Methotrexate oral tablet is a generic version of the brand-name drug Trexall. Methotrexate also comes in an injectable form, but this form isn’t described in this article. To learn more about this form, talk with your doctor.
This article describes methotrexate oral tablet’s dosages, its strength, and details on how to take it. You’ll also find information on cost savings and coupon options for methotrexate.
If you want to know more about Trexall, the brand-name version of methotrexate oral tablet, see this overview article. It covers details about the drug’s uses, side effects, ways to save on cost, and more.
Boxed warnings
This drug has boxed warnings about the risks of fetal harm, severe allergic reaction, and other serious side effects. Boxed warnings are serious warnings from the Food and Drug Administration (FDA).
See the end of this article for more information about these warnings.
Form and strength of methotrexate
Methotrexate oral tablet comes as follows:
- Form: tablet that you swallow
- Strength: 2.5 milligrams (mg)
Dosage of methotrexate
This article describes the recommended dosages* for methotrexate oral tablet.
If your doctor prescribes this medication, you should take the dosage they prescribe. Your doctor will determine the dosage that best meets your needs. Do not change your dosage of methotrexate oral tablet without your doctor’s recommendation.
* The drugmaker provides these recommended dosages.
Usual recommended dosages of methotrexate in adults
Usually, doctors start by prescribing a low dosage of methotrexate oral tablet. Then, they’ll adjust it over time until the right dosage is reached. Ultimately, your doctor will prescribe the smallest dosage of methotrexate oral tablet that gives the desired outcome.
Dosage for rheumatoid arthritis (RA), psoriasis, and other conditions
The table below shows recommended dosages of methotrexate for RA, psoriasis, and other conditions in adults. After you take your starting dosage, you’ll take a maintenance dosage for the remainder of the treatment.
Some dosages are in milligrams (mg). For certain conditions, the dosage depends on your body surface area (BSA). BSA is measured in meters squared (m2). Your doctor will calculate your BSA using your weight in kilograms (kg) and your height in centimeters (cm). (For reference, 1 kg is about 2.2 pounds [lb].)
| Condition | Starting dosage | Maintenance dosage | Maximum dosage |
| RA | 7.5 mg once per week | increase as needed | 20 mg once per week |
| psoriasis | 10 mg to 25 mg once per week | increase as needed | 30 mg once per week |
| acute lymphoblastic leukemia | 20 mg/m2 once per week | 20 mg/m2 once per week | based on neutrophil levels |
| mycosis fungoides | • alone: 25 mg to 75 mg once per week • together with chemotherapy: 10 mg/m2 twice per week | • alone: 25 mg to 75 mg once per week • together with chemotherapy: 10 mg/m2 twice per week | • alone: 25 mg to 75 mg once per week • together with chemotherapy: 10 mg/m2 twice per week |
| non-Hodgkin’s lymphoma | 2.5 mg 2 to 4 times per week | 2.5 mg 2 to 4 times per week | 2.5 mg 2 to 4 times per week |
For example, assume a person’s body weight is 78 kg (about 172 lb) and their height is 183 cm (about 72 inches). With these numbers, the doctor calculates a BSA of 2 m2. To treat mycosis fungoides in this person, the doctor may prescribe a starting dosage of 20 mg twice per week along with chemotherapy. The doctor calculates this using the recommended starting dose of 10 mg per m2 (mg/m2). So 10 mg is multiplied by a BSA of 2 m2.
Dosages of methotrexate in children
The table below shows recommended dosages of methotrexate for acute lymphoblastic leukemia and polyarticular juvenile idiopathic arthritis in children. These dosages are the same as for adults. A maintenance dosage is what your child will take after the starting dosage for the remainder of treatment.
Note: The manufacturer of methotrexate hasn’t given a specific age range for children. A doctor can recommend whether this drug should be given to children of certain ages.
Dosages depend on your child’s body surface area (BSA). BSA is measured in meters squared (m2). Your doctor will calculate your child’s BSA using their weight in kilograms (kg) and their height in centimeters (cm). (For reference, 1 kg is about 2.2 pounds [lb].)
| Condition | Starting dosage | Maintenance dosage | Maximum dosage |
| acute lymphoblastic leukemia | 20 mg/m2 once per week | 20 mg/m2 once per week | based on neutrophil levels |
| polyarticular juvenile idiopathic arthritis | 10 mg/m2 once per week | increase as needed | 30 mg/m2 once per week |
For example, assume a child’s body weight is 31 kg (about 68 lb) and their height is 127 cm (50 inches). With these numbers, the child’s doctor calculates a BSA of 1 m2. To treat acute lymphoblastic leukemia in this child, the doctor may prescribe a starting dosage of 20 mg once per week. The doctor calculates this using the recommended starting dose of 20 mg per m2 (mg/m2). So 20 mg is multiplied by a BSA of 1 m2.
