A disease-modifying drug (DMARD) · Written by the Lyng Pharmacy team, based on NHS and BNF guidance · Updated August 2026
Also sold asMetoject, Nordimet
Type of medicineDMARD / immunosuppressant
Available asTablets, pre-filled injection pens
How you get itPrescription only — specialist initiated
Methotrexate is used for rheumatoid arthritis, psoriasis, psoriatic arthritis and inflammatory bowel disease. It is highly effective, and it is also the medicine most associated with serious dosing errors in UK primary care — for one reason.
Weekly, not daily
Methotrexate for these conditions is taken ONCE A WEEK, on the same day each week — never daily. Taking it daily by mistake causes severe, sometimes fatal, toxicity. Write the day down, keep only one strength of tablet at home (2.5mg), and check the day before every dose.
Injections are also weekly, on the same day.
If you miss a dose, do not take it more than two days late — skip it and take the next one as scheduled. Never double up. Tell your specialist team.
Folic acid and monitoring
Folic acid is prescribed alongside to reduce side effects, usually on a different day from the methotrexate. Follow the specific days you have been given — do not take them together unless told to.
Regular blood tests check your full blood count, liver and kidney function. These are not optional; methotrexate is not continued without them. Keep your monitoring booklet up to date and bring it to appointments.
What to report immediately
Sore throat, fever, mouth ulcers, unexplained bruising or bleeding — possible bone marrow suppression
New or worsening cough or breathlessness — possible lung effects
Nausea and vomiting that will not settle, or severe diarrhoea
Yellowing of the eyes or skin
A widespread rash or blistering skin
Common milder effects: nausea, tiredness, mouth soreness and hair thinning.
Interactions, pregnancy and everyday care
Do not take trimethoprim or co-trimoxazole with methotrexate — the combination can cause severe blood problems. Tell any prescriber, including out-of-hours, that you take methotrexate. Anti-inflammatories such as ibuprofen also interact; check with us before buying anything over the counter.
Methotrexate must not be taken in pregnancy, and effective contraception is needed by both men and women. Discuss timing with your specialist well before trying to conceive.
Keep alcohol low — your team will give you a limit. Avoid live vaccines; have the flu jab annually and the pneumococcal vaccine, and speak to us about chickenpox or shingles exposure.
Use sun protection: methotrexate increases sun sensitivity and skin cancer risk.
Always read the label. This page is general information, not advice for your situation. Doses, warnings and interactions differ between products and between people. Check the leaflet inside your medicine, and ask our pharmacist if anything is unclear — that conversation is free and takes two minutes.
Questions about Methotrexate?
1 Lyng Lane, West Bromwich B70 7RW · Mon–Fri 8:30am–6pm, Sat 9am–1pm · 0121 500 5756
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