Methotrexate (MTX) is a yellow coloured chemo that’s used to treat many different cancers. It also comes in yellow tablets. It can be given along with other chemo drugs as part of a chemo regimen. The regimen will depend on the type of cancer you have.

How is it given? 

It can be given as:  

• an injection through a fast running salt water (saline) drip into a cannula, PICC line or central line (intravenously)
• a drip (infusion) into a cannula, PICC or central line
• an injection into the fluid around the spinal cord through a lumbar  puncture (intrathecally)
• tablets
• an injection under the skin (subcutaneously)
• an injection into an artery (intra-arterially)
• an injection into a muscle (intramuscularly)

Are there any side effects?

Some people only get a few side effects while others will have more. It’s hard to know how it will be for you. Methotrexate is given at different doses for different cancers and the side effects vary depending on the dose you are given. Also the side effects might be different if you are having more than one chemo drug.  Most side effects will disappear after treatment has finished.

A drug called folinic acid (leucovorin) is usually given 24 hours after methotrexate to help reduce side effects. It’s really important that the injections or tablets are taken at the right times. You might hear this being called ‘folinic acid or leucovorin rescue’.

 Common side effects

• Lowered resistance to infection: Your immune system doesn’t work so well when you’re having chemo, so you might pick up more colds and infections. This begins around 7 days after treatment is started and reaches its lowest point around 10–14 days after chemo. Your blood cells then gradually go back to normal.
  Keep an eye on your temperature and if it goes above 38°C (or you feel unwell) it’s important to let your doctor know. If necessary, you’ll be given antibiotics to keep any infection under control. 
• Bruising and bleeding: The number of platelets in your blood can fall because of the chemo. This can cause bleeding or bruising (for example, gums, nose bleeds, heavy periods or pin prick dots on the skin). Let your doctor know if you have any problems with this. If your platelets are really low, your doctor might suggest a platelet transfusion to increase the amount of platelets in your blood.
• Anaemia: The number of red cells (haemoglobin) in your blood can be low because of the chemo. This can make you feel tired and sometimes breathless. If necessary (to help with the symptoms) your doctor might suggest a blood transfusion to increase the amount of red cells in your blood.
• Sore mouth: You might get a sore, dry mouth or notice some small ulcers. It helps to drink plenty of fluids and brush your teeth regularly (with a soft toothbrush). Doctors can prescribe mouthwashes and medicine to prevent or clear any infection.
• Skin changes: Some people notice a yellowish tinge when the drug is being given but this clears quickly. Methotrexate can also cause painful blistering on the hands and feet.
• Hair loss: This  usually starts 3–4 weeks after the first course of treatment with high dose methotrexate , but it's less common if you’re having low dose methotrexate. Usually all the hair on your head will fall out . You may also notice that some or all of your eyelashes, eyebrows and body hair fall out. This can feel really tough to cope with but remember that it’s temporary and your hair will start to grow again once the treatment is finished. You might want to read our info on wigs and scarves in our deal with it section.
• Headaches and backache: Intrathecal methotrexate can sometimes cause headaches or backache. It can sometimes help to lie down for a short while afterwards.
• Taste changes: You may find that your food tastes different. Normal taste usually comes back when the treatment has finished.
• Your kidneys may be affected: High doses of methotrexate can affect the way your kidneys work. This doesn’t usually cause any problems with the standard doses. Sodium bicarbonate will be given (in a drip or a tablet) before and during the methotrexate to protect your kidneys. You’ll also have a blood test before each treatment. To make sure your kidneys are working properly.
• Diarrhoea: This can be easily treated with medicines. Let your doctor or nurse know if this is a problem.
• Sore or gritty eyes: Your doctor can give you some soothing eye drops if this happens.

These are the most common side effects. It can feel really scary reading about all of these. It’s important to remember that most of them can be controlled and they will get better after the treatment is finished.

It might help to talk to your doctor or nurse about things if you’re worried or nervous. They are there to help. Also have a look at our forum where you can talk to others who’ve been through a similar experience.

Anything else I should know 

Some people have a slight reaction to Methotrexate. This can include a skin rash, irritation of the throat and nostrils, wheezing, coughing or breathlessness. This is quite rare but the nurses will keep a close eye on you while the methotrexate is being given. Some people also feel flushed and feverish. You might be given medicines before it to try to prevent a reaction.

How will I feel?

Chemo affects everyone differently, but it’s likely that you may feel a bit rough sometimes when you’re having your treatment. You might also feel emotional, depressed or irritable at times. All of these feelings are normal for people having chemo. Some people find it really helps to talk things over with someone close or a counsellor. If you want to find out more, there’s lots of information in our deal with it section.