Low dose methotrexate: Summary

Last updated: March 10, 2020

✦  Low dose methotrexate is an effective regime for a range of indications but fatalities have been reported.

✦  Risk factors for developing toxicity include impaired renal function, advancing age, intercurrent illness, hypoalbuminaemia and prescription of interacting medicines.

✦  Effective patient counselling and regular monitoring are essential toreduce the risk of serious harm associated with low dose methotrexate.

✦  Local shared care agreements outline the roles and responsibilities of the specialist and primary care teams, and the patient.

Further information

Throughout this topic we have signposted you to expert guidance such as that produced by the British Association of Dermatologists, the British Society of Rheumatology and British Health Professionals in Rheumatology and the British Society for Gastroenterology.

More general information may be found in individual manufacturers’ Summaries of Product Characteristics (‘data sheets’) for methotrexate on the electronic Medicines Compendium and on the Medicines and Healthcare products Regulatory Agency site. These contain information about doses, special precautions, adverse effects and drug interactions.

There are several Medicines Q&As on the Specialist Pharmacy Services website about the use of low dose methotrexate including:

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