Dosage adjustments for methotrexate
Your doctor will prescribe a dosage of methotrexate oral tablet based on several factors. These include:
- the specific condition being treated and its severity
- any side effects you experience
- other health conditions you may have
Missed dose of methotrexate
Talk with your doctor or pharmacist right away if you realize you forgot to take a dose of methotrexate oral tablet. They may advise you to take the missed dose. Or they may advise you to skip it and take your next dose as scheduled.
For tips on how to plan your doses of methotrexate oral tablet and avoid missing a dose, read this article. You could also try:
- downloading a reminder app on your phone
- setting an alarm
- putting a note where you’ll see it, such as on your calendar, bathroom mirror, or bedside table
Frequently asked questions
Below are answers to some commonly asked questions about methotrexate oral tablet and its dosage.
Is 20 mg a high dose of methotrexate?
It depends on the condition methotrexate is treating. Always take the dose of methotrexate that your doctor prescribes for you. This helps ensure that your condition is being treated as effectively and safely as possible.
If you have questions about your dosage of methotrexate, discuss them with your doctor.
How does the oral tablet dosage of methotrexate compare with the injection dosage of the drug?
The dosages of methotrexate’s oral tablet and injection depend on the condition being treated. Both forms of methotrexate work the same and have the same active ingredient. The approved uses of methotrexate vary with the form.
If you’re interested in the methotrexate injection form, talk with your doctor. You can also learn more about the injection form in this article.
Is methotrexate taken long term?
Yes, doctors typically prescribe methotrexate oral tablet as a long-term treatment. If you and your doctor determine that it’s safe and effective for your condition, you’ll likely take it long term.
If you have questions about how long you should take methotrexate oral tablet, talk with your doctor.
Free prescription coupons
Seriously … free. Explore prices that beat the competition 70% of the time.
Get free cardHow methotrexate is taken
You’ll swallow methotrexate oral tablet, usually once per week for most conditions.
Doctors usually suggest taking methotrexate on an empty stomach. In some cases, they may recommend taking the drug with food if it causes stomach upset.
The maker of methotrexate oral tablet hasn’t stated whether the drug can be chewed, split, or crushed. If it’s hard for you to swallow tablets, view this article. It provides suggestions on how to swallow medications that come in pill form.
Also, be sure to talk with your doctor or pharmacist if you’re having difficulty taking your medication. They can offer recommendations about taking it.
Methotrexate coupon
Visit this page to access Optum Perks coupons and get price estimates for methotrexate when you use the coupons. These coupons can provide significant savings on your prescription costs.
Note: Optum Perks coupons cannot be used with any insurance copays or benefits.
Overdose of methotrexate
It’s important that you do not take more methotrexate oral tablet than your doctor prescribes. Doing so can lead to serious side effects.
Symptoms of methotrexate overdose
Symptoms of an overdose can include:
- nausea and vomiting
- mouth ulcers
- test results indicating low white blood cell count, low platelet count, low red blood cell count, and others
What to do if you take too much methotrexate
If you think you’ve taken too much methotrexate, call your doctor or pharmacist right away. Or you could call 800-222-1222 to speak with someone at America’s Poison Centers. You can also use its online resource. If you have severe symptoms, call 911 or a local emergency number immediately. You can also go to the closest emergency room.
What to ask your doctor
This article describes the usual recommended dosages for methotrexate oral tablet. If your doctor prescribes this medication, they’ll determine the dosage that’s best for you.
Do not change your dosage of methotrexate oral tablet without your doctor’s recommendation. You should take methotrexate oral tablet exactly as your doctor prescribes it. Let your doctor know if you have concerns or questions about your treatment plan.
Here’s a list of some possible questions you may want to ask your doctor:
- Will my dose of methotrexate increase my risk of side effects?
- What should I do if I forget to take my dose of methotrexate?
- Will my dose of methotrexate be adjusted based on my blood work?
Boxed warnings for methotrexate
This drug has boxed warnings about the risks of fetal harm, severe allergic reaction, and other serious side effects. Boxed warnings are serious warnings from the Food and Drug Administration (FDA).
Fetal harm. Taking methotrexate while pregnant can cause dangerous side effects in a fetus. This can include pregnancy loss. You should not take methotrexate while pregnant.
Severe allergic reaction. Methotrexate can cause serious allergic reaction. This can lead to anaphylaxis, which is a severe allergic reaction that can be fatal. If you’ve ever had an allergic reaction to methotrexate, you should not take it again.
Serious side effects. Methotrexate also may cause other serious side effects that can lead to life threatening complications, including death. Specifically, methotrexate may cause serious side effects affecting your:
- bone marrow
- digestive tract
- liver
- lungs
- skin
- kidneys
While you’re taking methotrexate, your doctor will monitor you closely for signs and symptoms of these serious side effects.
To learn more about any of these warnings, you can talk with your doctor.
Disclaimer: Optum Perks has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.