Methotrexate Injectable Solution

More Common Side Effects

The more common side effects of this drug include:

• nausea or vomiting

• stomach pain or upset

• diarrhea

• hair loss

• tiredness

• dizziness

• chills

• headache

• sores in your lungs

• mouth sores

• painful skin sores

• bronchitis

• fever

• bruising more easily

• increased risk of infection

• sun sensitivity

• rash

• stuffy or runny nose and sore throat

• abnormal results on liver function tests (may indicate liver damage)

• low blood cell levels

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious Side Effects

Call your doctor right away if you have serious side effects. Call 9-1-1 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

• Unusual bleeding. Symptoms can include:

  • vomit that contains blood or looks like coffee grounds
  • coughing up blood
  • blood in your stool, or black, tarry stool
  • bleeding from your gums
  • unusual vaginal bleeding
  • increased bruising

• Liver problems. Symptoms can include:

  • dark-colored urine
  • vomiting
  • pain in your abdomen
  • yellowing of your skin or the whites of your eyes
  • tiredness
  • lack of appetite
  • light-colored stools

• Kidney problems. Symptoms can include:

  • not being able to pass urine
  • decreased urination
  • blood in your urine
  • large or sudden weight gain

• Pancreas problems. Symptoms can include:

  • severe pain in your abdomen
  • severe back pain
  • upset stomach
  • vomiting

• Lung lesions (sores). Symptoms can include:

  • a dry cough that doesn’t produce phlegm
  • fever
  • shortness of breath

• Lymphoma (cancer). Symptoms can include:

  • tiredness
  • fever
  • chills
  • weight loss
  • loss of appetite

• Skin reactions. Symptoms can include:

  • rash
  • redness
  • swelling
  • blisters
  • peeling skin

• Infections. Symptoms can include:

  • fever
  • chills
  • sore throat
  • cough
  • ear or sinus pain
  • saliva or mucus that increases in amount or is a different color than normal
  • pain while urinating
  • mouth sores
  • wounds that won’t heal
  • anal itching

• Bone damage and pain

• Bone marrow damage. Symptoms can include:

  • low white blood cell levels, which can cause infection
  • low red blood cell levels, which can cause anemia (with symptoms of tiredness, pale skin, shortness of breath, or a fast heart rate)
  • low platelet levels, which can lead to bleeding

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

Methotrexate can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Alcohol interaction

Avoid drinking alcohol when you’re taking methotrexate. Alcohol can increase the side effects of methotrexate on your liver. This can cause liver damage or worsen liver problems that you already have.

Medications that might interact with this drug

Drugs you should not use with methotrexate

Do not take these drugs with methotrexate. When used with methotrexate, these drugs can cause dangerous effects in your body. Examples of these drugs include:

• Live vaccines
  • When used with methotrexate, live vaccines raise your risk infection. The vaccine may also not work as well. (Live vaccines, such as FluMist, are vaccines that contain small amounts of live, but weakened, viruses.)

Interactions that increase your risk of side effects

Increased side effects from other drugs: Taking methotrexate with certain medications raises your risk of side effects from those drugs. Examples of these drugs include:

• Certain asthma drugs such as theophylline
  • Increased side effects of theophylline can include rapid heartbeat.

Increased side effects from methotrexate: Taking methotrexate with certain medications raises your risk of side effects from methotrexate. This is because the amount of methotrexate in your body may be increased. Examples of these drugs include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, aspirin, diclofenac, etodolac, or ketoprofen
  • Increased side effects can include bleeding, problems with your bone marrow, or serious problems with your digestive tract. These problems can be fatal (cause death).
• Seizure drugs such as phenytoin
  • Increased side effects can include upset stomach, hair loss, tiredness, weakness, and dizziness.
• Gout drugs such as probenecid
  • Increased side effects can include upset stomach, hair loss, tiredness, weakness, and dizziness.
• Antibiotics such as penicillin drugs, which include amoxicillin, ampicillin, cloxacillin, and nafcillin
  • Increased side effects can include upset stomach, hair loss, tiredness, weakness, and dizziness.
• Proton pump inhibitors such as omeprazole, pantoprazole, or esomeprazole
  • Increased side effects can include upset stomach, hair loss, tiredness, weakness, and dizziness.
• Skin drugs such as retinoids
  • Increased side effects can include liver problems.
• Post-transplant drugs such as azathioprine
  • Increased side effects can include liver problems.
• Anti-inflammatory drugs such as sulfasalazine
  • Increased side effects can include liver problems.
• Antibiotics such as trimethoprim/sulfamethoxazole
  • Increased side effects can include bone marrow damage.

