Arthritis Treatment: What Are the Side Effects of Methotrexate?

The most common side effect of methotrexate — in clinical studies and among our participants — is nausea. Nausea, unfortunately, is nothing new to people who have run the gamut of non-steroidal anti-­inflammatory drugs, as most methotrexate recipients have done. But that doesn't make it any easier to bear. The nausea from methotrexate, however, often disappears on its own, and if not, it may be controlled by lowering the dose or by spreading it out — that is, by taking the three or four tablets of methotrexate every few hours over the course of the appointed day, instead of swal­lowing them all at once. Another option is to take the drug as an injection instead of a pill, but that necessitates a weekly trip to the doctor.

A weekly trip to the doctor may be avoidable, but a monthly one is mandatory if you are on methotrexate. Every few weeks, you must undergo the tests that show whether the drug is causing any of the more hidden noxious kinds of damage of which it is capable. You need a complete blood count because methotrexate can suppress the production of new blood cells and lead to severe forms of anemia. You also get a blood test to point up possible ill effects in the liver, called a liver-chemistry profile. Liver damage is one of the worst threats of methotrexate, because the damage, once begun, cannot be undone. The blood-chemistry profile, moreover, is not a complete check for liver problems, since the most serious damage does not show up in a blood test. Only an actual biopsy can tell for sure, and if you take methotrexate, you are supposed to undergo a liver biopsy after about two years of treatment. The other worrisome fallout from methotrexate is lung disease. If you take the drug, you are warned to be on the lookout for a dry cough accompanied by fever and shortness of breath. If you notice these symptoms, you need to see your doctor and have a chest X-ray immediately.

Who Can Take Methotrexate?

Methotrexate is not for everybody. The decision to prescribe it is not made lightiy, and the drug is reserved for those with the most severe cases of rheumatoid arthritis. In other words, you have to have a great deal of pain, stiffness, and swelling in several joints, plus fatigue. You also have to have proved yourself a reliable patient, since it takes a fair degree of responsibility on your part to follow the treatment plan, both in taking the drug on schedule and showing up at the doctor's office for frequent checkups to test for danger signs.

You cannot take methotrexate if you are pregnant or planning to have a baby. This warning also applies to men who are plan­ning to become fathers, since the drug may cause birth defects and even sterility. A few other physical conditions would rule out using methotrexate. If you drink a lot of alcohol, for example, the danger of cirrhosis of the liver rises dramatically.