If you are taking methotrexate, you will need close supervision, with regular laboratory visits.

At our clinic, we generally put patients on a weekly schedule of methotrexate, rather than a daily schedule. Studies show that this is the most effective way to treat severe skin conditions. We generally have all of our patients who are taking methotrexate, starting on Sunday and ending on Monday.

If you start a new medication from another physician, please call our office to let us know. This is especially true for aspirin and aspirin-related drugs, such as non-steroidal antiinflammatory medications, such as Motrin.

Antibiotics that contain trimethoprim may also interfere with methotrexate.

Illness can increase the risk of methotrexate. Dehydration from fever, or vomitting, or diarrhea can make you more susceptible to methotrexate toxicity. Make sure you drink plenty of fluids while you are on methotrexate therapy.

Avoid alcohol while you are on methotrexate. Alcohol and methotrexate do not mix.

Side effects of methotrexate include the following:

*Gastrointestinal side effects such as nausea of loss of appetite. Occasionally, sores in the mouth may occur. These side effects are usually temporary. Please let us know if they continue.

*Methotrexate must be avoided in pregnancy.

*Methotrexate interferes with male spermatogenesis. Men should not father children while on methotrexate or for 12 months afterwards, because of its effect on the sperm.

*Liver disease. Long-term therapy may cause scarring or cirrhosis of the liver. A liver biopsy may be required while you are on methotrexate therapy.

*Lung disease. Methotrexate may cause a rare lung reaction similar to pneumonia. Fever; dry, hacking cough; or shortness of breath should be reported if it does not stop.

A folic acid vitamin supplement may be taken while you are on methotrexate therapy as it does seem to prevent some of the side effects.