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Methotrexate (Maxtrex)

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This page tells you about the chemotherapy drug methotrexate and its possible side effects. There is information about


What methotrexate is

Methotrexate is a chemotherapy drug. Its brand name is Maxtrex. It is used to treat various types of cancer, including

Methotrexate is one of a group of chemotherapy drugs called anti metabolites. It is similar to a normal body molecule called folinic acid, but has a slightly different structure. So it stops some cells working properly. 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 also stops some normal cells working properly, causing side effects. You may have folinic acid 24 hours after you have had methotrexate. Folinic acid helps the normal cells to recover and helps to stop side effects.


How you have methotrexate

The way you have methotrexate depends on the type of cancer you have. You usually have it as a course of several cycles of treatment. You may have it on its own or in combination with other medicines. Your treatment plan will depend on the type of cancer you have. There is information about planning chemotherapy in the chemotherapy section

You may have methotrexate in one of the following ways.

An injection or infusion (drip) into a vein

You can have it through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have it through a central line, a portacath or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in just before your course of treatment starts and it stays in place as long as you need it.

An injection into a muscle (intramuscular injection)

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

Tablets that you swallow

It is very important that you take tablets according to the instructions your doctor or pharmacist gives you. For example, 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. And never stop taking a cancer drug without talking to your specialist first.

If you accidentally take too may tablets let your doctor know straight away. If you forget to take a dose take it as soon as you remember if it is within 2 days. If you have missed a dose by more than 2 days contact your doctor but do not take a double dose.

An injection into the spinal fluid (intrathecal injection)

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.

The side effects of methotrexate are listed below. You can use the links to find out more about each side effect or go to the cancer drug side effects section.


Common side effects

More than 10 in every 100 people have one or more of the side effects listed below.

A temporary drop in the number of blood cells made by the bone marrow, causing

  • An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery
  • Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
  • Bruising more easily due to a drop in platelets – you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)

Some of these side effects can be life threatening, particularly infections. You should contact your doctor if you have any of these side effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

  • Tiredness (fatigue) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
  • Taste changes
  • Mouth sores and ulcers
  • Diarrhoea – drink plenty of fluids and tell your doctor or nurse if diarrhoea becomes severe or lasts more than a couple of days, as you could get dehydrated
  • Gritty eyes – your doctor or nurse can give you eye drops to help
  • Hair loss or hair thinning with high dose methotrexate
  • Feeling or being sick happens in about 4 out of 10 people (40%) who have high doses of methotrexate

Occasional side effects

Between 1 and 10 in every 100 people have one or more of these.

  • Kidney changes that are mild and unlikely to cause symptoms may occur – they will almost certainly go back to normal when treatment finishes, but you will have regular blood tests to check how well your kidneys are working
  • Blurred vision or eye pain
  • Sensitivity of the skin to sunlight – don’t sit out in the sun, and cover up or use sun block on exposed skin
  • A skin rash, which may be itchy
  • Coughing or breathlessness caused by changes to lung tissue
  • Liver changes that are very mild and unlikely to cause symptoms – the liver will almost certainly go back to normal when treatment finishes, but you will have regular blood tests to check how well your liver is working
  • Darkening or lightening of skin
  • An allergic reaction including skin rashes and itching, a high temperature, shivering, redness of the face, feeling dizzy, a headache, breathlessness, anxiety and a need to pass urine – tell your doctor or nurse straight away if you have this
  • Women may stop having periods (amenorrhoea) but this may only be temporary
  • Loss of fertility – you may not be able to get pregnant or father a child after treatment with this drug, so talk to your doctor about your fertility before starting treatment if having a baby is important to you

Rare side effects

Fewer than 1 in 100 people have these effects.

  • Drowsiness
  • Dizziness
  • Stomach pains
  • Headaches and blurred vision
  • Mood swings
  • Low sex drive
  • Soreness or swelling in the vaginal area

Important points to re member

The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on

  • How many times you've had the drug before
  • Your general health
  • The amount of the drug you have (the dose)
  • Other drugs you are having

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies – some drugs can react together. Medicines that may react with methotrexate include

  • Some painkillers
  • Some antibiotics
  • Some medicines that make you pass more urine (water tablets)
  • Some medicines that lower blood sugar levels
  • Some drugs for skin disorders
  • Some anti epileptic drugs
  • Some gout medicines
  • Some vitamin combinations that contain folic acid

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

This drug may harm a baby developing in the womb so it is not advisable to become pregnant or father a child while you are having it. Talk about contraception to your doctor or nurse before having the treatment if there is any chance that you or your partner could become pregnant. You need to use reliable contraception during the treatment and for 3 to 6 months afterwards.

Breastfeeding is not advisable during this treatment because the drug may come through in the breast milk.


Immunisations and chemotherapy

You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).

You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy. It is safe to have the flu vaccine.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.


More information about methotrexate

This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at

If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at

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Updated: 21 May 2013