All medications
Conventional DMARDs & immunosuppressants
Methotrexate
Brand names: Otrexup, Rasuvo, RediTrex, Trexall, Xatmep
The cornerstone disease-modifying medicine for rheumatoid arthritis and a common treatment for many other inflammatory conditions.
Video lesson
Animated explainer
What it’s used for
Rheumatoid arthritis, psoriatic arthritis, polymyalgia rheumatica, myositis, vasculitis, lupus and sarcoidosis.
How it works
At the low weekly doses used in rheumatology, it calms overactive immune cells, partly by raising adenosine, a natural anti-inflammatory signal.
How it’s taken
Once a week, never daily, as tablets or an injection under the skin. Folic acid is taken on other days to reduce side effects. It takes 6 to 12 weeks to work.
Side effects
Nausea, tiredness the day after the dose, mouth sores, hair thinning, mild liver enzyme rises and lower blood counts. Rarely, lung inflammation.
Monitoring
Blood counts, liver and kidney tests every few weeks at first, then every 2 to 3 months.
Good to know
Limit alcohol. Stop methotrexate at least 1 to 3 months before trying to conceive. Avoid the antibiotic trimethoprim-sulfamethoxazole unless your rheumatologist approves.
At a glance
Class
Conventional DMARDs & immunosuppressants
Brand names
Otrexup, Rasuvo, RediTrex, Trexall, Xatmep
Reviewed by Farhan Tahir, MD, FACR
Questions about your own care?
Book an in-person or telehealth consultation with Dr. Tahir.
For education only. Don’t start, stop or change a medicine without talking to your care team.