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Methotrexate

Methotrexate is a type of chemotherapy. It's a treatment for a number of different types of cancer.

How methotrexate works

Methotrexate is one of a group of chemotherapy drugs called anti metabolites. These 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.

Methotrexate also stops some normal cells working properly, causing side effects. You might have another drug called folinic acid after methotrexate. This depends on how much methotrexate you have. It helps normal cells recover and reduces 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 bloodstream (intravenous)
  • a tablet or a liquid you can drink (solution)
  • an injection into your muscle 
  • an injection into your spinal fluid (intrathecal injection)

Into your bloodstream

You might have the treatment through a drip into your arm. Your nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.

Or you might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in the whole time you are having treatment.

Taking your tablets or liquid

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
  • high temperature (fever)
  • stiff neck
  • back or shoulder pain
  • sleepiness
  • temporary shaking (tremor)
  • irritability and confusion
  • feeling or being sick
  • difficult or unclear speech
  • fits (seizures)
  • swelling in the brain
Contact your advice line, doctor or nurse if you have any of these side effects.

When you have methotrexate

You usually have it as a course of several cycles of treatment. Each cycle varies depending on what type of cancer you have. Your doctor or nurse will tell you more about this. 

Tests during treatment

You have blood tests before 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.

Side effects

Side effects of treatment will depend on the amount you have (the dose) and how you have the drug.

We haven't listed all the side effects. Your doctor or nurse will talk to you about the possible side effects. Tell them if you notice anything unusual or different during and after treatment.

When to contact your team

Your doctor and nurse will monitor you closely for any side effects. Let them know as soon as possible if:

  • you have severe side effects 
  • your side effects aren’t getting any better
  • your side effects are getting worse

Early treatment can help manage side effects better. 

Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C.

Common side effects

Each of these side effects happens in more than 1 and 10 people (10%). You might have one or more of them. They include:

Increased risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include headaches, aching muscles, cough, sore throat, pain passing urine, feeling cold and shivery or tooth ache. Infections can sometimes be life threatening. You should contact your team urgently if you think you have an infection. 

Bruising, bleeding gums and nosebleeds

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. 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 petechia).

Mouth sores and ulcers

Mouth sores and ulcers can be painful. Keep your mouth and teeth clean; drink plenty of fluids; avoid acidic foods such as oranges, lemons and grapefruits; chew gum to keep the mouth moist and tell your doctor or nurse if you have ulcers.

Liver changes

You might have liver changes that are very mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in levels of chemicals produced by the liver.

Indigestion or heartburn

Contact your doctor or pharmacist if you have indigestion or heartburn. They can prescribe medicines to help.

Tummy (abdominal) pain

Tell your doctor or nurse if you have this. They may give you medicine to help. 

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques, can all help.

Loss of appetite

You might not feel like eating and may lose weight. It is important to eat as much as you can. Eating several small meals and snacks throughout the day can be easier to manage. You can talk to a dietitian if you are concerned about your appetite or weight loss. 

Kidney changes

You might have some changes in the way your kidneys work. You'll have regular blood tests to check how well they are working.

Occasional side effects

Each of these effects happens in more than 1 in 100 people (1%). You might have one or more of them. They include:

  • breathlessness and looking pale due to a drop in red blood cells (anaemia)
  • tiredness (fatigue)
  • headaches
  • drowsiness
  • dizziness
  • diarrhoea
  • skin changes such as a rash, itching or reddening of the skin
  • thickening and scarring of the lung tissue causing a cough and shortness of breath
  • hair loss - your hair usually grows back once treatment has finished

Rare side effects

Each of these effects happens in fewer than 1 in 100 people (less than 1%). You might have one or more of them. They include:

  • an allergic reaction that can cause a rash, shortness of breath, redness or swelling of the face and dizziness
  • confusion
  • depression
  • high blood sugar levels (diabetes)
  • your skin and eyes being very sensitive to sunlight
  • muscle and joint pain
  • weakening of the bones (osteoporosis)
  • ulcers and swelling (inflammation) of the stomach and bowel, bladder or vagina
  • fits (seizures)
  • weakness on one side of your body
  • a severe skin reaction that may start as tender red patches which leads to peeling or blistering of the skin. You might also feel feverish and your eyes may be more sensitive to light. This is serious and could be life threatening

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

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.

It’s important to drink plenty during treatment for methotrexate. If you become dehydrated you may increase the side effects of the drug. 

Avoid drinking alcohol while having methotrexate.

Pregnancy and contraception

This treatment might harm a baby developing in the womb. It is important not to become pregnant or father a child while you're having treatment and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Breastfeeding

Don’t breastfeed during this treatment because the drug may come through into 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.

Fertility

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.

Driving and use of machinery

This drug can cause tiredness and dizziness. Don’t drive or operate heavy machinery if you have these symptoms.

Immunisations

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 (as an injection)
  • be in contact with other people who've had live vaccines as injections

Avoid close contact with people who’ve recently had live vaccines taken by mouth (oral vaccines) such as oral polio or the typhoid vaccine.

This also includes the rotavirus vaccine given to babies. The virus is in the baby’s poo for up to 2 weeks and could 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 should also avoid close contact with children who have had the flu vaccine nasal spray if your immune system is severely weakened. 

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Information and help

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