• Tell your health care team if you have or had significant medical condition(s), especially if you have / had:

  • liver problems (such as hepatitis),

  • kidney problems,

  • or if you have any allergies.

• Some methotrexate tablets contains a small amount of lactose. If you cannot have lactose, talk to your healthcare team.

Remember to:

• Tell your health care team about all of the other medications you are taking.
• Keep taking other medications that have been prescribed for you, unless you have been told not to by your health care team.

• Methotrexate may be given through an IV (injected into a vein), as IM (injected into muscle), or as a tablet (pill) you take by mouth. This will depend on what you are taking methotrexate for. Talk to your healthcare team about your treatment schedule.

• If you missed your treatment appointment for methotrexate IV or IM, talk to your health care team to find out what to do.

• If you are taking methotrexate oral tablets:

  • Take these by mouth exactly as directed by your health care team. How often you take them will depend on your treatment schedule.

  • Swallow whole with a glass of water on an empty stomach, at least 1 hour before or 2 hours after food.

  • Avoid taking methotrexate tablets with milk products. They can make the drug not work as well.

  • If you miss your dose, talk to your health care team to find out what to do.

  • If you vomit (throw up) after taking your medication, talk to your health care team about what to do.

  • If you take too much of your oral anticancer medication by accident, or if you think a child or a pet may have swallowed your medication, you must call the Ontario Poison Control Center right away at: 1-800-268-9017.
     

To Prevent or Treat Nausea and Vomiting

• You may be given medications to help prevent nausea (feeling like throwing up) and vomiting (throwing up) before they start.
  
  These are called anti-nausea medications and include medications such as ondansetron (Zofran®), granisetron (Kytril®), dexamethasone (Decadron®), prochlorperazine (Stemetil®), or others.

To Lower your Chance of Side Effects

• If you are receiving high doses of methotrexate, you will also be given leucovorin (a type of vitamin) and fluids through an IV (injected into a vein) to reduce the side effects of methotrexate.

• If you are given leucovorin, talk to your health are team about how and when to take this medication.  See our leucovorin patient info sheet for more information.

Will this medication interact with other medications or natural health products?

• This medication can interact with many other medications, vitamins, foods and natural health products. Interactions can make the treatment not work as well or cause severe side effects.

• Tell your health care team about all of your:

  • prescription and over-the-counter (non-prescription) medications and all other drugs, such as cannabis / marijuana (medical or recreational)

  • natural health products such as vitamins, herbal teas, homeopathic medicines, and other supplements

• Check with your health care team before starting or stopping any of them.

• If you take seizure medications (such as phenytoin), your health care team may monitor your blood levels closely and may change your dose.

• If you are taking a blood thinner (such as warfarin), your health care team may need extra blood tests and may change your dose.
   

What should I do if I feel unwell, have pain, a headache or a fever?

• Always check your temperature to see if you have a fever before taking any medications for fever or pain (such as acetaminophen (Tylenol®)).

  • Fever can be a sign of infection that may need treatment right away.

  • If you take these medications before you check for fever, they may lower your temperature and you may not know you have an infection.

How to check for fever:

Keep a digital (electronic) thermometer at home and take your temperature if you feel hot or unwell (for example, chills, headache, mild pain).
 

• You have a fever if your temperature taken in your mouth (oral temperature) is:
   
  • 38.3°C (100.9°F) or higher at any time
    
    OR
     
  • 38.0°C (100.4°F) or higher for at least one hour.

If you do have a fever:

• Try to contact your health care team. If you are not able to talk to them for advice, you MUST get emergency medical help right away.
• Ask your health care team for the Fever pamphlet for more information. 
   

If you do not have a fever but have mild symptoms such as headache or mild pain:

• Ask your health care team about the right medication for you. Acetaminophen (Tylenol®) is a safe choice for most people.

• DO NOT take ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or ASA (Aspirin®), until you talk to your health care team as they may make your side effects worse.

• Talk to your health care team if you already take low dose aspirin for a medical condition (such as a heart problem). It may still be safe to take.

What to DO while on this medication:

• DO check with your health care team before getting any vaccinations, surgery, dental work or other medical procedures.

• DO consider asking someone to drive you to and from the hospital on your treatment days.

• DO tell your health care team about any serious infections that you have now or have had in the past.

• DO protect your skin from the sun. Wear a long sleeved shirt, long pants and a hat. Apply sunscreen with UVA and UVB protection and an SPF of at least 30. Your skin may be more sensitive to the sun and you could develop a bad sunburn or rash more easily.

• DO drink plenty of fluids (unless told differently) to prevent kidney problems. Drink at least 6 to 8 cups (2 Litres) of water or other liquids per day and urinate (pee) often., unless your healthcare team has told you to drink more or less.

What NOT to DO while on this medication:

• DO NOT smoke or drink alcohol while on treatment without talking to your health care team first. Smoking and drinking can make side effects worse and make your treatment not work as well.

• DO NOT drive, operate machinery or do any tasks that need you to be alert if you feel tired or dizzy.

Oral tablets:

• Store in the original packaging at room temperature, away from heat, light or moisture. Keep out of reach of children and pets. 
   
• Do not throw out any unused drugs at home. Bring them to your pharmacy for safe disposal.

How to safely touch oral anti-cancer medications

If you are a patient:

• Wash your hands before and after touching your oral anti-cancer medication.
• Swallow each pill whole. Do not crush or chew your pills.

If you are a caregiver:

• Wear nitrile or latex gloves when touching tablets, capsules or liquids.
• Wash your hands before putting on your gloves and after taking them off, even if your skin did not touch the oral anti-cancer medication.
• Throw out your gloves after each use. Do not re-use gloves.
• Do not touch oral anti-cancer medications if you are pregnant or breastfeeding.

What to do if oral anti-cancer medication gets on your skin or in your eyes

If medication gets on your skin:

• Wash your skin with a lot of soap and water.
• If your skin gets red or irritated, talk to your health care team.

If medication gets in your eyes:

• Rinse your eyes with running water right away. Keep water flowing over your open eyes for at least 15 minutes.

The following table lists side effects that you may have when getting methotrexate. Methotrexate is usually given along with other medications to treat cancer; some of the side effects listed below may be due to those other medications. How likely you are to have a side effect will depend on your methotrexate dose.

The table is set up to list the most common side effects first and the least common last. It is unlikely that you will have all of the side effects listed and you may have some that are not listed.

Read over the side effect table so that you know what to look for and when to get help. Refer to this table if you experience any side effects while on methotrexate.

Other rare, but serious side effects are possible.
If you experience ANY of the following, speak to your cancer health care provider or get emergency medical help right away:

• Bleeding from your gums, unusual nosebleeds, bruising easily or more than normal, or blood in your urine (pee) or stools (poo). If you have bleeding that doesn’t stop or is very heavy, you must get emergency help.

• Signs of kidney problems such as lower back pain, swelling, pee less than usual and have weight gain that is not normal for you.

• Signs of an allergic reaction such as rash, swollen lips, face or tongue, chest and throat tightness

• Severe chest, belly , back or arm pain

• Pain, swelling or hardening of a vein in your arm or leg

• New cough, trouble breathing or coughing up blood

• Feeling confused, trouble speaking or moving your arms or legs

• Severe headache

• New problems with balance, memory, difficulty with speaking or movements, personality changes

• Any new changes to your vision

• Severe muscle weakness, twitching

• Seizures

• Severe rash in areas where you have had radiation before

• Severe rash, marks that may appear as “bulls-eyes”, may blister or peel, or appear together with swollen lymph glands

• Red or purple patches on your skin or a rash that do not turn white when pressed

Other Notes:

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