Methotrexate (Rheumatrex)

By Dr. Brian Bressler

What is it?

Methotrexate is under a class of medications called immunosuppressants. It works by partially inhibiting the activities of the immune system which results in a decrease in inflammation.

Why do I need this medication?

This medication is used for the treatment of ulcerative colitis and Crohn’s Disease and is often used to reduce, eliminate, and avoid the need for steroids.

How long do I have to take this medication?

Methotrexate is used to induce remission and is also used as a maintenance drug to reduce the chances of a flare. This requires the medication to be taken on a regular basis.

How do I take it?

Methotrexate can be taken either as a pill or via a subcutaneous injection. This must be taken once a week.

When will I start to feel better?

You can start to see the full benefits of Methotrexate after a few months.

Is it safe to get pregnant on this medication?

No. Whether you are male or female, Methotrexate can cause birth defects. It is necessary to use birth control to avoid pregnancy while taking this medication, and to continue for at least 3 months after your treatment ends.

Read more: Pregnancy and Crohn's Disease or Ulcerative Colitis

Can I drink alcohol while on this medication?

It is important to consume alcohol in moderation as the combination of Methotrexate and alcohol can increase stress on the liver.

What are the side effects/risks?

  • Increased risk of infection
    • Because Methotrexate acts by modulating the activity of the immune system, the resistance to infections is slightly decreased.
    • Nausea
    • Methotrexate is often taken at night and over the weekend during off times from work to help offset these potential side effects. Anti-nausea medications can be taken prior to your dose.
  • Liver toxicity
    • Methotrexate can cause liver injury. It is necessary to monitor the liver function regularly with blood tests.  Folic acid deficiency
    • Because this medication competes with the body for folic acid, it is important to take a folic acid supplement daily. This is an over the counter supplement and should be taken every day except on the day of your methotrexate dose.
  • Interstitial Pneumonitis
    • Methotrexate can cause damage to the lungs. Call the doctor if you develop a dry cough, fever, or shortness of breath.

Check out the other treatments for ulcerative colitis and other treatments for Crohn's disease

Other Considerations

  • While on therapy, it is necessary to go for bloodwork regularly to monitor the side effects of the medication on your blood count and liver enzymes. It is recommended to do a blood test every 1-2months while on Methotrexate.
  • Ensure all vaccinations are up to date. When taking this medication, all live vaccines must be avoided.
  • For women, it is important to receive annual pap tests, even if previous exams have been negative.

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