Methotrexate (Non-Cancer)

Side effects may occur when taking Methotrexate, but the majority of these effects tend to resolve spontaneously. Common side effects include:

• Nausea and vomiting (Can be minimized by taking Methotrexate after food)
• Loss of appetite
• Dizziness
• Diarrhoea
• Mouth ulcers
• Hair loss (Reversible after stopping the medicine)
• Malaise i.e. general feeling of discomfort
• Skin rash may occur with excessive exposure to the sun (Avoid prolonged exposure to sun and use sunscreen)

Folic acid tablet may be prescribed by your doctor to prevent or decrease certain side effects. It is usually taken the day after Methotrexate.

Consult your doctor or pharmacist about any symptoms that becomes bothersome

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• STOP taking Methotrexate and let your doctor know if you develop an allergic reaction. Rash due to allergic reaction to Methotrexate is rare. Possible symptoms of allergic reaction are:
• rash, hives, or itching
• red, swollen, blistered or peeling skin with or without fever
• wheezing or tightness in the chest or throat
• trouble breathing or talking
• unusual hoarseness
• swelling of the mouth, face, lips, tongue or throat
• STOP taking Methotrexate and seek medical attention immediately if you experience any of the rare but severe side effects:
• liver problems - possible symptoms are dark urine, feeling tired, lack of appetite, nausea, abdominal pain, light-coloured stools, vomiting, or yellow skin or eyes
• breathlessness or persistent dry cough
• severe mouth ulcers or severe sore throat that does not heal within 3 days
• Methotrexate may increase risk of developing certain kinds of infections due to reduced white blood cells (a key component of the body's immune system that helps to fight infections). Tell your doctor immediately if you experience any symptoms of infection such as temperature exceeding 38°C, chills, cough, painful or bloody urination, feeling very tired or weak.
• Avoid raw (e.g. sashimi) or half-cooked foods (e.g. half-boiled eggs) to prevent food poisoning.
• While having treatment with Methotrexate, you must see your doctor as scheduled to monitor response to treatment and minimize any possible side effect.
• Methotrexate may impair fertility in both men and women. Both men and women of childbearing age must use a reliable method of contraception to avoid the risk of an unplanned pregnancy as Methotrexate can cause serious defects to unborn child. You should not plan to have children while taking Methotrexate and for at least 6 months after stopping Methotrexate.
• Low amount of Methotrexate passes into human breast milk and may cause serious unwanted effects to the child. You should not breastfeed if you are taking Methotrexate.
• Methotrexate may interact with other medicine or supplement that you are taking. Inform the doctor, pharmacist or specialty nurse (such as dermatology, gastroenterology or rheumatology) before starting any medicines and supplements. Medicines such as certain antibiotics (e.g. co-trimoxazole) should be avoided as they might increase the chance of you experiencing severe side effects.
• Alcohol may interact with Methotrexate and increase the risk of liver toxicity. It should be avoided if possible or kept to minimum amount as suggested by your doctor.
• Immunization status should be current before starting the medicine. Do not receive any live vaccine while you are on Methotrexate. Always consult your doctor before going for immunisation.