Overview
Methotrexate (often referred to as MTX) is one of the most widely used disease-modifying treatments for inflammatory arthritis and other autoimmune conditions. For many people, it becomes a long-term part of their health management. Understanding what to expect and how to manage treatment safely is important for getting the best results.
The Weekly Dose — Why It Matters
One of the most important things to remember about methotrexate for arthritis is that it is taken ONCE A WEEK, not every day. Taking it every day instead of weekly has caused serious accidental harm. Write the day on a calendar, set a phone alarm, or use a weekly pill organiser to help remember. Do not take it more often than prescribed.
Folic Acid — Take it Every Week
Folic acid is always prescribed alongside methotrexate to reduce side effects (especially nausea and mouth sores). It is taken on a different day to methotrexate — typically 5mg once a week. Do not skip folic acid doses.
Blood Monitoring
Regular blood tests are essential throughout methotrexate treatment. Tests monitor the liver (liver enzymes), kidneys, and blood cells. Initially, tests are done every 2–4 weeks and can be spaced to 3-monthly once stable. Never miss monitoring appointments — they detect any problems early.
Alcohol
Alcohol must be avoided or strictly limited (ideally no more than 1–2 units per week, and no binge drinking) because methotrexate and alcohol are both processed by the liver and can cause liver damage together.
Contraception
Both men and women must use reliable contraception while on methotrexate. Women must avoid pregnancy for at least 3 months after stopping. Men should avoid fathering a child for at least 3 months after stopping.