Methotrexate
Brand Names: Rasuvo, Xatmep, Otrexup, Jylamvo, Trexall, Trexall, Rheumatrex
Methodology & AI Transparency ⓘ
Methotrexate Key Takeaways
Translated by Sarah Jenkins (AI RN Plain-English Translator) at a 7th-grade reading level
- 1 What it does: Methotrexate tablets are a dihydrofolate reductase inhibitor indicated for the: Treatment of adults and pediatric patients with acute lymphoblastic leukemia (ALL) as part of a combination chemotherapy maintenance regimen ( 1.1 ) Treatment of adults with mycosis fungoides ( 1.1 ) Treatment of adults with relapsed or refractory non-Hodgkin lymphoma as part of a metronomic combination regimen ( 1.1 ) Treatment of adults with rheumatoid arthritis ( 1.2 ) Treatment of pediatric patients with polyarticular juvenile idiopathic arthritis (pJIA) ( 1.3 ) Treatment of adults with severe psoriasis ( 1.4 ) 1.1 Neoplastic.
- 2 Real-world patient consensus: Tracked across 16 patient dosage logs with a 75% satisfaction benchmark (RxCUI 105585).
- 3 Typical cash cost range: Dispensing cost comparison spans $7.70 mail/discount cash up to $34.50 uninsured retail (federal NADAC $936.1226).
- 4 Top reported side effects / signs: Leading openFDA/SPL adverse events for Methotrexate: nausea (10%), headache (8.3%), dizziness (6.8%).
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Methotrexate Mechanism, CYP450 Pathways & DailyMed Monograph
Methotrexate tablets are a dihydrofolate reductase inhibitor indicated for the: Treatment of adults and pediatric patients with acute lymphoblastic leukemia (ALL) as part of a combination chemotherapy maintenance regimen ( 1.1 ) Treatment of adults with mycosis fungoides ( 1.1 ) Treatment of adults with relapsed or refractory non-Hodgkin lymphoma as part of a metronomic combination regimen ( 1.1 ) Treatment of adults with rheumatoid arthritis ( 1.2 ) Treatment of pediatric patients with polyarticular juvenile idiopathic arthritis (pJIA) ( 1.3 ) Treatment of adults with severe psoriasis ( 1.4 ) 1.1 Neoplastic.
12.1 Mechanism of Action Methotrexate inhibits dihydrofolic acid reductase. Dihydrofolates must be reduced to tetrahydrofolates by this enzyme before they can be utilized as carriers of one-carbon groups in the synthesis of purine nucleotides and thymidylate. Therefore, methotrexate interferes with DNA synthesis, repair, and cellular replication. Actively proliferating tissues such as malignant cells, bone marrow, fetal cells, buccal and intestinal mucosa, and cells of the urinary bladder are in general more sensitive to this effect of methotrexate. The mechanism of action in rheumatoid arthritis and in psoriasis is unknown.
Following administration (2.5 mg/1 Tablet), Methotrexate achieves ~60% systemic bioavailability (Methotrexate) bioavailability and peak plasma tmax within 0.75 to 6 hours (methotrexate) onset, governed by a Terminal t½ estimated at 4–9 hrs depending on renal/hepatic reserve (Methotrexate) terminal half-life through mixed metabolic conjugation and unchanged urinary excretion across methotrexate regimens.
Before initiating Methotrexate at 2.5 mg/1 Tablet, clinical safety checklists rule out methotrexate tablets are contraindicated in: pregnant women receiving methotrexate tablets for treatment of non-neoplastic diseases .; patients with a history of a severe hypersensitivity reactions, including anaphylaxis, to methotrexate.; in pregnancy for non-neoplastic diseases ( 4 ) history of severe hypersensitivity to methotrexate ( 4 ). Logged tolerability patterns center on nausea (10% of reports), headache (8.3% of reports), dizziness (6.8% of reports).
Assess baseline hepatic panels and interacting prescriptions when starting Methotrexate (folate analog metabolic inhibitor).
Shifts in intragastric pH can modestly influence dissolution kinetics of oral Methotrexate dosage forms.
Standard Adult Titration & Dosages
Absolute & Relative Contraindications
- Methotrexate tablets are contraindicated in: Pregnant women receiving methotrexate tablets for treatment of non-neoplastic diseases .
- Patients with a history of a severe hypersensitivity reactions, including anaphylaxis, to methotrexate.
