Methotrexate is a prescription drug that is most commonly used in Rheumatoid Arthritis and in cancer treatment.
This video covers the most common side effects, if you would (or wouldn't) be a good fit for methotrexate, how to minimize the chance of side effects and what you can do if you do experience side effects.
1. Your Doctor Will Draw Labs.
One of the first things your doctor will do before you start methotrexate is to draw your labs.
These will most likely include a complete blood count or CBC, liver enzymes, kidney function including your creatinine clearance and other labs as needed.
Not only will your doctor draw these labs before you start methotrexate - but he will continue drawing these labs periodically while you continue to take methotrexate.
Why all these labs? Because as you're going to see below the most common or serious side effects can be spotted first in your labs before they ever become serious.
2. You Should Not Take Methotrexate IF You ...
In arthritis Methotrexate is considered the “gold standard” or first-line treatment.
But that doesn't mean it's for everyone. There are certain groups of people who should avoid taking methotrexate.
These include women who are pregnant or could become pregnant. And yes that even means older women. If an older woman could still have a child and isn't using some form of birth control methotrexate would not be a good choice as it can cause birth defects.
Anyone with liver or kidney issues would also be a poor candidate for methotrexate use. Again these are why we are drawing the labs above to spot these folks before we get them started.
Lastly alcohol use. Ideally we want people who don't drink at all to take methotrexate. That's because drinking can be hard on the liver.
Of course this comes down to how much you're drinking as well.
Having an occasional drink does not mean you can't take methotrexate. But if you're someone who considers yourself a more regular drinker you may want to consider talking to your doctor about other options.
3. Most Common Side Effects (Not As Serious)
The most common side effect tends to be stomach related.
Upset stomach and nausea can be somewhat common and problematic and people taking methotrexate .
The other side of fact that can pop up is called stomatitis. This is inflammation of the mouth and lips. But most commonly shows up as sores in the mouth.
One of the reasons this can happen is because methotrexate interferes with a folic acid process in your body. What your doctor will probably do is prescribe folic acid along with your methotrexate.
Stomatitis very seldom pops up when this is done.
4. Most Serious Side Effects (Less Common, Especially At Lower Doses)
There are some side effects that can pop up with methotrexate that are very rare but can be more serious.
I do want to point out that when you're using methotrexate for Rheumatoid Arthritis these types of side effects are pretty rare because you're using lower doses.
But when you're using methotrexate to treat cancer these can become more common.
These more serious side effects include blood abnormalities (liver and kidney problems).
The other serious side effects we are probably most worried about is any sort of immune system problems and folks who have immune system issues.
If you’re someone who has serious immune system issues methotrexate is not going to be a great choice.
5. Three Ways To Deal With Side Effects
So what do you do if methotrexate starts causing some of these side effects?
There's a few options that you have.
The first is to just talk to doctor and discuss switching to a different medication. I do want to point out that sometimes side effects can go away after a while of taking methotrexate.
So, if you can, try to give it a good four to six weeks of use before you discuss switching - as long as the side effects are mild.
Your second option is to consider switching to a subcutaneous form of methotrexate.
Some people get a little freaked out when they hear that they have to inject a medication. But remember this is a subcutaneous injection. It's really easy to do at home and it's almost painless when you use proper technique.
Another option you have to deal with the side effects of methotrexate is to split your daily dose up.
What that means is that methotrexate is dosed one day a week. If your particular dose is 4 tablets in one day and you are having side effects you could split the daily dose up to take 2 tabs in the morning and two tablets in the evening (say 12 hours apart).
You do NOT want to split methotrexate up in two different days though. This can increase the risk of liver toxicity.
