Methotrexate prescription: what you need to know

Methotrexate is a common medicine used to treat autoimmune diseases and certain cancers. Doctors prescribe it for rheumatoid arthritis, psoriasis, some vasculitis, and certain blood or solid tumours. It works by slowing down cells that divide too quickly and by calming an overactive immune system. Because it affects cell growth, methotrexate needs careful dosing and monitoring.

If your doctor suggests methotrexate, expect a clear plan. Most rheumatology starts with a low weekly dose that increases slowly. Never take methotrexate daily unless your doctor instructs it. Weekly dosing is key to safety. Your prescriber will order blood tests before you start and regularly after that. Tests check liver function, kidney function, and blood counts.

Side effects range from mild to serious. Common problems include nausea, mouth sores, and mild hair thinning. Serious issues can include liver damage, low blood counts, and lung inflammation. Tell your doctor right away if you have unusual breathlessness, persistent fever, severe abdominal pain, or signs of infection. Avoid alcohol while on methotrexate because it raises liver risk.

Interactions matter. Many over-the-counter drugs and supplements can affect methotrexate. Nonsteroidal anti-inflammatory drugs like ibuprofen can increase risk in some patients. Certain antibiotics and supplements like folic acid interact—although folic acid is usually recommended to reduce side effects. Always tell every clinician and pharmacist you take methotrexate.

Pregnancy and breastfeeding need extra caution. Methotrexate can cause serious birth defects and must not be taken when trying to conceive. Men and women should discuss contraception timelines with their prescriber. If you become pregnant while on methotrexate, contact your healthcare team immediately.

Getting a prescription online is possible but needs care. Use a licensed provider and a reputable pharmacy. Avoid sites that sell methotrexate without a prescription. A valid prescription should come from someone who reviewed your tests and medical history. If a site offers fast orders with no medical review, walk away.

Practical tips

Practical tips for people taking methotrexate: take the tablet on the same day each week, use a pillbox or calendar, and keep all upcoming blood test appointments. Carry a list of your medicines and allergies. Ask your clinic what symptoms require urgent contact. Keep your vaccination status up to date because live vaccines may be unsafe on methotrexate.

If you have questions about switching from steroids like prednisolone to methotrexate, ask your rheumatologist for real-world expectations and monitoring plans. Many patients see better disease control and fewer steroid side effects over time, but the switch takes planning and tracking.

Monitoring and common questions

Typical monitoring includes blood tests every 2 to 4 weeks during the first months, then every 1 to 3 months once stable. If you miss a blood test, reschedule. Keep a photo of your prescription and test results on your phone for visits. If side effects start, call before stopping the drug — your doctor can adjust dose or add folic acid to ease symptoms.

Talk openly with your healthcare team. Methotrexate works well for many people, but safe use depends on clear prescriptions, regular tests, and sensible daily habits.