Methotrexate Side Effects

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By eHow Contributing Writer

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Methotrexate is an anti-metabolite drug used to treat rheumatoid arthritis, psoriasis and certain cancers. Psoriasis and rheumatoid arthritis must be severe before methotrexate is used. Because methotrexate can be highly toxic, only physicians who have experience with anti-metabolite drugs should prescribe it, and patients must be closely monitored while taking it.

Frequently Reported Side Effects

The most common side effects are nausea or abdominal distress, ulcerative stomatitis, and a low white cell count. Other common side effects are fatigue, chills and fever, dizziness and decreased resistance to infection. Elevated liver function tests occur in about 15% of arthritis patients.

Liver Symptoms

Methotrexate can cause both fibrosis and cirrhosis of the liver. This can be fatal, and a higher dosage, particularly one combined with alcohol, obesity or diabetes, can lead to more severe hepatotoxicity.

Neoplasms

Methotrexate raises the risk for lymphoma. Any existing tumors are subject to "tumor lysis syndrome," or abnormally fast growth.

Gastrointestinal Symptoms

Diarrhea or ulcerative stomatitis require cessation of methotrexate, as a potentially fatal intestinal perforation may occur.

Lung Disease

Methotrexate can cause lesions on the lungs which may not heal fully even if treatment is stopped.

Skin Symptoms

Severe and sometimes fatal skin reactions such as necrosis can occur, sometimes after a single dose.

With Non-Steroidal Anti-inflammatory Drugs

Severe and sometimes fatal reactions can occur when high dosages of methotrexate are administered with non-steroidal anti-inflammatory drugs like indomethacin, ketoprofen and aspirin. These include bone marrow suppression, aplastic anemia, and gastrointestinal toxicity.