Major side effects of low-dose methotrexate
- Joel M Kremer, MD
Joel M Kremer, MD
- Pfaff Family Professor and Chair in Medicine
- The Albany Medical College
- Section Editor
- Ravinder N Maini, BA, MB BChir, FRCP, FMedSci, FRS
Ravinder N Maini, BA, MB BChir, FRCP, FMedSci, FRS
- Section Editor — Rheumatoid Arthritis
- Emeritus Professor of Rheumatology, Imperial College London
- Visiting Professor, Oxford University
Methotrexate (MTX) use can be associated with a variety of adverse effects over a wide range of severity; the risk of most side effects is influenced by the MTX dose and treatment regimen. In rheumatoid arthritis (RA) and other disorders, MTX is administered as long-term, low-dose therapy, usually 7.5 to 25 mg weekly, unlike its use for treatment of malignant disease, where it is may be administered in a cyclic fashion in doses of 1 gram or more.
The most commonly observed side effects of MTX at doses typically used for the treatment of RA are rarely life-threatening, in contrast with the high doses used in the treatment of malignancies. Nevertheless, they may become clinically significant if they result in premature discontinuation or dose alteration of a drug that is the best therapeutic alternative for a given individual.
Potentially life-threatening hepatotoxicity, pulmonary damage, and myelosuppression may be seen with use of MTX as either high- or low-dose therapy, while nephrotoxicity is a manifestation of high-dose therapy that occurs rarely, if ever, with low-dose MTX treatment.
The major side effects of low-dose MTX are reviewed here. The use of low-dose MTX in patients with RA and other rheumatic diseases and the clinical use and adverse effects of high-dose MTX and related adverse effects are described separately. (See "Use of methotrexate in the treatment of rheumatoid arthritis" and "Therapeutic use and toxicity of high-dose methotrexate".)
Symptoms and findings — One or more of the following common toxicities associated with methotrexate (MTX) are seen in some form, at some time, in most patients:To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- COMMON TOXICITIES
- Symptoms and findings
- POTENTIAL SEVERE ADVERSE EFFECTS
- Pulmonary toxicity
- Risk of infection
- Risk of lymphoproliferative disorders
- Pregnancy risk
- OTHER ADVERSE EFFECTS
- PREVENTION OF SIDE EFFECTS WITH FOLATE
- SUMMARY AND RECOMMENDATIONS