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I am starting Methotrexate, what should I know?

Updated: Oct 16, 2023


What Side Effects can Methotrexate lead to and how to prevent them:

  1. Gastrointestinal Symptoms: Methotrexate may cause nausea, abdominal pain, and occasionally, vomiting. These symptoms occur because the drug affects rapidly dividing cells in your body, such as those in your gut. Fortunately, we can prevent or minimize these symptoms by adding folic acid to our regimen (see below) or taking the methotrexate subcutaneously rather than by mouth..

  2. Hair Loss: Another potential side effect is hair loss. Since hair cells also proliferate quickly, they can be affected by methotrexate. However, this is not as severe as with higher-dose chemotherapy and preventative measures are available to help mitigate hair loss, including taking folic acid.

  3. Low Blood Cell Counts: Methotrexate can temporarily reduce the number of red and white blood cells. This can result in anemia and a decreased ability to fight infections. Fortunately, here again, folic acid can prevent these complications as well.

  4. Liver Toxicity: There is a possibility of liver toxicity with methotrexate. However, by understanding the liver's regenerative capacity, we can prevent this side effect. Methotrexate is usually taken once a week to allow sufficient time for the liver to regenerate. Additionally, it is important to avoid excessive alcohol consumption, as it can interfere with liver regeneration.

  5. Oral Ulcers: Some patients may experience oral ulcers while taking methotrexate. Although the exact mechanism is not fully understood, taking folic acid and allowing it to dissolve in the mouth has been observed to be effective in preventing oral ulcers for some individuals.

Importance of Folic Acid:

As you read before, folic acid helps with a lot of the side effects of methotrexate. Folic acid is a vitamin which plays a crucial role in managing methotrexate treatment. It acts as an antidote to methotrexate toxicity and helps reduce side effects without diminishing the drug's effectiveness. It is now standard practice to prescribe folic acid alongside methotrexate treatment. A daily dose of one milligram is typically recommended, although some patients may require higher doses.


Monitoring and Blood Work:


To ensure the safe and effective use of methotrexate, regular blood work is necessary. Initially, blood work is typically done monthly for the first three months, and later, every three to four months once a stable dose is achieved. These tests monitor blood cell counts and liver function, helping us identify any potential issues.


Conclusion

To summarize, Methotrexate is a well-established and effective medication used in rheumatological treatments. By understanding the drug's potential side effects and employing preventive measures, patients can experience positive outcomes and effectively manage their conditions. Remember, it's essential to follow your doctor's recommendations and communicate any concerns or changes in your health during treatment.



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