Side effects of methotrexate (Maxtrex)

Find out about the side effects of the drug methotrexate for mouth and salivary gland cancer.

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

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

Common side effects

Signs of an infection include headaches, aching muscles, a cough, a sore throat, pain passing urine, or feeling cold and shivery.

Contact your advice line or doctor straight away if you have any of these signs, or your temperature goes above 37.5C or below 36C. Severe infections can be life threatening.

Chemotherapy reduces the number of white blood cells in the blood. This increases your risk of infections. White blood cells help fight infections.

When the level is very low it is called neutropenia (pronounced new-troh-pee-nee-ah).

You have antibiotics if you develop an infection. You might have them as tablets or as injections into the bloodstream (intravenously). To have them into your bloodstream you need to go into hospital.

You might feel very tired during your treatment. It might take 6 months to a year for your energy levels to get back to normal after the treatment ends. A low red blood cell count will also make you feel tired.

You can do things to help yourself, including some gentle exercise. It’s important not to push yourself too hard. Try to eat a well balanced diet.

Talk to your doctor or nurse if you are finding the tiredness difficult to manage.

Chemotherapy makes the level of red blood cells fall (anaemia). Red blood cells contain haemoglobin, which carries oxygen around the body. When the level of red blood cells is low you have less oxygen going to your cells. This can make you breathless and look pale. Tell your doctor or nurse if you feel breathless.

You have regular blood tests to check your red blood cell levels. You might need a blood transfusion if the level is very low. After a transfusion, you will be less breathless and less pale.

You can also feel tired and depressed when your blood count is low and feel better once it is back to normal. The levels can rise and fall during your treatment. So it can feel like you are on an emotional and physical roller coaster.

You might notice you:

  • bruise more easily
  • have nosebleeds
  • have bleeding gums when you brush your teeth

This is due to a drop in the number of platelets that help clot your blood.

If your platelets get very low you may have lots of tiny red spots or bruises on your arms or legs called petechiae.

Tell your doctor or nurse straight away if you have petechiae.

You have a platelet transfusion if your platelet count is very low. It is a drip of a clear fluid containing platelets. It takes about 15 to 30 minutes. The new platelets start to work right away. 

Tell your doctor or nurse if you have this.

Changes in taste can make you go off certain foods. Many people go off tea and coffee, for example. You might also find that some foods taste different. Some people find that they prefer to eat spicier foods.

Your taste usually gradually goes back to normal when your treatment is over. It may take a few weeks.

Tips

  • Choose foods that have strong flavours, such as herbs, spices, marinades and sauces if all your food tastes the same.
  • Season your food with spices or herbs, such as rosemary, basil and mint.
  • Garnish cold meat or cheese with pickle or chutney.
  • Try lemon or green tea if tea or coffee taste strange.
  • Sharp tasting fizzy drinks such as lemonade or ginger beer are refreshing.
  • Some people find that cold foods taste better than hot foods.

Your mouth and throat might get sore. It may be painful to swallow drinks or food. You will have mouth washes to keep your mouth healthy.

You can have painkillers to reduce the soreness. Take them half an hour before meals to make eating easier.

Tell your doctor or nurse if your throat is sore.

Tell your doctor or nurse if you have diarrhoea. They can prescribe medicine to help you. 

Drink at least 2.5 litres of fluid a day. This helps to keep you hydrated.

Ask your nurse about soothing creams to apply around your back passage (rectum). The skin in that area can get very sore and even break if you have severe diarrhoea.

Contact your doctor or nurse immediately if you have diarrhoea 4 or more times a day, or any diarrhoea at night.

Your eyes might be sore because the drugs cause a reaction on the inside of your eyelids. Or you may not be making enough tears. Your eyes can feel sore and gritty and might be red. Tell your doctor or nurse if you have this. They can prescribe eye drops, ointments or artificial tears for you.

You could lose all your hair or it may become thinner. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. It usually starts gradually within 2 to 3 weeks after treatment starts.

Your hair will grow back once your treatment has finished. This can take several months and your hair is likely to be softer. It can also grow back a different colour or be curlier than before.

Tips

  • Ask about getting a wig before you start treatment so you can match the colour and texture of your real hair.
  • You could choose a wig for a whole new look.
  • Think about having your hair cut short before your treatment starts.
  • Some people shave their hair off completely so they don't have to cope with their hair falling out.
  • Wear a hairnet at night so you won't wake up with hair all over your pillow.

