Methotrexate is a medication used in children to treat autoimmune conditions. Examples include:
The doses used to treat these conditions are considered low dose and are therefore NOT chemotherapy.
Low dose methotrexate works to slow down your child’s overly active immune system to reduce symptoms of their disease.
Methotrexate can be given enterally (by mouth or feeding tube) or by injection under the skin (subcutaneous).
Low dose Methotrexate is usually given once a week on the same day each week.
It is ok to give tablets either with or without food.
Do NOT crush the tablets.
Tablets may be cut in half or quarters using a tablet cutter (used for methotrexate ONLY) inside a clear snap lock (zip lock) bag.
If your child cannot swallow tablets, they can be dispersed (mixed) in water using an oral or enfit dispenser.
You can do this by:
Prefilled syringes with attached needles must be immediately placed into a cytotoxic sharp’s container after use. Avoid recapping the needle at any time.
Close the sharps container when it is almost full and either take it with you to your next specialist appointment at QCH or with prior arrangement, return it to a participating pharmacy.
It is unlikely that you will get an accidental needle-stick injury but if you do happen to prick yourself with the needle while preparing the injection or disposing of the syringe, you should:
Never give a double dose of the medicine to catch up a missed dose.
If you forgot to give a dose and remember any time over the next two days, give the missed dose. For example, if you usually give methotrexate on a Monday, you can give it on a Tuesday or Wednesday. If you remember after this, do NOT give the missed dose.
If your child vomits less than 30 minutes after having a dose of oral/enteral methotrexate, give them the same dose again. If it is subcutaneous do not readminister.
If your child vomits more than 30 minutes after having a dose of either oral or subcutaneous methotrexate, do NOT give them another dose. Wait until the next normal dose.
Avoid stopping methotrexate without discussing with your child’s specialist team.
If you think your child has had too much methotrexate, call the Poisons Information Centre on 13 11 26, even if your child shows no effects.
Tell your doctor or pharmacist about any other medicines or products your child takes before starting methotrexate. This includes prescription, over the counter medicines, vitamins, supplements, herbal or complementary medicines that you buy from a pharmacy, supermarket, health food shop or online.
You can give your child medicines that contain paracetamol or ibuprofen (anti-inflammatories) to treat pain and fever unless your doctor has told you not to.
Side effects to be aware of include upset stomach, nausea, vomiting, diarrhea, loss of appetite, mouth ulcers, skin sensitivity to the sun, rash, skin itch, and elevated liver enzymes in the blood.
Folic acid may be prescribed to reduce the likelihood of experiencing side effects of methotrexate. It should be taken on a different day(s) from the methotrexate, normally the day before and/or after taking methotrexate.
Regular blood tests are important for monitoring liver enzyme levels.
Only give this medicine to your child who was prescribed it. Never give it to anyone else, even if their condition appears to be the same, as this could do harm. Contact Poisons Information Centre on 13 11 26 if another person takes this medicine.
Always have valid prescriptions and enough supply of methotrexate. Methotrexate injections for subcutaneous use (under the skin) may need to be collected from your local hospital pharmacy. Methotrexate tablets should be collected from your local community pharmacy.
Methotrexate prefilled syringes and tablets are usually stored at room temperature. This means in a cool dry place (such as a cupboard) away from heat, direct sunlight and moisture, and kept below 25oC. Prefilled syringes can be stored in the refrigerator (2-8oC) if required, without affecting potency. Storage recommendations can change over time so always check storage information provided by the manufacturer.
Store all medicines out of sight and where children cannot reach them. Always keep medicine in the container or box that it came in.
Dispose of expired medicines or medicines you no longer need to your pharmacy.
This fact sheet is about using this medicine in children and young people. Some information may be different from the manufacturer’s Consumer Medicine Information (CMI). Talk to your doctor, nurse or pharmacist if you have any questions or concerns.
In an emergency, always contact 000 for immediate assistance
Pharmacy Department
Level 2, Queensland Children’s Hospital
501 Stanley Street, South Brisbane 4101
t: 07 3068 1901 (9am – 5pm Mon – Fri)
(9am – 12pm Sat – Sun/public holidays)
Outpatient Speciality Clinics (9am – 5pm Mon – Fri)
Rheumatology
t: 07 3068 2389
Dermatology
t: 07 3068 5893
Gastroenterology
t: 07 3068 4325
Endorsed by Queensland Children’s Hospital Medication Safety Committee and developed by 2023 with input from parents and carers.
Updated: 06/01/2023, v1.0.
Contact CHQMedicationSafety@health.qld.gov.au for sources used to create this Fact Sheet.
Disclaimer: We take great care to make sure the information in this Fact Sheet is correct, up-to-date and reflects current use in Australia. However, medicines can be used in different ways for different patients. It is important that you ask the advice of your doctor or pharmacist if you are not sure about something.
This Fact Sheet is to be used as an aid, rather than a substitute for a discussion with your doctor or pharmacist. Children’s Health Queensland Hospital and Health Service accepts no responsibility for any inaccuracies, omissions, reliance placed, or the success of any treatment regimens detailed in this Fact Sheet.