Methotrexate: Uses, Side Effects, and What You Need to Know

When you hear methotrexate, a drug used to treat autoimmune diseases and some cancers by slowing down overactive immune cells. Also known as MTX, it's one of the most prescribed medications for rheumatoid arthritis and psoriasis — and it’s been around long enough that doctors still rely on it, even with newer options. But it’s not a simple pill. It’s a powerful tool that demands respect, and understanding how it works is the first step to using it safely.

Methotrexate is a type of immunosuppressant, a class of drugs that calm down the immune system when it attacks the body by mistake. That’s why it helps with conditions like rheumatoid arthritis, where your immune system mistakenly targets your joints. It’s also used in lower doses for psoriasis, where skin cells grow too fast. In higher doses, it’s used as chemotherapy for cancers like leukemia and lymphoma — it stops rapidly dividing cells, whether they’re cancerous or not. But here’s the catch: it doesn’t just target bad cells. It affects your gut lining, bone marrow, and liver too. That’s why side effects like nausea, fatigue, and low blood counts are common.

People on methotrexate often worry about how it interacts with other things they take. Alcohol? That’s a no-go — it increases liver damage risk. Folic acid? That’s a yes — most doctors prescribe it alongside methotrexate to reduce side effects without lowering effectiveness. And if you’re on other meds like NSAIDs or certain antibiotics, you need to check with your doctor. These can pile up in your system and make methotrexate more toxic. It’s not just about the drug itself — it’s about your whole health picture.

What you won’t always hear is how people manage life on methotrexate long-term. Some feel better than they have in years. Others struggle with the fatigue or the monthly blood tests. Some switch to biologics after a while. Others stick with methotrexate because it works and it’s affordable. The stories are different, but the goal is the same: control the disease without losing your quality of life.

Below, you’ll find real guides from people who’ve walked this path — whether they’re comparing methotrexate to newer drugs, dealing with side effects, or figuring out how to take it safely with other conditions. No fluff. No marketing. Just practical info from those who’ve been there.