Interactions that can make your drugs less effective

When methotrexate is less effective: When methotrexate is used with certain drugs, it may not work as well to treat your condition. This is because the amount of methotrexate in your body may be decreased. Examples of these drugs include:

• Antibiotics such as tetracycline, chloramphenicol, or  antibiotics that work on bacteria in your bowel (such as gentamicin, vancomycin, and nystatin)
  • Your doctor may adjust your dose of methotrexate.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking. Methotrexate warnings

People with liver disease

Don’t use methotrexate if you have a history of liver problems, including alcohol-related liver problems. This drug can make your liver function worse. If your doctor prescribes this drug, they will decide your dosage partly based on your liver health. Depending on your level of liver disease, your doctor may decide that you should not take methotrexate.

People with weakened immune systems

Don’t use methotrexate if you have a weakened immune system or an active infection. This drug can make these problems worse.

People with low blood counts

These include low counts of white blood cells, red blood cells, or platelets. Methotrexate can make your low blood cell levels worse.

People with kidney disease

If you have kidney problems or a history of kidney disease, you may not be able to clear this drug from your body well. This may increase the levels of methotrexate in your body and cause more side effects. This drug can also cause problems with your kidney function or even cause your kidneys to fail, leading to the need for dialysis. If your doctor prescribes this drug, they will decide your dosage partly based on your kidney health. If your kidney damage is severe, your doctor may decide that you should not take methotrexate.

People with ulcers or ulcerative colitis

Do not use methotrexate. This medication can make these conditions worse by increasing the risk of ulcers (sores) in your gastrointestinal tract.

People with rapidly growing tumors

Methotrexate can cause tumor lysis syndrome. This condition can occur after the treatment of certain cancers. It can cause problems with your electrolyte levels, which can lead to severe kidney failure or even death.

People with pleural effusion or ascites

Pleural effusion is fluid around the lungs. Ascites is fluid in your abdomen. Methotrexate may stay in your body for a longer time if you have these medical problems. This could lead to more side effects.

People with worsened psoriasis due to light exposure

If you’ve had psoriasis that gets worse from ultraviolet (UV) radiation or exposure to sunlight, methotrexate may cause this reaction to happen again.

Pregnant women

Methotrexate can cause serious harm to a pregnancy. It can also cause fertility problems (make it harder to get pregnant). The pregnancy warning depends on the condition your doctor is treating with this drug.

• For rheumatoid arthritis or psoriasis treatment: Do not use this drug during pregnancy.
• For cancer treatment: Talk to your doctor if you’re pregnant or plan to become pregnant. You should use methotrexate during pregnancy only if the potential benefit justifies the potential risk to the fetus.

If you’re a woman of childbearing age, your doctor will likely give you a pregnancy test to make sure you’re not pregnant before starting this drug. You should use effective birth control during your treatment and for at least one menstrual cycle after stopping treatment with this drug. Call your doctor right away if you:

• miss a period
• think your birth control didn’t work
• become pregnant while taking this drug 

If you’re a man, you should use effective birth control during your treatment and for at least 3 months after your treatment ends.

Women who are breast-feeding

Methotrexate passes through breast milk and can cause side effects in a child who is breastfed. 

Do not breastfeed while taking methotrexate. Talk with your doctor about the best way to feed your child.

For seniors

While taking methotrexate, seniors are more likely to have problems with their liver, kidneys, or bone marrow. They’re also more likely to have low folic acid levels. Your doctor should monitor you for these and other side effects.

For children

Polyarticular juvenile idiopathic arthritis: This medication has been studied in children ages 2–16 years with this condition. 

Psoriasis: This medication has not been studied in children with psoriasis. It should not be used to treat this condition in people younger than 18 years.

When to call the doctor

Call your doctor right away if you become pregnant while taking this drug.

