What is methotrexate?

Methotrexate is used for patients with inflammatory bowel disease (IBD) who have failed other treatments.

Is there anything special I need to know about methotrexate?

  • Methotrexate is taken either as a pill or by injection (shot).
  • Call your GI doctor if you have a fever over 102F or if you have other signs of infection.
  • You should NOT receive live viral vaccines when you are taking methotrexate (such as chicken pox vaccine, intranasal flu vaccine or measles-mumps-rubella [MMR])
  • Your GI doctor will also prescribe a daily folic acid tablet if you are taking methotrexate.

Are there any foods or drinks I should not eat or drink while taking methotrexate?

There are no known problems with taking methotrexate with any specific foods or drinks, but if you are taking it as a pill, you should take it 1 hour before eating or 2 hours after a meal. Alcohol intake should be limited to avoid injury to the liver.

Are there other medications I cannot take with methotrexate?

The following drugs can increase the effects of methotrexate:

  • ibuprofen (Motrin®, Advil®)
  • omeprazole (Prilosec®)
  • lansoprazole (Prevacid®)
  • esomeprazole (Nexium®)
  • pantoprazole (Protonix®)
  • penicillin

Is it safe to take methotrexate for a long period of time?

  • The U.S. Food & Drug Administration (FDA) has approved methotrexate for the treatment of psoriasis and rheumatoid arthritis. Although the FDA has not approved methotrexate for the treatment of Crohn’s disease, it has been used to treat Crohn’s disease for long periods of time.
  • Like any immunosuppressant, it can increase your risk for certain infections.

Major side effects

  • Headache
  • Nausea and vomiting
  • Rash
  • Joint pain
  • Fatigue

Minor side effects

  • Decreased blood cell counts
  • Liver injury

There is an increased risk of infection with any immunosuppressant medicine. If you experience any of the following symptoms you should notify your GI doctor.

  • Fever over 102F, chills, sweating
  • Pain when you urinate or urinating more often than usual
  • A wound that will not heal
  • A cough with more sputum than you usually have or a change in the color of sputum
  • Warm, red or painful skin
  • Very bad sore throat
  • Ear or sinus pain
  • Mouth sores (although those can be due to IBD)
  • Sores on your body
  • Muscle aches
  • Shortness of breath
  • Feeling tired or weak

Rev. 8/2021. Mass General for Children and Massachusetts General Hospital do not endorse any of the brands listed on this handout. This handout is intended to provide health information so that you can be better informed. It is not a substitute for medical advice and should not be used to treatment of any medical conditions.

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