Hair loss is usually only a problem with high dose methotrexate.

Feeling or being sick can start a few hours after treatment and last for a few days. Anti sickness injections and tablets can control it. Tell your doctor or nurse if you feel sick. You might need to try different anti sickness medicines to find one that works.

Contact your doctor or nurse straight away if you’ve been sick more than once in a day.

Tips

  • Avoid eating or preparing food when you feel sick.
  • Avoid foods that are fried, fatty, or have a strong smell.
  • Drink plenty of liquid to stop you from getting dehydrated.
  • Relaxation techniques help control sickness for some people.
  • Ginger can help – try it as crystallised stem ginger, ginger tea or ginger ale.
  • Fizzy drinks help some people when they’re feeling sick.

Occasional side effects

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

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

Don't use sunbeds or sit in the sun. Cover up or use sunscreen if you go out in the sun. 

Remember to put sun cream on your head or wear a hat if you have lost hair there.

A rash can also be itchy. Tell your doctor or nurse if you have a skin rash. They can prescribe medicine to stop the itching and soothe your skin.

Dizziness

This drug might make you feel dizzy. Don’t drive or operate machinery if you have this.

It is important to tell your doctor or nurse if you have a cough, or are breathless.

The changes are usually very mild and unlikely to cause symptoms. They will almost certainly go back to normal when treatment is finished. 

You have regular blood tests throughout your treatment so your doctor can check this.

Your skin may become lighter or darker when you are having treatment but this goes back to normal when you finish.

Loss of appetite

You might lose your appetite for various reasons when you are having cancer treatment. Sickness, taste changes or tiredness can all put you off food and drinks.

Tips

  • Eating several small meals and snacks throughout the day can be easier to manage.
  • Ask your doctor or nurse to recommend high calorie drinks to sip between treatments, if you are worried about losing weight.
  • You can make up calories between treatments for the days when you really don’t feel like eating.
  • Drink plenty of fluids even if you can't eat.
  • Don't fill your stomach with a large amount of liquid before eating.
  • Try to eat high calorie foods to keep your weight up.

This usually happens with the first or second treatment. Symptoms include a skin rash, itching, feeling hot and shivering. Other symptoms include redness of the face, dizziness, a headache, shortness of breath and anxiety.

Tell your doctor or nurse if you feel light headed or dizzy. You have your blood pressure checked regularly.

Women might stop having periods (amenorrhoea) but this may be temporary.

Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men

You may be able to store sperm before starting treatment.

It can take a few months or sometimes years for fertility to return to normal. You can have sperm counts to check your fertility when your treatment is over. Ask your doctor about it.

Women

Chemotherapy can cause an early menopause. This stops you from being able to become pregnant in the future. Talk to your doctor about this before your treatment. It’s sometimes possible to store eggs or embryos before treatment.

This drug can cause dry eyes or blurred vision. 

Your doctor can prescribe eye drops, ointments or artificial tears if you have dry eyes. 

Tell your doctor if you have any eyesight changes. 

Rare side effects

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

You may feel drowsy with this treatment. Do not operate machinery or drive if you are feeling drowsy.

Let your doctor or nurse know if you have headaches. They can give you painkillers such as paracetamol to help.

Mood changes can include feeling very sad and depressed. Tell your doctor or nurse if you’re feeling depressed. They can arrange for you to talk to someone and give treatment if necessary.

Sex hormones have an important role in your sex drive. Interest in sex can be affected by:

  • tiredness (fatigue)
  • stress or anxiety 
  • loss of confidence or self esteem 
  • changes to how your body feels, such as vaginal dryness 

Talking to your partner about how you feel might help. You may not feel like having sex for a while. Hugging, cuddling, and kissing can be comforting. If you feel more relaxed, you may enjoy physical contact. 

Some anti depressant medication can lower your sex drive. It's very important to talk to your doctor if you want to stop taking them. Stopping anti depressants suddenly can cause side effects.

Talk to your nurse if you have this.

You might notice a ringing sound in your ears (tinnitus). This often gets better on its own once the treatment ends.

You may get pain in your muscles or back. Tell your doctor or nurse so they can give you painkillers and advice on what to do to help ease the pain.

About methotrexate

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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