- In pregnancy for non-neoplastic diseases ( 4 ) History of severe hypersensitivity to methotrexate ( 4 )
Logged Side-Effect Incidence (16 Reports)
Methotrexate Real-World Side Effects: openFDA FAERS vs. Patient Micro-Logs
Peer-Reviewed Human Clinical Trials & Meta-Analyses (Methotrexate)
| Study & Plain-English Finding | Sample (N) | Rigor | Primary Source |
|---|---|---|---|
| New Insights on Benefits and safety of filgotinib in patients with moderately active autoimmune: What a 1,755-Participant Study Found In this subpopulation with moderately active RA, the real-world benefits and safety of filgotinib were similar to those in the overall FINCH 1 population (patients with active moderate to severe RA). Rheumatology (Oxford, England) • 2025-04-01 • Phase III Randomized Trial | N = 1,755 | 96/100 | PMID 39331638 ↗ |
| New Insights on Benefits and safety of tofacitinib modified-release 11 mg once daily plus: What a 694-Participant Study Found Tofacitinib modified-release 11 mg once daily plus methotrexate conferred improvements in disease activity measures, functional outcomes and PROs, with most (84.5%) patients achieving CDAI-defined LDA after 24 weeks of... RMD open • 2021-06-15 • Phase III Randomized Trial | N = 694 | 93/100 | PMID 34103405 ↗ |
| New Insights on Olokizumab, a monoclonal antibody against interleukin 6, in combination with: What a 428-Participant Study Found Treatment with OKZ was associated with significant improvement in signs, symptoms and physical function of autoimmune joint pain (autoimmune joint pain (rheumatoid arthritis)) without discernible differences between the two... Annals of the rheumatic diseases • 2022-04-15 • Phase III Randomized Trial | N = 428 | 93/100 | PMID 34344706 ↗ |
| New Insights on Trajectory of clinical responses in patients with early autoimmune joint pain: What a 451-Participant Study Found A high proportion of individual patients achieving clinical endpoints at IP week 24 with abatacept + methotrexate sustained their responses through week 52. Arthritis research & therapy • 2023-04-22 • Phase III Randomized Trial | N = 451 | 93/100 | PMID 37087459 ↗ |
| New Insights on Differences and similarities in clinical and functional responses among patients: What a 1,146-Participant Study Found These results suggest that patients with a greater response did well, irrespective of which therapy they received. Arthritis research & therapy • 2021-08-24 • Phase III Randomized Trial | N = 1,146 | 90/100 | PMID 34429160 ↗ |
Methotrexate Public Price Transparency Ledger
| Dispensing Channel / Benchmark | Verification Source | Reference Cost | Details |
|---|---|---|---|
| Pharmacy Acquisition Cost (CMS NADAC) | CMS Medicaid NADAC Weekly National Survey | $936.1226/unit (~$28083.68/30u) | Wholesale baseline |
| Mark Cuban Cost Plus Drugs (Mail-Order Generic) | Public Wholesale Price List (NADAC + 15% + pharmacy fee) | $7.70 / mo | Formulary listing ↗ |
| Average U.S. Walk-In Retail Cash Price | Chain Pharmacy Uninsured Cash Index | $34.50 / mo | Before coupon/insurance |
| Patient-Logged Out-of-Pocket Average | 16 Anonymous DotMD Community Micro-Logs | $8.85 / mo | View logs ↓ |
Methotrexate Federal Verification & Benchmark Summary
| Metric | Verified Benchmark | Source |
|---|---|---|
| Methotrexate RxNorm Concept ID | 105585 | U.S. National Library of Medicine (RxNorm) |
| CMS NADAC Pharmacy Acquisition Unit Cost | $936.1226 / unit | CMS Medicaid NADAC Weekly Feed |
| Walk-In Chain Pharmacy Cash Average | $34.50 / mo | U.S. Uninsured Retail Cash Index |
| Public Mail-Order Wholesale Benchmark | $7.70 / mo (Cost Plus Drugs) | Mark Cuban Cost Plus Public API |
| Real-World Patient Consensus | 75.00% Worth It (16 anonymous logs) | DotMD Zero-PHI Patient Ledger |
Methotrexate Patient Community, Cohort Filters & Dosage Logs
Cross-verified Methotrexate (folate analog metabolic inhibitor) monograph synthesizing RxNorm 105585, openFDA FAERS signals, and $7.70–$34.50 cash benchmarks.
Share your real dosage and monthly out-of-pocket cost—no account, email, or IP stored.
Filter Methotrexate community threads and patient logs by age, biological sex, dosage, and treatment duration.