Center for Inflammatory Bowel Disease Treatment and Research

What does this medication do?

Methotrexate is a maintenance medication. It is used to help keep patients with Crohn’s disease feeling well and off steroids. It decreases the activity of the immune system (which normally protects the body from infection). Methotrexate helps to decrease the body’s response to disease (inflammation) in the intestine. It may take several days to weeks to see the full effect.

How well does methotrexate treat Crohn’s disease?

Studies suggest that about half (50%) of patients treated with methotrexate will respond to this medication. For most patients, “respond” means feeling well and coming off of corticosteroids. Methotrexate may work with other Crohn’s disease medications to help maintain remission of the disease.

What are the side effects?

Use of low dose methotrexate in Crohn’s disease has only a few side effects. The most common side effects include:

• Nausea or stomach upset
• Mouth sores (like canker sores) - frequent mouth care with a soft toothbrush or cotton swab and rinsing your mouth well may help.
• Hair loss has also been reported but is less common. Hair usually grows back when the medicine is stopped.
• Methotrexatecan lower the number of white blood cells in the body. This can increase the risk of developing infections.
• This medication may also decrease the number of platelets in the blood which your body needs to stop bleeding (clotting). Blood counts will be monitored closely, especially during the first few weeks to months of therapy. We may change the dose of medication depending on the blood counts, so it is very important to follow your physician’s instructions for laboratory testing. Methotrexate can increase liver enzymes (hepatitis). Your physician will monitor liver enzymes with your routine blood work. Hepatitis usually reverses (goes away) once the medication is stopped.
• You should notify your healthcare provider immediately if you have dark urine or if your skin or eyes turn yellow.
• Rare side effects of methotrexate therapy include scarring of lung tissue which can cause difficulty breathing and decreased kidney function.
• The use of immunosuppressant medications may slightly increase the risk of developing lymphoma (a tumor of the lymph glands). The precise risk is unknown, but it is estimated to be about 1/3000. This is a slight increase in risk over children and young adults of the same age who are not taking this medication.

How to take your methotrexate and other facts:

• You can take methotrexate as an injection or as a tablet. Methotrexate injections are given into the fatty part of the skin using an insulin syringe.
• Methotrexate should be taken once per week, on the same day every week.
• You will also need to take a supplement called Folic Acid while taking this medication.
• You may take this medication with food.
• This medication may increase sensitivity to the sun. This means you can get sunburned more easily while taking this medication. Avoid getting too much sun or tanning beds, wear protective clothing, and use sunscreen when outdoors.
• Do NOT drink alcohol while taking this medication.
• Drink plenty of fluids that do not contain caffeine unless told not to by your physician.
• Females of childbearing age should NOT become pregnant while taking this medication. Use of this medication during pregnancy can cause birth defects in the unborn baby.
• Parents should wear gloves when giving this medication to their child.
• Store this medication at room temperature and protect it from light.
• You should not receive live virus vaccines (ex. MMR, chicken pox, nasal flu) while taking this medication. Inactivated vaccines (e.g. tetanus and influenza shot) are safe. It is a good idea to call your doctor or nurse before receiving any vaccinations.
• Check with your doctor or nurse practitioner before starting any new medications, herbs, or vitamins while taking this medication.

You should call your doctor immediately if you:

• have a fever greater than 100°F
• have been exposed to chicken pox
• have been exposed to any other serious illness caused by a virus while taking this medication