Methotrexate can halt joint damage and calm autoimmune disease for many people. That sounds great, but this drug needs careful handling. You can get big benefits, yet you also need to watch for side effects and follow a clear plan with your doctor.
At low doses, methotrexate reduces inflammation by changing how your immune system signals and repairs. Doctors commonly prescribe it for rheumatoid arthritis, psoriasis, and some autoimmune conditions. The usual schedule for autoimmune disease is a dose taken once a week — not daily. Doses vary from 7.5 mg to 25 mg weekly depending on the patient and response. There are oral tablets and an injectable form; injections are sometimes used if stomach side effects occur or absorption is a problem.
Take your weekly dose the same day each week. Mark it on a calendar or set a phone alarm. Taking methotrexate more often than prescribed can cause serious harm.
Common side effects include nausea, mouth sores, fatigue, and mild liver enzyme rises. Less common but serious problems are liver damage, low blood counts, and lung inflammation. Because of these risks, your doctor will order regular blood tests: liver enzymes, complete blood count, and sometimes kidney tests. A chest X-ray or lung tests might be checked if you have new cough or breathing issues.
Folic acid is often given with methotrexate to reduce side effects like mouth sores and anemia. A typical approach is a daily low dose of folic acid or a larger dose once a week — follow your prescriber’s instructions. If you notice yellowing skin, unusual bruising, severe belly pain, persistent cough, or shortness of breath, call your doctor right away.
Drug interactions matter. Avoid high-dose NSAIDs for long periods without talking to your provider. Alcohol should be limited because both alcohol and methotrexate stress the liver. Tell every healthcare provider and your pharmacist that you take methotrexate before getting new medicines or vaccines.
Pregnancy and breastfeeding: methotrexate can cause birth defects and must not be used if you are pregnant or planning pregnancy. Both people who can become pregnant and their partners may need to wait months after stopping methotrexate before trying to conceive. Discuss safe timing with your doctor.
Small habits make a big difference: keep follow-up blood tests on schedule, use a weekly pill reminder, limit alcohol, and take folic acid as advised. If the drug isn’t working or side effects are heavy, don’t stop it on your own—talk to your clinician about dose changes or alternatives. Methotrexate can be powerful and safe when used correctly.
