Methotrexate is a chemotherapy drug used to treat many different cancers.
This information should ideally be read with our general information about chemotherapy and the type of cancer you have.
How methotrexate is givenBack to top
You will be given methotrexate in the chemotherapy day unit or during a stay in hospital. A chemotherapy nurse will give it to you. Methotrexate can be given in combination with other drugs.
During treatment, you usually see a cancer doctor, a chemotherapy nurse or a specialist nurse. This is who we mean when we mention doctor or nurse in this information.
Before or on the day of treatment, a nurse or a person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that it is okay for you to have chemotherapy.
You will also see a doctor or nurse before you have chemotherapy. They will ask you how you have been feeling. If your blood results are alright on the day of your treatment, the pharmacist will prepare your chemotherapy. Your nurse will tell you when your treatment is likely to be ready.
Before you start, your nurse will give you anti-sickness drugs and sometimes a steroid. Methotrexate is then usually given in one of the following ways:
- through a short, thin tube that the nurse puts into a vein in your arm or hand (cannula)
- through a fine tube that goes under the skin of your chest and into a nearby vein (central line)
- through a fine tube that is put into a vein in your arm and goes up into a vein in your chest (PICC line).
Your nurse can give you methotrexate as a slow injection or drip (infusion) into your cannula or line. They usually run the drip through a pump, which gives you the treatment over a set time. You will usually have fluids through a drip at the same time.
Methotrexate may also be given:
- as an injection into a muscle (intramuscular injection)
- as tablets
- by injection into the fluid around the spinal cord (intrathecally)
- by injection into an artery (inter-arterial injection), but this is rare.
When methotrexate is being given
Some people might have this side effect while they are having methotrexate:
The drug leaks outside the vein
If this happens when you’re having methotrexate, it can damage the tissue around the vein. This is called extravasation. If you have any stinging, pain, redness or swelling around the vein, tell the nurse straight away. Extravasation is not common but, if it happens, it’s important that it’s dealt with quickly.
Folinic acid rescue
A drug called folinic acid (leucovorin) is usually given 24 hours after starting methotrexate treatment to reduce the side effects. Folinic acid can be given into your cannula or line while you’re attached to a drip. You have it regularly with fluids until the methotrexate is out of your system.
Folinic acid is sometimes given as tablets. It is very important to take the tablets on time and to take them all exactly as explained.
Taking your methotrexate tablets
If you are taking methotrexate as tablets, always take them exactly as explained. This is important to make sure they work as well as possible. You should swallow the tablets whole with a full glass of water. Take them while sitting upright or standing.
If you are sick just after taking the tablets, contact the hospital. You may need to take another dose. If you forget to take a tablet, do not take a double dose. Keep to your regular schedule and let your doctor or nurse know.
Other things to remember about your tablets:
- Keep them in the original package.
- Store them at room temperature away from heat and direct sunlight.
- Keep them safe and out of children’s reach.
- If your treatment is stopped, return any remaining tablets to the pharmacist.
Methotrexate by injection into the spinal fluid
Methotrexate can be given into the spinal fluid to allow the drug to reach the spinal cord and brain. This is called intrathecal chemotherapy.
The doctor numbs an area of skin over your spine with local anaesthetic. Then they gently insert a needle between two of the spinal bones. This is called a lumbar puncture. They inject the chemotherapy drug through this needle into the spinal fluid. Your cancer doctor and nurse will explain everything in advance so you know what to expect.
You may get a headache after a lumbar puncture. To help prevent this, you may need to lie flat for a few hours afterwards and drink plenty of fluids.
Your course of methotrexate
You have chemotherapy as a course of several sessions (cycles) of treatment over a few months. Your doctor or nurse will tell you the number of cycles you are likely to have.
Possible side effects of methotrexateBack to top
We explain the most common side effects of methotrexate here. But we don’t include all the rare ones that are unlikely to affect you.
You may get some of the side effects we mention, but you are very unlikely to get all of them. If you have other chemotherapy drugs along with methotrexate, some side effects may be worse. You may also have side effects not listed here. Always tell your doctor or nurse about the side effects you have.
Your doctor can prescribe drugs to help control some side effects. It is very important to take them exactly as your nurse or pharmacist has explained. This will help the drugs work as well as possible for you. Your nurse will give you advice about managing side effects. After your treatment is over, side effects will start to improve.
