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Treats cancer and changes how your immune system works.

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Prescription onlyLower-cost generic available

Our bottom line

Otrexup (Methotrexate) is a first line treatment for many autoimmune diseases and types of cancer. If you're taking it for a long time, you'll have to get routine blood tests.


  • Recommended as first line treatment for rheumatoid arthritis.
  • Available as a generic medication. Comes as a tablet, an injection that you give yourself weekly, and as an infusion that you get in your doctor's office or at an infusion center.
  • If you accidentally take too much, there's an antidote to help your body recover.


  • You have to be on birth control for at least 2 to 3 months after you finish Otrexup (Methotrexate) since it can cause birth defects.
  • You have to avoid alcohol and being in the sun too long.
  • You'll have to get blood tests done if you're taking this long-term because it can cause harmful side effects.

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What to expect when you take Otrexup (Methotrexate) for Cancer

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Tips from our pharmacists
  • Don't use alcohol, NSAIDs (anti-inflammatory medications), or stay in the sun too long.
  • Use birth control and avoid pregnancy for at least 2 months (for women) and 3 months (for men) after you finish Otrexup (Methotrexate).
  • Drink plenty of liquids to stay hydrated while taking this.
  • Take the medication exactly as your doctor or pharmacist tells you. Call your doctor or pharmacist if you're confused.
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Side effects for Otrexup (Methotrexate)

From clinical trials of Methotrexate / Juvenile rheumatoid arthritis (5 to 20 mg/m2/wk or 0.1 to 0.65 mg/kg/wk) 

  • Elevated liver function testsElevated liver function tests14% for Methotrexate vs.0% for placebo
  • Gastrointestinal reactions (e.g., nausea, vomiting, diarrhea)Gastrointestinal reactions (e.g., nausea, vomiting, diarrhea)11% for Methotrexate vs.0% for placebo
  • Mouth and lip swellingMouth and lip swelling2% for Methotrexate vs.0% for placebo
  • Low white blood cellsLow white blood cells2% for Methotrexate vs.0% for placebo
  • HeadacheHeadache1% for Methotrexate vs.0% for placebo
  • Hair loss or baldnessHair loss or baldness1% for Methotrexate vs.0% for placebo

Risks and Warnings for Otrexup (Methotrexate)

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    • Higher risk if:
    • Women of childbearing age
    • Men of childbearing potential

    Talk to your doctor if you are planning to have a baby or are pregnant. Otrexup (Methotrexate) can cause birth defects, including death. You or your partner will need to be on birth control for at least 2 to 3 months after you finish Otrexup (Methotrexate) to lower this risk.

    This is a black box warning. The FDA requires this warning when there is a significant risk of serious or life-threatening effects that anyone taking the drug should consider.

Means that some groups have a high risk of experiencing this side effect

Tips from pharmacists and people taking Otrexup (Methotrexate)

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The FDA category for this medication is X. It is advised that you: Unsafe
  • Upsides and downsides from our pharmacists
  • You have to avoid alcohol and being in the sun too long.
  • Tips from our pharmacists
  • Don't use alcohol, NSAIDs (anti-inflammatory medications), or stay in the sun too long.
Kidneys and liver
  • Risks from our pharmacists
  • If you're taking Otrexup (Methotrexate), you’ll need to have your blood checked to avoid toxic effects (blood cells, platelets, liver enzymes, kidney function) and chest X-rays when you start and every 1 to 2 months during treatment. Otrexup (Methotrexate) can also cause malignant lymphoma (cancer of the white blood cells). It can happen when you take low-doses of Otrexup (Methotrexate).
  • You are at higher risk of having toxic symptoms because of too much Otrexup (Methotrexate) in your blood if you have kidney disease, or if you have fluid in the abdomen (ascites) or in the lungs (pleural effusion). Your doctor will monitor your body's reaction to Otrexup (Methotrexate) very closely if they decide you need to be on Otrexup (Methotrexate).
  • Tumor lysis syndrome happens when cancer cells are broken down very quickly and damage the kidneys. The damage can be so bad that people need dialysis. If you're taking Otrexup (Methotrexate) to treat cancer, your doctor can give you medicines and take measures to prevent this reaction.