How does this medicine work?

Methotrexate (meth-o-trex-ate) destroys cancer cells by interfering with a specific phase of the cell’s life cycle.

How is it given?

Methotrexate is given as a pill, or by injection into the vein, muscle, or spinal fluid as directed by the doctor.
Methotrexate is usually given weekly; give it at regular times to keep a steady level in the bloodstream. Your child should be awake and alert when taking any medicine.
For children who cannot swallow pills:

  • Put on gloves.
  • Crush it in a tablet crusher or between 2 spoons inside a clear plastic bag.
  • Mix the powder with a very small amount (about 1 teaspoon) of soft food, such as applesauce, chocolate syrup, or jelly. Make sure your child takes all of the mixture.
  • Wash spoons and container right after use. Discard the plastic bag and gloves.

Are there any precautions about food or other medicines?

It is best to take methotrexate on an empty stomach (no food from 2 hours before until 1 hour after a dose). Especially avoid milk products, since they can decrease absorption of the medicine.

Avoid alcohol-containing foods, beverages, or over-the-counter medicines such as cough syrup while taking this medicine.

Check with the doctor before giving any other prescription or non-prescription medicines, herbs, or vitamins. Avoid taking ibuprofen products, aspirin, vitamin C, and Bactrim/Septra® during high doses. If your child is taking Dilantin®, talk with your doctor. Do not take folic acid supplements while taking methotrexate, unless your doctor tells you to.

What should I do if a dose is missed?

If one dose is missed, give it as soon as you remember. If your child vomits within 30 minutes after receiving a dose, give it again. If your child vomits after 30 minutes, do not repeat the dose. Call the oncology clinic or your doctor if more than one dose is missed or vomited.

What are the side effects?

Side effects increase with higher doses
Low-dose side effects are:


  • low blood cell counts


  • nausea, vomiting
  • hair loss
  • eye and skin sensitivity to the sun


  • mouth sores
  • liver damage

Moderate to high doses can cause:


  • low blood cell counts


  • nausea, vomiting
  • hair loss
  • sensitivity to the sun
  • mouth sores
  • loss of appetite
  • diarrhea
  • rash


  • tiredness
  • osteoporosis (weakened bones)
  • kidney, liver, or lung damage

Spinal fluid administration can cause:

Central nervous system changes such as

  • drowsiness
  • blurred vision
  • headache or backache
  • tingling or numbness in arms or legs
  • seizures

When should I call the clinic?

Call hematology helpline 982403210 if:

  • fever
  • sore throat
  • bleeding or bruising
  • shortness of breath
  • pain while urinating
  • mouth sores
  • continued diarrhea or vomiting
  • central nervous system changes as above
  • exposure to chickenpox, which can be more serious in a child taking methotrexate
  • signs of allergic reaction:
    • fever or chills
    • rash or hives
    • wheezing
    • trouble breathing – call 112

What else do I need to know?

Continued nausea, vomiting, diarrhea, or mouth sores may require a change in the dose or stopping the medicine for a while.

Leucovorin may be given to decrease side effects of high doses of methotrexate.

Blood samples may be needed to check the effects of the medicine.

All patients should wear sunscreen during methotrexate treatment and for 1 year after treatment is completed.

All caregivers should wear gloves when handling urine, stool, and vomit while your child is receiving the chemotherapy and for 48 hours afterward. Urine, stool, and vomit can be safely disposed of in septic tanks and the sewer system.

You and your child should know the names of all the medicines he or she is taking. It is important to share this information with anyone involved in your child’s care.

Always make sure you have enough medicine on hand as the pharmacy may need 2 or 3 days to refill the prescription. Check the label for the expiration date.
Flush outdated medicines down the toilet instead of putting them in the garbage.

Store all medicines in their original container and away from direct sunlight or heat. Do not store in humid places such as the bathroom. Keep them out of children’s reach, locked up if possible.

If too much or the wrong kind of chemotherapy medicine is taken, call the oncology clinic immediately.


This sheet is not specific to your child but provides general information. If you have any questions, please call:

Hematology Clinic
3rd floor, Kedar
Opp.Krupa Petrol Pump,
Parimal Garden, Ambawadi
Clinic: 07926463219
Whattsapp: 8238065890