This page tells you about the chemotherapy drug methotrexate and its possible side effects. There is information about
Methotrexate is a chemotherapy drug. Its brand name is Maxtrex. It is a treatment for various types of cancer, including
- Breast cancer
- Bladder cancer
- Bone cancer
- Some types of acute leukaemia
- Gestational trophoblastic tumours
- Non Hodgkin lymphoma
- Soft tissue sarcomas
- Lung cancer
- Head and neck cancers
- Ovarian cancer
- Cervical cancer
- Testicular cancer
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.
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.
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 before or during your course of treatment and it stays in place as long as you need it.
You can read our information about having chemotherapy into a vein.
An injection into a muscle (intramuscular injection)
You have the injection into a muscle, usually into your buttock or upper thigh.
You can read about injections into a muscle.
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 many 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 don't 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. You can read about having a having a lumbar puncture.
You have blood tests before starting treatment and regularly during your treatment. The tests check your levels of blood cells. They also check how well your liver and kidneys are working. You will also have chest X-rays to check your lungs.
We've listed the side effects associated with methotrexate below. You can use the links to find out more about each side effect. Where there is no link, please go to our cancer drug side effects section or use the search box at the top of the page.
You may have a few side effects. They 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)
The side effects may be different if you are having methotrexate with other drugs.
Tell your doctor or nurse straight away if any of the side effects get severe.
More than 10 in every 100 people have one or more of the side effects listed below.
- 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, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C
- 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, or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae)
- Tummy (abdominal) pain – let your nurse know if you have this
- Tiredness and weakness (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
- 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 – your nurse will give you anti sickness medicines
Between 1 and 10 in every 100 people have one or more of these effects.
- Kidney changes that are mild and unlikely to cause symptoms – they will almost certainly go back to normal when treatment finishes
- Blurred vision or sore eyes
- 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 may be due to changes in 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
- Darkening or lightening of skin
- Loss of appetite
- An allergic reaction – let your nurse know straight away if you feel hot or have any skin rashes, itching, dizziness, headaches, or shivering. Also let them know if you have breathlessness, anxiety, flushing of the face, or a sudden need to pass urine
- Low blood pressure – let your nurse know if you feel faint
- Women may stop having periods (amenorrhoea) but this may only be temporary
- Loss of fertility – you may not be able to become pregnant or father a child after this treatment. 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
Fewer than 1 in 100 people have these effects.
- Mood swings
- Low sex drive
- Soreness or swelling in the vaginal area
- Ringing in the ears (tinnitus)
- Joint or muscle pain
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. Avoid vitamin supplements containing folic acid because these can stop methotrexate working so well.
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 and for at least 6 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.
Do not breastfeed during this treatment because the drug may come through in the breast milk.
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.
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 www.medicines.org.uk.
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 www.mhra.gov.uk.
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