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Last Updated on March 16, 2024

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The active ingredient Methotrexate (MTX) is one of the most important means against cancers at low doses against psoriasis, rheumatoid arthritis and inflammatory bowel disease. He is generally well tolerated, can cause mucosal inflammation and disturbance of blood formation in rare cases, however. To reduce the side effects of Methotrexate, folinic acid is given in addition. Here you can read everything about Methotrexate.

How Methotrexate works

With Psoriasis () is enabled on the defense system (immune system) and attacks its own body cells. It is thereby a permanent inflammatory reaction in the body that can leave serious damage.

Therefore, the immune system must be “modulated”. Methotrexate belongs to the group of so-called “immunomodulators”. In low concentrations, it inhibits the formation of which need the cells of the immune system strongly to cell division. Thus, the acute inflammatory response is suppressed. The effect of treatment but occurs only after one to two months.

Methotrexate also inhibits folic acid formation and thus cell division in healthy cells. To mitigate this side effect, additional folic acid is added.

Also for the treatment of cancers MTX is suitable. Here, however significantly more drug must be given as an example in psoriasis. Cancer cells (tumor cells) are characterized by their rapid growth. For the constant cell division particularly much folate is needed. By inhibiting folic acid education Methotrexate can therefore block the growth of tumors. Again, by the addition of folic acid, the toxic effect can be reduced to healthy body cells.

Pharmacokinetics and metabolism of Methotrexate

The recording from the intestine when taking the drug in tablet form is very different (from 20 to 100 percent). Excretion is relatively slowly through the kidneys.

When is Methotrexate used?

Among the areas of application (indications) of Methotrexate include:

  • cancer
  • psoriasis (psoriasis)
  • Rheumatoid arthritis (rheumatoid arthritis-related)
  • Crohn’s disease, ulcerative colitis (inflammatory bowel disease)

How Methotrexate is taken?

In the treatment of psoriasis, arthritis and inflammatory bowel disease are injected once a week from 7.5 to 20 milligrams of Methotrexate or swallowed up to 30 milligrams in the form of tablets. This treatment is the so-called “low-dose MTX” (low-dose Methotrexate).

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In cancer treatment, the dosage is significantly higher. It depends on the type of tumor and the treatment regimen. Are usual doses between 40 and 80 milligrams of Methotrexate per square meter of body surface area, which can be injected or swallowed. The treatment time is then between seven and 14 days. Also possible are so-called “high-dosage regimens”, in which single doses are administered between one and 20 grams of MTX.

Since the elimination of the active substance via the kidneys occurs, the dose should be reduced in patients with impaired renal function.

What are the side effects of Methotrexate?

Often (that is, at one to ten percent of patients) induces Methotrexate (MTX) side effects such as inflammation of the mouth and intestinal mucosa and myelosuppression (bone marrow depression). The latter means that the formation of blood cells, which normally takes place in the bone marrow, is disturbed.

Occasionally (in less than one percent of people) there is, increased susceptibility to infections, allergic rashes and osteoporosis.

Even more rarely can occur in men decreased fertility.

What should I watch for while taking Methotrexate?

pregnant women, patients with a weakened immune system and patients with severe renal or hepatic dysfunction medications with Methotrexate may not get.


Other drugs used to treat rheumatoid arthritis or psoriasis (called DMARDs such as hydroxyChloroquine) may not be combined with Methotrexate.

During the treatment with the drug should not be vaccinated with a live vaccine, as it may lead to serious vaccine complications due to the suppressed immune system.

With simultaneous use of blood-thinning agents must be regularly blood clotting are checked.

Driving and using machines

The ability to react is not strongly influenced by the use of medication with Methotrexate.

Pregnancy and lactation

The drug Methotrexate harms both the unborn child and the infant, and must therefore not be used during pregnancy and lactation.

Pregnancy must be excluded before start of treatment by a physician. During treatment, effective contraception must be ensured.

Want a woman to become pregnant, should be switched from Methotrexate to a better proven drug against rheumatoid arthritis and inflammatory bowel diseases such as Prednisone / Prednisolone, Sulfasalazine, hydroxyChloroquine, or Azathioprine.

How to get medicines with Methotrexate

medication with Methotrexate are only available on prescription. You get it therefore only with a prescription from a doctor in pharmacy.

Since when Methotrexate is known?

The drug Methotrexate has been developed by the company Lederle in the US in the year 1955th At that time they went out only of its effect as a cancer treatment. Later it was discovered its good effects at lower doses as an immunomodulator. Since Methotrexate rheumatism, psoriasis and inflammatory bowel disease are treated successfully.

More interesting facts about Methotrexate

In a poisoning with Methotrexate, for example, at too high a dosage in patients with renal dysfunction, will be given as an antidote (antidote) called “Carboxypeptidase G2”. This builds Methotrexate from, and the concentration in the blood decreases rapidly to non-toxic levels.

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