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Methotrexate (for immune disorders)

How does this medicine work?

Methotrexate (meth-o-trex-ate) is an immunosuppressant. It is used to treat cancer. In lower doses, it can be used to treat rheumatoid arthritis, severe psoriasis (a skin disease) and other medical problems.

How is it given?

Methotrexate comes in tablet or injectable form. In some cases, the injectable form may be given by mouth. If your child is
taking it by injection, see the education sheet "Injections."

Methotrexate is usually given once a week. Pick a day of the week and always give it on that day to keep a steady level in the bloodstream. If your directions are different than that, check with the doctor or pharmacist. It can cause serious side effects if it is taken too often.

Your child should be awake and alert when taking any medicine.

___ For children who cannot swallow tablets:

  1. Put on gloves.
  2. Crush the pill in a tablet crusher or between 2 spoons inside a clear plastic bag.
  3. Mix the powder with a very small amount (about 1 teaspoon) of soft food, such as applesauce, chocolate syrup, jelly, or water. Make sure your child takes all of the mixture.
  4. Wash spoons and container right after use. Discard the plastic bag and gloves.

Do not mix medicine into hot drinks, because the heat may destroy its effectiveness.

Are there any precautions about food or other medicines?

Avoid taking this medicine with milk products, since they can decrease absorption of the medicine.

Avoid alcohol-containing foods, beverages, or over-the-counter medicines such as cough syrup while taking this medicine.

Check with the doctor, nurse practitioner, or pharmacist if your child is taking any other prescription or non-prescription medicines, vitamins, or herbal supplements.

What should I do if a dose is missed?

If a dose is missed, give it as soon as you remember that day. If you do not remember until a later day, call the doctor for advice before giving it.

If your child vomits within 30 minutes after receiving a dose, give it again. If your child vomits after 30 minutes, do not repeat the dose. Call the clinic if more than one dose is vomited.

What are the side effects?


  • low blood cell counts


  • nausea, vomiting diarrhea
  • hair loss
  • eye and skin sensitivity to the sun


  • mouth sores
  • liver damage

Side effects increase with higher doses. Folic acid supplements may be prescribed to decrease the side effects.

When should I call the clinic?

  • fever
  • sore throat
  • bleeding or bruising
  • shortness of breath
  • pain while urinating
  • mouth sores
  • continued vomiting or diarrhea
  • exposure to chickenpox, which can be more serious in a child taking methotrexate
  • signs of allergic reaction:
    - rash or hives
    - wheezing
    - trouble breathing - call 911

What else do I need to know?

Continued nausea, vomiting, diarrhea, or mouth sores may require a change in the dose or stopping the medicine for a while.

Prevent sunburn. During treatment and for one year after, use sunscreen (SPF 30 or higher), a hat, and protective clothing when outdoors.

Blood samples may be needed to check the effects of the medicine.

You and your child should know the names of all the medicines he or she is taking. Share this information with anyone involved in your child's care.

Always make sure you have enough medicine on hand. Each time you refill the prescriptions, check to see how many refills are left. If no refills are left, the pharmacy will need 2 or 3 days to contact the clinic to renew the prescription.

Check the label for the expiration date. Bring outdated or extra medicines back to the clinic or pharmacy for disposal. Do not flush them down the toilet or throw them in the garbage.

Before giving the first dose, read the label. Be sure it is what was prescribed. After a refill, if the medicine looks different to you, ask your pharmacist or call the clinic before giving it.

Store all medicines in their original container and away from direct sunlight or heat. Do not store in humid places such as the bathroom. Keep them out of children's reach, locked up if possible.

If too much or the wrong kind of medicine is taken, call the Poison Control Center at 1-800-222-1222. If your child is unconscious or has a seizure, call 911.


This is not specific to your child but provides general information. If you have any questions, please call the doctor or pharmacist.

Children's Hospitals and Clinics of Minnesota
Last reviewed 8/2015

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This page is not specific to your child, but provides general information on the topic above. If you have any questions, please call your clinic. For more reading material about this and other health topics, please call or visit Children's Minnesota Family Resource Center library, or visit

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