Low dose methotrexate: patient counselling

Last updated: March 09, 2020


Low dose methotrexate can cause a range of acute and chronic serious side effects such as myelosuppression, lung and liver toxicity, and mucositis. 

Deaths and severe harm have occurred as a result of these adverse effects; poor renal function, interacting medicines and prescribing and/or dispensing errors have been contributing factors. Effective patient counselling can help to mitigate some of these risks.

  • Prior to starting methotrexate patients should be advised of the risks and benefits of the drug, including the need for regular blood tests and folic acid, and the once weekly dose schedule and the usual tablet strength (2.5mg)

  • They should also be aware of the potential for drug interactions and to highlight that they take methotrexate if there are any changes to the other medicines they are prescribed or buy over-the-counter.

  • Fatalities due to methotrexate have been most likely secondary to myelosuppression, therefore patients should be counselled to promptly report symptoms such as mouth ulceration or unexplained bruising or bleeding. They should also seek urgent attention if they develop nausea, vomiting, abdominal pain or dark urine, or breathlessness  or cough. 

  • Intercurrent infection that fails to settle after several days or respond to conventional treatment may also require, usually temporary, suspension of methotrexate.

  • In addition patients should be aware that any illness that causes dehydration may be a reason to omit methotrexate.

The British Association of Dermatologists have produced an information leaflet for patients taking methotrexate for skin conditions which covers most of these points. There is also a version specifically for parents and carers on the Medicines for Children website.

https://www.nras.org.uk/data/files/NRLS-0267-Oral-methotrexa-osage-record-2006-v1.pdf

   ⇦ PREVIOUS PAGE     – Page 3 of x –     NEXT PAGE