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The Daily Insight

What are the most common side effects of methotrexate

Author

Mia Lopez

Updated on April 16, 2026

feeling sick.headaches.vomiting.diarrhoea.shortness of breath.mouth ulcers.minor hair loss and hair thinning.rashes.

What are the worst side effects of methotrexate?

Methotrexate may cause serious or life-threatening skin reactions. If you experience any of the following symptoms, call your doctor immediately: fever, rash, blisters, or peeling skin. Methotrexate may decrease the activity of your immune system, and you may develop serious infections.

What should you avoid while taking methotrexate?

What should I avoid while taking methotrexate? Avoid drinking alcohol. It may increase your risk of liver damage. Do not receive a “live” vaccine while using methotrexate, or you could develop a serious infection.

How long after taking methotrexate Do side effects start?

“The most common side effects are fatigue a day or two after you take methotrexate, which is why I suggest taking it at night,” he says. “Also gastrointestinal issues. Your stool may be loose, or you may feel queasy or nauseated for a day or two after.

What methotrexate does to the body?

Methotrexate is a type of medicine called an immunosuppressant. It slows down your body’s immune system and helps reduce inflammation. It is used to treat inflammatory conditions, including: rheumatoid arthritis.

How does methotrexate make you feel?

GI problems such as nausea and vomiting are the most common side effects associated with methotrexate, affecting between 20% and 65% of rheumatoid arthritis (RA) patients who take the drug. Up to one-third develop mouth ulcers or sores. Many also complain of headaches, fatigue and an overall “blah” feeling.

What happens if you don't take folic acid with methotrexate?

You should take folic acid with methotrexate to help prevent a folate deficiency. Taking methotrexate can lower levels of folate in your body. A folate deficiency can lead to symptoms like upset stomach, low blood cell counts, tiredness, muscle weakness, mouth sores, liver toxicity and nervous system symptoms.

Does methotrexate affect sleep?

Another study, published in August 2017 in the journal NeuroImmunoModulation, concluded that inflammation influences sleep. Researchers revealed that treatment with methotrexate or Enbrel (etanercept) improved sleep quality.

Is 20mg of methotrexate a lot?

The usual maximum weekly adult dose for oral methotrexate is 20 milligrams (due to increased risk of bone marrow suppression). The usual oral pediatric dose of methotrexate for rheumatoid arthritis is 5 to 15 milligrams once weekly.

Why should you not touch methotrexate?

Even touching or inhaling the dust from the tablet can allow the medicine to get into the body. Methotrexate goes into sperm, so it’s important that a man taking it doesn’t get his partner pregnant. Whether you’re male or female, you must use birth control while taking methotrexate.

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Can you be in the sun while taking methotrexate?

Methotrexate is often listed as causing sun sensitivity. However, methotrexate is not, in fact, a sun sensitizing drug, but rather produces a reaction called radiation recall. Areas where patients have had sunburns in the past may react again after starting methotrexate.

Can I go in the sun while taking methotrexate?

Methotrexate may make your skin sensitive to real or artificial sunlight. Avoid unnecessary or prolonged exposure to sunlight and wear protective clothing, sunglasses and sunscreen. Do not use sunlamps during your treatment with methotrexate.

Does methotrexate make you put on weight?

As helpful as this medication is, those taking methotrexate may experience some side effects, including nausea and vomiting, mouth sores and ulcers, headaches, and fatigue. 1 Research has shown that using this drug can also result in weight gain.

Does methotrexate shorten your life?

The results resoundingly confirm prior studies, finding methotrexate use for RA associated with a 70% reduction in mortality (or a mere 5% less after adjusting for the propensity to treat). The mortality risk was not affected by likelihood to withdraw methotrexate shortly before death.

Can I drink coffee with methotrexate?

The significant relief with a schedule of coffee intake synchronized with MTX has urged the recommendation that adult patients with RA and MTX intolerance should drink “a few cups more coffee” on the day of MTX administration [4].

Does methotrexate lower your immune system?

