Methotrexate (also sold under the brand names Rheumatrex and Trexall) is an immunosuppressant drug often prescribed for people with inflammatory types of arthritis.
Many patients on methotrexate have few or no side-effects. Among those who do have problems, most side-effects resolve by lowering the dose or, if needed, discontinuation of the drug. But your dose should never be lowered - nor discontinued - without the guidance of your physician. Sudden discontinuation of the drug may put you at risk for a flare of your disease; so your doctor will want to monitor you appropriately.
However, it is important for you to be aware of any symptoms of possible side-effects so that you can report them to your doctor promptly - and appropriate action can be taken if necessary.
Some serious side effects can occur without causing any symptoms you would immediately notice. That's why your physician will want to monitor you with frequent blood tests, which can range from once every two weeks to once every six weeks, once your dose has been stabilized. These blood tests may include: CBC (complete blood count, especially to check your white blood cell count that indicates your risk of infection); liver chemistries; kidney function. Close follow-up of these laboratory tests is essential.
When you are started on methotrexate, ask about your doctor's practice for monitoring and follow-up. For example, some physicians will call you only if your test results are abnormal, while others call to report even normal results. Others expect you to call in to check on your labs - and may want you to stop the drug if you can't call in. That's because, occasionally, your white blood cell count can drop suddenly, leaving you at risk for infection. In such instances, continuing the drug can be dangerous but stopping it generally causes the count to return to normal.
Other side effects, both minor and serious, do cause symptoms. Following are common problems you should be aware of while taking methotrexate.
Some aspects of your lifestyle may need to be changed while taking methotrexate.