How can I get prescribed methotrexate for my condition?

How to Get Prescribed Methotrexate

To be prescribed methotrexate, you must see a physician (typically a dermatologist, rheumatologist, or gastroenterologist) who will evaluate your condition, perform required baseline testing, and determine if you meet criteria for treatment—methotrexate is primarily prescribed for conditions like psoriasis, rheumatoid arthritis, and other inflammatory diseases requiring systemic therapy. 1

Conditions That Qualify for Methotrexate Prescription

Methotrexate is FDA-approved and commonly prescribed for:

• Severe psoriasis requiring systemic therapy 1
• Rheumatoid arthritis (most common indication) 1
• Psoriatic arthritis 1
• Juvenile rheumatoid arthritis (FDA-approved for children) 1
• Other inflammatory conditions including severe atopic eczema, discoid lupus, giant-cell arteritis, polymyalgia rheumatica, systemic lupus erythematosus, and dermatomyositis (off-label uses) 1

Required Pre-Treatment Evaluation

Before prescribing methotrexate, your physician must complete the following assessments 1:

Medical History Assessment

• Alcohol intake (must be limited to well below national guidelines; excessive alcohol is a contraindication) 1
• Pregnancy plans (absolute contraindication during pregnancy and for 3 months after stopping) 1
• History of liver disease, hepatitis B/C, or HIV 1
• Kidney disease (severe renal dysfunction is an absolute contraindication) 1
• Tuberculosis exposure 1
• Varicella (chickenpox) history 1
• Pulmonary disease or respiratory symptoms 1

Mandatory Baseline Laboratory Tests

Your physician must order these tests before prescribing 1:

• Complete blood count (CBC) with differential 1
• Liver function tests (AST, ALT, albumin, bilirubin) 1
• Kidney function (creatinine, estimated GFR) 1
• Hepatitis B and C serology 1
• Chest X-ray (within the previous year) 1
• Consider: HIV serology, varicella zoster virus serology (if no chickenpox history), fasting glucose, lipid profile, pregnancy test 1

Absolute Contraindications That Prevent Prescription

You cannot be prescribed methotrexate if you have 1:

• Pregnancy, attempting to conceive, or breastfeeding 1
• Severe kidney dysfunction (creatinine clearance <20 mL/min) or on dialysis 1
• Severe liver dysfunction or cirrhosis 1
• Bone marrow dysfunction or failure 1
• Active tuberculosis or active hepatitis infection 1
• Pulmonary fibrosis or significantly reduced lung function 1
• Active peptic ulceration 1
• Concurrent trimethoprim therapy 1
• Hypersensitivity to methotrexate 1

What to Expect During the Prescribing Visit

Your physician will 1:

1. Explain the weekly dosing schedule (methotrexate is taken once weekly, NOT daily—daily dosing can be fatal) 1, 2
2. Prescribe only 2.5 mg tablets to avoid accidental overdose 1
3. Explain onset of benefit takes 3-12 weeks (sometimes up to 16 weeks) 1
4. Mandate effective contraception for both men and women of reproductive age 1
5. Emphasize toxicity monitoring with regular blood tests—patients unable to comply should not receive the drug 1
6. Warn about toxicity symptoms: fever/flu-like illness, mouth ulceration, tiredness, unexplained bruising or bleeding, nausea, vomiting, abdominal pain, dark urine, breathlessness, or cough 1
7. Recommend vaccinations: pneumococcal vaccine and yearly influenza vaccination 1
8. Discuss drug interactions (NSAIDs, antibiotics, salicylates can increase toxicity) 1

Initial Prescription Details

Starting dose for healthy adults 1:

• 5-15 mg once weekly (oral) for skin diseases 1
• 10-15 mg once weekly (oral) for rheumatoid arthritis 1
• Lower doses (2.5-5 mg weekly) for patients with renal impairment 1

Mandatory concurrent prescription 1:

• Folic acid supplementation: At least 5 mg weekly (on a different day than methotrexate) OR 1 mg daily except on methotrexate day 1

Required Monitoring Schedule

Once prescribed, you must comply with regular monitoring 1:

• First month: Blood tests (CBC, liver function, kidney function) every 7-14 days 1
• After stabilization: Blood tests every 2-3 months 1
• Clinical assessment for side effects at each visit 1

Common Pitfalls to Avoid

• Never take methotrexate daily—this is a fatal error; it must be taken once weekly only 1, 2
• Do not drink excessive alcohol—this significantly increases liver toxicity risk 1
• Avoid pregnancy for 3 months after stopping (applies to both men and women) 1
• Report infections immediately—methotrexate may need to be temporarily stopped 1, 3
• Inform all healthcare providers you are taking methotrexate, especially before surgery or when prescribed new medications 1