Allergies

Methotrexate can cause a severe allergic reaction. Symptoms may include:

• trouble breathing
• swelling of your throat or tongue
• hives

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal.

All possible dosages and drug forms may not be included here. Your dosage, drug form, and how often you take the drug will depend on:

• your age
• the condition being treated
• how severe your condition is
• other medical conditions you have
• how you react to the first dose

What are you taking this medication for?

Psoriasis

Brand: Otrexup

Form: subcutaneous injection (auto-injector) Strengths: 7.5 mg/0.4 mL, 10 mg/0.4 mL, 15 mg/0.4 mL, 20 mg/0.4 mL, 25 mg/0.4 mL

Brand: Rasuvo

Form: subcutaneous injection (auto-injector) Strengths: 7.5 mg/0.15 mL, 10 mg/0.2 mL, 12.5 mg/0.25 mL, 15 mg/0.3 mL, 17.5 mg/0.35 mL, 20 mg/0.4 mL, 22.5 mg/0.45 mL, 25 mg/0.5 mL, 27.5 mg/0.55 mL, 30 mg/0.6 mL Adult dosage (ages 17–64 years)

• Typical starting dosage: 10–25 mg once per week
• Maximum dosage: 30 mg once per week

Child dosage (ages 2–16 years)

A safe and effective dosage hasn’t been established for this age group for this condition.

Child dosage (ages 0–1 year)

This drug has not been proven to be safe and effective for children younger than 2 years of age.

Senior dosage (ages 65 years and older)

The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug may stay in your body for a longer time. This raises your risk of side effects.

Your doctor may start you on a lowered dose or a different dosing schedule. This can help keep levels of this drug from building up too much in your body.

Warnings

This medication must be injected only once per week. Taking this medication on a daily basis can lead to death.

Rheumatoid arthritis

Brand: Otrexup

Form: subcutaneous injection (auto-injector) Strengths: 7.5 mg/0.4 mL, 10 mg/0.4 mL, 15 mg/0.4 mL, 20 mg/0.4 mL, 25 mg/0.4 mL

Brand: Rasuvo

Form: subcutaneous injection (auto-injector) Strengths: 7.5 mg/0.15 mL, 10 mg/0.2 mL, 12.5 mg/0.25 mL, 15 mg/0.3 mL, 17.5 mg/0.35 mL, 20 mg/0.4 mL, 22.5 mg/0.45 mL, 25 mg/0.5 mL, 27.5 mg/0.55 mL, 30 mg/0.6 mL Adult dosage (ages 17–64 years)

• Typical starting dosage: 7.5 mg once per week

Senior dosage (ages 65 years and older)

The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug may stay in your body for a longer time. This raises your risk of side effects.

Your doctor may start you on a lowered dose or a different dosing schedule. This can help keep levels of this drug from building up too much in your body.

Warnings

This medication must be injected only once per week. Taking this medication on a daily basis can lead to death.

Polyarticular juvenile idiopathic arthritis

Brand: Otrexup

Form: subcutaneous injection (auto-injector) Strengths: 7.5 mg/0.4 mL, 10 mg/0.4 mL, 15 mg/0.4 mL, 20 mg/0.4 mL, 25 mg/0.4 mL

Brand: Rasuvo

Form: subcutaneous injection (auto-injector) Strengths: 7.5 mg/0.15 mL, 10 mg/0.2 mL, 12.5 mg/0.25 mL, 15 mg/0.3 mL, 17.5 mg/0.35 mL, 20 mg/0.4 mL, 22.5 mg/0.45 mL, 25 mg/0.5 mL, 27.5 mg/0.55 mL, 30 mg/0.6 mL Child dosage (ages 2–16 years)

• Typical starting dosage: 10 mg per meter squared (m2) of body surface area, once per week

Child dosage (ages 0–1 year)

This drug has not been proven to be safe and effective for children younger than 2 years of age.

Warnings

This medication must be injected only once per week. Taking this medication on a daily basis can lead to death.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you. Important considerations for taking methotrexate

Take this drug at the time(s) recommended by your doctor

Store this drug carefully

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A prescription for this medication is refillable

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Travel

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Self-management

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Clinical monitoring

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Sun sensitivity

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Not every pharmacy stocks this drug. When filling your prescription, be sure to call ahead

Hidden costs

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Insurance

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