Massage is NOT Contraindicated in Patients Taking Methotrexate
Massage therapy is not listed as a contraindication or precaution in any established clinical guidelines for methotrexate use, and there is no evidence-based reason to avoid massage in patients receiving methotrexate therapy.
Established Contraindications to Methotrexate
The comprehensive guidelines clearly define what is actually contraindicated with methotrexate therapy, and massage is notably absent from these lists:
Absolute Contraindications 1:
- Pregnancy and breastfeeding
- Cirrhosis or severe hepatic dysfunction
- Severe renal dysfunction or dialysis
- Bone marrow dysfunction or failure
- Active tuberculosis or hepatitis virus infections
- Pulmonary fibrosis or significantly reduced lung function
- Active peptic ulceration
- Concurrent trimethoprim therapy
- Hypersensitivity to methotrexate
Relative Contraindications 1:
- Mild-to-moderate renal or liver impairment
- History of hepatitis B and C
- Gastritis
- Excessive alcohol intake
- Patient unreliability
- Recent live vaccinations
- Immunodeficiency states
Why Massage is Safe
There is no pharmacological, physiological, or clinical rationale for avoiding massage in patients on methotrexate. The drug's toxicity profile involves hematologic, hepatic, pulmonary, and renal systems 1, 2, 3, none of which would be adversely affected by massage therapy.
Key Safety Considerations
The actual precautions for methotrexate patients relate to:
- Infection risk: Methotrexate should be temporarily discontinued during severe infection 4, but routine massage does not pose significant infection risk in patients without active infection
- Drug interactions: Concerns involve medications like sulfonamides, salicylates, NSAIDs, and antifolate drugs 2, 5—not physical therapies
- Monitoring requirements: Regular blood tests for liver function, renal function, and complete blood counts 1—unrelated to massage
Clinical Bottom Line
Patients taking methotrexate can safely receive massage therapy. The only reasonable precaution would be to avoid massage in areas with active skin lesions (if being treated for psoriasis) or if the patient has severe thrombocytopenia from methotrexate toxicity 1, which would be a general precaution for any patient with severe platelet deficiency, not specific to methotrexate use.
The extensive literature on methotrexate safety focuses on systemic toxicities, drug interactions, and lifestyle modifications like alcohol restriction 1—massage therapy is simply not a concern in methotrexate management.