Serious and life-threatening side effects
Sometimes cancer drugs can result in very serious side effects, which rarely may be life-threatening. Your cancer doctor and nurse can explain the risk of these side effects to you.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. You can call them if you feel unwell or need advice at any time of day or night. Save these numbers in your phone or keep them somewhere safe.
More information about this drug
We are unable to list every side effect for this treatment here, particularly the rarer ones. For more detailed information, you can visit the electronic Medicines Compendium (eMC).
Risk of infection
Chemotherapy can reduce the number of white blood cells in your blood. This will make you more likely to get an infection. When the number of white blood cells is low, it’s called neutropenia.
Contact the hospital straight away on the number you’ve been given if:
- your temperature goes over 37.5°C (99.5°F) or over 38°C (100.4°F), depending on the advice given by your chemotherapy team
- you suddenly feel unwell, even with a normal temperature
- you have symptoms of an infection – these can include feeling shaky, a sore throat, a cough, diarrhoea or needing to pass urine a lot.
The number of white blood cells usually increases steadily and returns to normal before your next treatment. You will have a blood test before having more chemotherapy. If your number of white blood cells is still low, your doctor may delay your treatment for a short time.
Bruising and bleeding
Methotrexate can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. If you have any bruising or bleeding you can’t explain, tell your doctor. This includes nosebleeds, bleeding gums, blood spots or rashes on the skin. Some people may need a drip to give them extra platelets.
Anaemia (low number of red blood cells)
Methotrexate can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. If you feel like this, tell your doctor or nurse. If you are very anaemic, you may need a drip to give you extra red blood cells (blood transfusion).
This may happen in the first few days after chemotherapy. Your doctor will prescribe anti-sickness (anti-emetic) drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist explains to you. It is easier to prevent sickness than to treat it after it has started.
If you still feel sick or are vomiting, contact the hospital as soon as possible. They can give you advice and change the anti-sickness drug to one that works better for you. Some anti-sickness drugs can make you constipated. If this is a problem, tell your doctor or nurse.
Loss of appetite
You may lose your appetite during your treatment. Try to eat small meals regularly. Don’t worry if you don’t eat much for a day or two. If your appetite doesn’t improve after a few days, let your nurse or dietitian know. They can give you advice on getting more calories and protein in your diet. They may give you food supplements or meal replacement drinks to try. Your doctor can prescribe them. You can also buy them from chemists.
Your doctor can prescribe drugs to control diarrhoea. Let them know if it is severe or if it doesn’t get better. If you have diarrhoea, make sure you drink at least two litres (three and a half pints) of fluids every day.
Feeling very tired is a common side effect. It is often worse towards the end of treatment and for some weeks after. Try to pace yourself and get as much rest as you need. It helps to balance this with some gentle exercise, such as short walks. If you feel sleepy, don’t drive or operate machinery.
Hair loss is rare with standard doses of methotrexate. If you are having high-dose treatment with methotrexate, all of the hair from your head will fall out. Your eyelashes, eyebrows and other body hair may also thin or fall out. This usually starts after your first or second cycle of chemotherapy. It is almost always temporary and your hair will grow back after chemotherapy ends. It is important to cover your scalp when you are out in the sun until your hair grows back. Your nurse can give you advice about coping with hair loss.
Scalp cooling is a way of lowering the temperature of the scalp to help reduce hair loss. Your nurse can tell you if this is an option for you.
Your mouth may become sore and you may get ulcers. This can make you more likely to get an infection in your mouth. Gently clean your teeth or dentures in the morning, at night and after meals. Use a soft-bristled or children’s toothbrush. Your nurse might ask you to rinse your mouth regularly or use mouthwashes. It is important to follow any advice you are given and to drink plenty of fluids.
If you have any problems with your mouth, tell your nurse or doctor. They can prescribe medicines to prevent or treat mouth infections and reduce any soreness.
Methotrexate may affect your skin. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day. During treatment, and for several months afterwards, you'll be more sensitive to the sun and your skin may burn more easily than usual. You can still go out in the sun, but use a suncream with a sun protection factor (SPF) of at least 30. You should also cover up with clothing and a hat. If you’ve had radiotherapy, the area that was treated may become red or sore.
Always tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.
Changes in the way the kidneys work
Methotrexate can affect how your kidneys work, but usually only when it’s given in high doses. You will have blood tests before and during treatment to check this. You will have extra fluids through a drip before and after chemotherapy. This is to protect your kidneys.
If there are any changes in how much urine you are producing, tell your nurse. You may be given sodium bicarbonate as a drip or as tablets during treatment. This is to reduce the risk of kidney problems. The nurses will also test your urine regularly.
