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Methotrexate (Maxtrex)

Find out about the chemotherapy drug methotrexate, how you have it and other important information.

Methotrexate is a type of chemotherapy. It is a treatment for various types of cancer. It's brand name is Matrex. 

How it works

Methotrexate is one of a group of chemotherapy drugs called anti metabolites. Anti metabolites often stop cells making and repairing DNA. Cancer cells need to make and repair DNA so that they can grow and multiply. Methotrexate stops the cells working properly.

It also stops some normal cells working properly, causing side effects. To help normal cells recover you might have another drug called folinic acid for 24 hours after you have methotrexate. This will help reduce side effects.

How you have methotrexate

How you have methotrexate depends on what type of cancer you have. You can have it as: 

  • an injection into your blood stream
  • a tablet
  • an injection into your muscle (buttock or thigh)
  • an injection into your spinal fluid (intrathecal injection)

For mouth and oropharyngeal cancer you usually have methotrexate as an injection into your bloodstream. 

Into your bloodstream

You can have the chemotherapy through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

Or you might have treatment through a long line: a central line, a PICC line or a portacath. These are long plastic tubes that give the drug into a large vein in your chest. The tube stays in place throughout the course of treatment.

Taking your tablets or capsules

You must take tablets and capsules according to the instructions your doctor or pharmacist gives you.

Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, not more or less.

Never stop taking a cancer drug without talking to your specialist first.

Injection into your muscle (intramuscular)

You have the injection into a muscle, usually into your buttock or upper thigh.

Injection into your spinal fluid

Your doctor injects the drug into the fluid around your spinal cord during a lumbar puncture. The side effects may be less with this way of having methotrexate but it can cause a headache, sleepiness, back or shoulder pain, temporary shaking, irritability and confusion. 

When you have methotrexate

You usually have it as a course of several cycles of treatment.

Tests during treatment

You have blood tests before starting treatment and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Important information

Other medicines, foods and drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Methotrexate can react with alcohol and damage your liver. Avoid drinking alcohol while having methotrexate treatment.

Pregnancy and contraception

This drug may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment with this drug and for at least 6 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Breast feeding

Don’t breastfeed during this treatment because the drug may come through in your breast milk.

Treatment for other conditions

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.


You may not be able to become pregnant or father a child after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment. Women may be able to store eggs or ovarian tissue but this is rare.


Don’t have immunisations with live vaccines while you’re having treatment and for at least 6 months afterwards.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and shingles vaccine (Zostavax).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine
  • be in contact with other people who've had live vaccines as injections

Avoid contact with people who’ve had live vaccines taken by mouth (oral vaccines). This includes the rotavirus vaccine given to babies. The virus is in the baby’s urine for up to 2 weeks and can make you ill. So, avoid changing their nappies for 2 weeks after their vaccination if possible. Or wear disposable gloves and wash your hands well afterwards.

You also need to avoid anyone who has had oral polio or typhoid vaccination recently.

More information about this treatment

We haven't listed all the very rare side effects of this treatment. For further information see the Electronic Medicines Compendium (eMC) website

You can report any side effect you have that isn’t listed here to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Information and help

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