Methotrexate (Maxtrex)

• What methotrexate is
• How you have treatment
• Common side effects
• Occasional side effects
• Important points to re member
• Immunisations and chemotherapy

Methotrexate is a chemotherapy drug. Its brand name is Maxtrex. It is used to treat various types of cancer, including breast cancer, bladder cancer and bone cancers, as well as some types of leukaemia. It is one of a group of chemotherapy drugs called anti-metabolites.

Methotrexate is similar to a normal body molecule called folinic acid, but has a slightly different structure. So it stops some cells working properly. Anti-metabolites often stop cells making and repairing DNA. Cancer cells need to make and repair DNA to grow and multiply.

Methotrexate also stops some normal cells working properly, causing side effects. You may have folinic acid 24 hours after you have had methotrexate. It helps the normal cells recover and helps stop side effects.

The way you have methotrexate depends on the type of cancer you have. You may have it in one of the following ways.

• An injection or infusion (drip) into a vein
• An injection into the spine (intrathecally)
• An injection into a muscle (intramuscular injection)
• A tablet that you swallow

You usually have chemotherapy as a course of several cycles of treatment. The treatment plan for methotrexate depends on your type of cancer. There is more about planning chemotherapy in the chemotherapy section of CancerHelp UK.

The side effects of methotrexate are listed below. You can use the links to find out more about each side effect or click on 'search' at the top of the page.

With this drug, many people have a temporary drop in the number of blood cells made by the bone marrow, leading to the following side effects

• Increased risk of getting an infection from a drop in white blood cells - it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery. 
• Tiredness and breathlessness due to a drop in red blood cells (anaemia) - you may need a blood transfusion
• Bruising more easily due to a drop in platelets - you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia).

These effects on your bone marrow can begin about 7 days after each treatment and usually go back to normal after about 21 to 28 days. Some of these side effects can be life threatening, particularly infections.  You should contact your doctor if you have any of these side effects.  Your doctor will check your blood counts regularly to see how well your bone marrow is working

Other common side effects include

• Fatigue during and after treatment - most people find their energy levels are back to normal within 6 months to a year
• Taste changes
• Mouth sores and ulcers
• Diarrhoea - drink plenty of fluids and tell your doctor if diarrhoea becomes severe or lasts more than a couple of days, as you could get dehydrated
• Gritty eyes
• Hair loss or hair thinning with high dose methotrexate
• This drug may harm a baby developing in the womb, so it is not advisable to become pregnant or father a child while you are having chemotherapy - talk about contraception with your doctor before having the treatment if there is any chance that you or your partner could become pregnant

Some people have the following side effects

• Feeling or being sick happens in about 4 out of 10 people (40%) with high doses of methotrexate
• Damage to the kidneys
• Blurred vision or eye pain
• Sensitivity of the skin to sunlight - don’t sit out in the sun and cover up or use sun block on exposed skin
• A skin rash, which may be itchy
• Coughing or breathlessness caused by changes to lung tissue
• Liver changes that are very mild and unlikely to cause symptoms - the liver will almost certainly go back to normal when treatment is finished, but you will have regular blood tests to check how well your liver is working
• Darkening or lightening of skin
• An allergic reaction including skin rashes and itching, a high temperature, shivering, redness of the face, feeling dizzy, a headache, breathlessness, anxiety and a need to pass urine
• Women may stop having periods (amenorrhoea) but this may only be temporary
• Loss of fertility - you may not be able to get pregnant or father a child after treatment with this drug, so talk to your doctor about your fertility before starting treatment if this is a concern

The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on

• How many times you've had the drug before
• Your general health
• The amount of the drug you have (the dose)
• Other drugs you are having

Some side effects are inconvenient or upsetting but not damaging to your health.

Some side effects are serious medical conditions and need treating. Where we have urged you to contact your doctor, this is because

• Your side effect may need treating
• Your drug dose may need reducing to try to prevent the side effect

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and other over the counter remedies - some drugs can react together.

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them.

Your chemotherapy nurse, clinic or ward nurse will have given you a contact number. You can ring if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them.

You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy.

It is perfectly safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but no one in the UK is given an oral vaccine now. So there is no problem in being with any baby or child who has recently had any vaccination in the UK. If you live abroad, you might need to make sure that you aren't in contact with anyone who has had oral polio or oral typhoid vaccination recently.