One-quarter of people who take the drug methotrexate for common immune system disorders—from rheumatoid arthritis to multiple sclerosis—mount a weaker immune response to a coronavirus disease (COVID-19) vaccine, a new study shows.

Can I take vitamin D with methotrexate?

No interactions were found between methotrexate and Vitamin D3. This does not necessarily mean no interactions exist. Always consult your healthcare provider.

What happens when you take methotrexate and folic acid on the same day?

You may hear people suggest that you skip taking folic acid the same day that you take your methotrexate, but the jury is out on the benefit of doing this. “There are studies suggesting no decrease in the efficacy of MTX if taken the same day as folic acid, but the same may not be true for folinic acid.

Can you take turmeric while on methotrexate?

Conclusion. Turmeric extract can successfully attenuate MTX-hepatotoxicity. The effect is partly mediated through extract’s antinflammatory activity.

How can I reduce the side effects of methotrexate?

Taking folic acid on the non-methotrexate days will help to minimise the side-effects. Another way of reducing side-effects is to cut down the dose of methotrexate – you’re only taking 10 mg, which is a relatively small dose, but even a reduction to 7.5 mg may help.

Does methotrexate affect your appetite?

Mouth lesions, low blood counts, poor appetite, nausea, and abdominal discomfort are the most common side effects of methotrexate. Tiredness, dizziness, skin rash, hair loss, and increased susceptibility to infection have also been reported.

Do methotrexate side effects get worse over time?

You may feel more nausea and fatigue immediately after taking methotrexate, but it is important for patients to know that these symptoms typically subside over time and won’t necessarily last all week long.

Should I stop methotrexate if I have Covid?

A: No. It is safe to continue your medicines and if you stop suddenly, your arthritis may flare. You must never stop steroid tablets by mouth suddenly. If you catch coronavirus, you should stop your immunosuppressing medicines (apart from prednisolone) and seek advice from your rheumatology team.

Can you drink wine while taking methotrexate?

Patients may drink alcohol whilst taking long-term low weekly doses of methotrexate (25mg or less) for skin conditions, rheumatoid arthritis and other inflammatory conditions, but they should be advised that both alcohol and methotrexate can potentially damage the liver, so they should not drink more alcohol than

What is the safest drug for rheumatoid arthritis?

Hydroxychloroquine is an antimalarial drug which is relatively safe and well-tolerated agent for the treatment of rheumatoid arthritis.

Does methotrexate affect your teeth?

Chemotherapy treatments. Mucositis, or inflammation of the mouth’s inside lining, is linked to a handful of chemotherapy medications, including methotrexate. These drugs are responsible for altering regular mucus membrane functions and can contribute to tooth decay.

Should I take methotrexate at night or in the morning?

Conclusion: Pharmacokinetic variables suggest that MTX can be administered either in the morning (10 AM) or evening (6 PM) in the treatment of RA.

Can methotrexate affect your eyes?

Methotrexate-related ocular toxicities consist of peri-orbital edema, ocular pain, blurred vision, photophobia, conjunctivitis, blepharitis, decreased reflex tear secretion87 and non-arteritic ischemic optic neuropathy. The optic neuropathy has been linked to folate deficiency, either nutritional or genetic.

What painkiller can you take with methotrexate?

You can usually carry on taking painkillers like paracetamol if needed, unless your doctor advises otherwise. Avoid taking non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin or ibuprofen, or medicines containing NSAIDs, such as over-the-counter cold medication, without first speaking to your doctor.

Does methotrexate affect the kidneys?

These drugs can indirectly cause kidney damage by raising blood pressure levels and putting additional stress on the kidneys. Other rheumatoid arthritis drugs, such as methotrexate, can be toxic to the kidneys at high doses and are not recommend for people with existing kidney damage and RA.

Can methotrexate cause leg pain?

The use of MTX in high doses has been associated with an osteopathy, which is characterised by severe bone pain, osteoporosis, and insufficiency fractures of the legs.