Methotrexate (Maxtrex)

Methotrexate is one chemotherapy drug you might have as a treatment for mouth and salivary gland cancer.

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.  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 blood stream (intravenous)
  • a tablet or a liquid you can drink (solution)
  • 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 have treatment 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.

Talk to your specialist or advice line before you stop taking a cancer drug.

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. 


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.

Important information

Other medicines, foods and drink

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

Avoid vitamin supplements containing folic acid because these can stop methotrexate working so well.

Pregnancy and contraception

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

This should be for at least 6 months after the treatment finishes.


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

Blood clots

You are more at risk of developing a blood clot during treatment. Drink plenty of fluids and keep moving to help prevent clots.

Treatment for other conditions

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


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 Zostavax (shingles vaccine).

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 vaccines taken by mouth (oral vaccines). This includes the rotavirus vaccine given to babies. So, you mustn't change their nappies for 2 weeks after their vaccination.

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


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

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.

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