective injection.
As with all medicines, avoid driving and hazardous work until you have learned how methotrexate affects you, as it can occasionally cause fatigue or confusion.
Does methotrexate affect fertility or pregnancy?
Methotrexate should not be used by either partner when trying to conceive or during pregnancy because it can cause birth defects or miscarriages. This is why doctors advise both men and women to use reliable contraception during treatment. Also, because traces of methotrexate can remain in body tissue for some time, couples are usually advised to avoid pregnancy for at least 3-6 months after stopping these drugs. If you find you are pregnant, or decide you would like have a child while on methotrexate, talk to your doctor about this.
What are the possible side effects?
As with all medicines, methotrexate can cause some unwanted side effects, although not everyone has them.
- Any medication can cause an allergic reaction. If you have any sudden wheeziness, feel faint, have difficulty in breathing, swelling of the face, lips or mouth, or any rash or itching, stop taking your methotrexate and contact your doctor immediately.
- Common side effects at the beginning of treatment with methotrexate can include feeling sick, vomiting and diarrhoea. The following suggestions may help:
- Taking the folic acid supplement as prescribed
- Taking your methotrexate at a different time of day, for example before you go to bed at night. If these side effects persist or are severe, talk to your doctor, who may be able to prescribe you an anti-sickness medication to take before your methotrexate. You may also be able to switch from the tablet to the injection.
- As mentioned earlier, methotrexate affects the immune system, and can increase your risk of infections, some of which may make you seriously ill. Try to avoid close contact with people who have infections, and contact you doctor immediately if you think you have an infection.
- In rare cases, methotrexate can affect the lungs. Tell your doctor if you become breathless, have a persistent cough, pain or difficulty breathing.
- Methotrexate has been known to damage the liver, although this is uncommon in people who take methotrexate for IBD. Liver damage may occur with very few outward signs, but in some cases people notice a yellowing or discolouration of the skin or whites of the eyes, and develop severe itching of the skin, which could indicate jaundice. If this happens, you should contact your doctor immediately. Blood tests can show up liver damage, but special scans and a biopsy of the liver may be needed.
- Rarely, methotrexate can harm the kidneys. Kidney function should be checked alongside your blood count and liver tests.
- Methotrexate can affect blood clotting, for example by reducing the number of platelets (blood cells that assist with clotting). If you find that you bruise or bleed easily, have nose bleeds, or have blood spots or rashes on the skin, stop taking your methotrexate and contact your doctor immediately. Methotrexate may also cause anaemia (lack of oxygen-carrying red blood cells) – your doctor should be able to tell from blood tests whether you have this. There is some evidence that immunosuppressants such as methotrexate may also slightly increase the risk of other blood disorders, such as lymphoma.
- Methotrexate can increase the skin’s sensitivity to sunlight, and the risk of developing some types of skin cancer. This can be reduced by wearing hats, light clothing and high SPF sun block.
- Some other side effects of methotrexate are listed below. Seek medical attention if you develop any of these side effects, or notice any other unusual symptoms while on methotrexate.
- Skin rash
- Mouth or gum ulcers
- Hair loss
- Abdominal pain
- Headache or dizziness or unusual sensations in the head and confusion
- Fatigue or drowsiness
- Blurred vision
- Mobility problems
This information is designed to answer common questions you may have if you have been given methotrexate to treat your Crohn’s Disease or Ulcerative Colitis (UC), the two main forms of Inflammatory Bowel Disease (IBD). It is not intended to replace specific advice from your own doctor or any other health professional. You can obtain further information from the information leaflet supplied with your medication, and from the website: http://www.medicines.org.uk.
© Crohn’s and Colitis UK 2015