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What is methotrexate?

Methotrexate (also called MTX) is an anticancer medicine. It is available as a 2.5 mg, 5 mg, and 15 mg tablet and an oral liquid to be taken by mouth. It is also available as a yellow liquid given by vein (IV) or injected into a muscle.

Methotrexate can pose a health hazard to caregivers. All caregivers should take safety precautions while giving this drug. For 48 hours after this drug is given, the patient’s body fluids can contain the drug. During that 48-hour period, caregivers should follow safety guidelines when handling the patient’s vomit, blood, urine, and bowel movements, including diapers. These guidelines include wearing gloves when cleaning up body fluids. For a complete list of safety precautions, see “Do you know… Protecting caregivers from drug hazards.”

Possible side effects of methotrexate


  • Mild nausea and vomiting
  • Headache if MTX is given during a spinal procedure

Later (usually more than a day after treatment starts)

  • Low blood counts (2 to 14 days after treatment) with a higher risk of infection, bleeding, and anemia
  • Mouth and lip sores; sores around the anus
  • Hair loss
  • Rash
  • Skin more sensitive to the sun or sunlamps
  • Decreased liver function
  • Decreased kidney function (more common with high-dose MTX)

These are the most common side effects, but there may be others. Please report all side effects to the doctor or nurse.

In case of a severe side effect or reaction, call the doctor, nurse, or pharmacist at 901-595-3300. If you are outside the Memphis area, dial toll-free 1-866-2STJUDE (1-866-278-5833).

Special instructions for methotrexate

  • Do NOT take this medicine by mouth every day. Increased side effects or serious harm (including death) could occur if taken each day. It is very important that you take your medicine as your doctor tells you.
  • Your medicine bottle may have multiple doses with instructions for how to take one time each week. Take only the number of tablets or amount of oral liquid as instructed. If you have any questions, please talk with the pharmacist when you pick up the medicine or call the pharmacy with questions.
  • Take the tablets on an empty stomach about one (1) hour before a meal or 2 to 3 hours after a meal.
  • Sometimes, a large number of tablets are needed to make up the total weekly dose. If you have problems swallowing the tablets, gelatin capsules can be requested from the pharmacy. Multiple tablets can be placed into a single capsule using the safe handling guidelines below.
  • Methotrexate tablets should be stored at room temperature.
  • Methotrexate oral liquid should be stored in the refrigerator. Use an oral syringe to take the dose from the bottle. Discard the oral syringe in the trash. Do not wash and reuse.
  • Keep this and all medicine out of the reach of children and pets.
  • Taking in large amounts of folic acid (vitamin B9) can decrease the cancer-fighting effects of methotrexate. At least one (1) week before you start taking MTX, you should stop taking multivitamins by mouth if they contain folic acid. Do not start taking the vitamin or any product containing folic acid again until one (1) week after your last dose of MTX.
  • You should not consume energy drinks, foods, and supplements that contain 100 percent or more of the daily value of folic acid while taking methotrexate.
  • Drink plenty of fluid while you are taking MTX.
  • Sometimes you will take leucovorin, starting at 24 to 42 hours after you take MTX. Leucovorin may reduce some of the side effects of MTX. Your doctor will tell you if you need to take leucovorin after MTX.
  • The staff will take blood samples regularly to check for changes in liver function and blood counts. Sometimes they will check the blood levels of MTX and use that information to adjust the leucovorin dosage.

Safe handling for methotrexate

All chemotherapy drugs taken by mouth can pose a health hazard to caregivers and patients. You should be careful when handling this medicine and try to keep the drug from touching the skin. Taking precautions will ensure that both the patient and the caregiver are protected as well as possible.

  • Prepare a clean area where the drug can be handled safely (away from areas where food is prepared, out of the reach of children, and out from under any air vents or fans).
  • We suggest you or the caregiver wear gloves while handling this medicine. Wash your hands right away if your skin comes in contact with the medicine.
  • Carefully wash tablet cutters with warm soapy water after each use and allow to dry. Completely clean up any spills in the area where the medicine is prepared.


This document is not intended to take the place of the care and attention of your personal physician or other professional medical services. Our aim is to promote active participation in your care and treatment by providing information and education. Questions about individual health concerns or specific treatment options should be discussed with your physician.

St. Jude complies with health care-related federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

ATTENTION: If you speak another language, assistance services, free of charge, are available to you. Call 1-866-278-5833 (TTY: 1-901-595-1040).

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-866-278-5833 (TTY: 1-901-595-1040).

تنبيه: إذا كنت تتحدث باللغة العربية فيمكنك الاستعانة بخدمات المساعدة اللغوية المتوفرة لك مجانا. .يرجى الاتصال بالرقم. 5833-278-866-1  (الهاتف النصي: 1040-595-901-1).