Precautions and Warnings With Methotrexate

If you have liver disease or low blood cell counts, or are planning to receive radiation treatments, let your healthcare provider know before taking methotrexate. There are many warnings and precautions listed for this drug, as it is a powerful medication that can sometimes cause lymphoma and other serious problems. Do not take methotrexate if you are pregnant or have a weakened immune system.

What Should I Tell My Healthcare Provider?

Prior to taking methotrexate (Rheumatrex®, Trexall®), talk to your healthcare provider if you have:
 
  • Low blood cell counts of any type, such as anemia or low platelets
  • Plans to receive radiation treatments
  • Liver disease, such as cirrhosis, hepatitis, or liver failure
  • Alcoholism
  • A weakened immune system due to HIV, AIDS, or various other causes
  • Any allergies, including to food, dyes, or preservatives.
     
Also, let your healthcare provider know if you are:
 
  • Pregnant or thinking of becoming pregnant
  • Breastfeeding.
     
Be sure to tell your healthcare provider about all other medicines you may be taking, including prescription and nonprescription medications, vitamins, and herbal supplements.
 

Specific Methotrexate Precautions and Warnings

Warnings and precautions to be aware of prior to taking methotrexate include the following:
 
  • Methotrexate is a powerful medication capable of producing significant toxicity. It should be reserved for treating severe diseases in people who have already tried less toxic treatment alternatives.
     
  • All people taking this drug must be closely and regularly monitored. This may include various tests, such as blood tests to check liver and kidney function, chest x-rays, and even periodic liver biopsies. Frequent blood tests to check blood cell counts are also necessary.
     
  • Low blood cell counts due to methotrexate can be quite dangerous. Depending on the type, such problems can increase the risk of dangerous infections or life-threatening bleeding.
     
  • This medication can cause serious lung problems. Let your healthcare provider know if you develop a dry cough and/or shortness of breath.
     
  • In rare cases, methotrexate can cause serious skin reactions that may involve a potentially disfiguring or fatal loss of skin tissue. Let your healthcare provider know if you develop any unexplained rash during treatment.
     
  • Taking methotrexate while receiving radiation treatments may increase the risk of tissue and bone damage.
     
  • This medicine may sometimes cause lymphoma (a type of cancer), which will sometimes go away once treatment is stopped.
     
  • Methotrexate is considered a pregnancy Category X medicine, which means it presents a clear risk of harm to the fetus (see Methotrexate and Pregnancy for more information). Women should use appropriate birth control while taking it and should not attempt to get pregnant until a full menstrual cycle after stopping the medication. Men should not try to conceive a child for at least three months after stopping the drug.
     
  • Methotrexate can interact with certain medications (see Drug Interactions With Methotrexate).
     
  • This drug passes through breast milk and could potentially cause serious problems in a nursing child. Therefore, if you are breastfeeding, check with your healthcare provider before taking methotrexate (see Methotrexate and Breastfeeding).
     
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