Your eyes may become watery and feel sore. They may also become more sensitive to light. Your doctor can prescribe eye drops to help with this. If your eyes get red and inflamed (conjunctivitis), tell your doctor. This is because you may need antibiotic eye drops. Methotrexate may also cause blurry vision or eye pain. Always tell your doctor or nurse if you have eye pain or notice any change in your vision.
Muscle and joint pain
You may get pain in your joints or muscles for a few days after having methotrexate. Tell your doctor if this happens so they can prescribe painkillers. Let them know if the pain does not get better. Try to get plenty of rest. Taking regular, warm baths may help.
You may get pain or discomfort in your tummy (abdomen), feel bloated or have indigestion or wind. Your doctor can prescribe drugs to help improve these symptoms. Tell them if the pain doesn’t improve, or if it gets worse.
Changes in the way the liver works
Methotrexate may affect how your liver works. This is usually mild and goes back to normal after treatment. You are very unlikely to notice any problems, but your doctor will take regular blood samples to check your liver is working properly.
Methotrexate may cause headaches. If this happens, let your doctor or nurse know. They can give you painkillers.
Less common side effects of methotrexateBack to top
Effects on the nervous system
High doses of methotrexate can affect the nervous system. You may feel drowsy or confused. If you notice these symptoms, tell your doctor or nurse straight away. It is important not to drive or operate machinery if you notice these effects. Rarely, methotrexate can cause seizures (fits). You doctor or nurse will explain more about this.
Effects on the lungs
Methotrexate can cause changes to the lungs. Always tell your doctor if you have:
- a cough
- a fever
You should also let them know if any existing breathing problems get worse. If necessary, they can arrange for you to have tests to check your lungs.
Raised levels of uric acid in the blood
Methotrexate may cause the cancer cells to break down quickly. This releases uric acid (a waste product) into the blood. Too much uric acid can cause swelling and pain in the joints, which is called gout.
Your doctor may give you tablets called allopurinol (Zyloric ®) to help prevent this. Drinking at least two litres (three and a half pints) of fluids a day will also help. You will have regular blood tests to check the uric acid levels.
If you have intrathecal chemotherapy, the side effects you have may be different from the ones listed above. Intrathecal methotrexate can cause headaches, dizziness, tiredness, blurred vision and loss of balance for a few hours. If you have any of these effects, tell your doctor.
It is important to tell your doctor or nurse straight away if you feel ill or have severe side effects. This includes any we don’t mention here.
Other information about methotrexateBack to top
Blood clot risk
Cancer increases the chance of a blood clot (thrombosis) and chemotherapy can add to this risk. A clot can cause symptoms such as:
- pain, redness and swelling in a leg
- chest pain.
Contact your doctor straight away if you have any of these symptoms. A blood clot is serious, but your doctor can treat it with drugs that thin the blood. Your doctor or nurse can give you more information.
Some medicines can interact with chemotherapy or be harmful when you are having chemotherapy. This includes ones you can buy in a shop or chemist. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs. Some medicines can make the side effects of methotrexate worse, such as ibuprofen and aspirin. Before taking any medicines, check with your pharmacist, nurse or doctor.
Your doctor will advise you not to drink alcohol while you're having methotrexate, as it can interact with the drug.
Methotrexate may affect your fertility (being able to get pregnant or father a child). If you are worried about this, you can talk to your doctor or nurse before treatment starts.
Your doctor will advise you not to become pregnant or to father a child during treatment. This is because the drugs may harm a developing baby. It is important to use effective contraception during chemotherapy and for six months afterwards. You can talk to your doctor or nurse about this.
If you have sex within the first couple of days of having chemotherapy, you need to use a condom. This is to protect your partner in case there is any chemotherapy in your semen or vaginal fluid.
Changes to your periods
Chemotherapy can sometimes stop the ovaries working. You may not get a period every month and they may eventually stop. In some women, this is temporary, but for others it is permanent and they start the menopause.
Women are advised not to breastfeed during treatment and for a few months after. This is in case there is chemotherapy in their breast milk.
Medical and dental treatment
If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are having chemotherapy. If you are taking chemotherapy tablets, explain that no one should stop or restart them without advice from your cancer doctor. Give them contact details for your cancer doctor.
If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having chemotherapy.
This page has been compiled using information from a number of reliable sources, including the electronic Medicines Compendium (eMC; medicines.org.uk). If you’d like further information on the sources we use, please feel free to contact us.
This information was reviewed by a medical professional.
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