Side effects may occur when taking Methotrexate, but the majority of these effects tend to resolve spontaneously. Common side effects include:

• Nausea and vomiting (Can be minimized by taking Methotrexate after food)
• Loss of appetite
• Dizziness
• Diarrhoea
• Mouth ulcers
• Hair loss (Reversible after stopping the medicine)
• Malaise i.e. general feeling of discomfort
• Skin rash may occur with excessive exposure to the sun (Avoid prolonged exposure to sun and use sunscreen)

Folic acid tablet may be prescribed by your doctor to prevent or decrease certain side effects. It is usually taken the day after Methotrexate.

Consult your doctor or pharmacist about any symptoms that becomes bothersome

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• STOP taking Methotrexate and let your doctor know if you develop an allergic reaction. Rash due to allergic reaction to Methotrexate is rare. Possible symptoms of allergic reaction are:
• rash, hives, or itching
• red, swollen, blistered or peeling skin with or without fever
• wheezing or tightness in the chest or throat
• trouble breathing or talking
• unusual hoarseness
• swelling of the mouth, face, lips, tongue or throat
• STOP taking Methotrexate and seek medical attention immediately if you experience any of the rare but severe side effects:
• liver problems - possible symptoms are dark urine, feeling tired, lack of appetite, nausea, abdominal pain, light-coloured stools, vomiting, or yellow skin or eyes
• breathlessness or persistent dry cough
• severe mouth ulcers or severe sore throat that does not heal within 3 days
• Methotrexate may increase risk of developing certain kinds of infections due to reduced white blood cells (a key component of the body's immune system that helps to fight infections). Tell your doctor immediately if you experience any symptoms of infection such as temperature exceeding 38°C, chills, cough, painful or bloody urination, feeling very tired or weak.
• Avoid raw (e.g. sashimi) or half-cooked foods (e.g. half-boiled eggs) to prevent food poisoning.
• While having treatment with Methotrexate, you must see your doctor as scheduled to monitor response to treatment and minimize any possible side effect.
• Methotrexate may impair fertility in both men and women. Both men and women of childbearing age must use a reliable method of contraception to avoid the risk of an unplanned pregnancy as Methotrexate can cause serious defects to unborn child. You should not plan to have children while taking Methotrexate and for at least 6 months after stopping Methotrexate.
• Low amount of Methotrexate passes into human breast milk and may cause serious unwanted effects to the child. You should not breastfeed if you are taking Methotrexate.
• Methotrexate may interact with other medicine or supplement that you are taking. Inform the doctor, pharmacist or specialty nurse (such as dermatology, gastroenterology or rheumatology) before starting any medicines and supplements. Medicines such as certain antibiotics (e.g. co-trimoxazole) should be avoided as they might increase the chance of you experiencing severe side effects.
• Alcohol may interact with Methotrexate and increase the risk of liver toxicity. It should be avoided if possible or kept to minimum amount as suggested by your doctor.
• Immunization status should be current before starting the medicine. Do not receive any live vaccine while you are on Methotrexate. Always consult your doctor before going for immunisation.

• Methotrexate should be taken as prescribed by the doctor. It is usually given orally once weekly, taken at the same day of each week. Occasionally, the dose is split into 2 doses taken at 2 different days of the week, to improve absorption or avoid side effects such as nausea.
• A typical adult dose ranges from 7.5 milligrams to 25 milligrams per week. For children , the dose is usually calculated based on body weight or body surface area. The dose varies for each person depending upon many factors such as how active your disease is and how you respond to or tolerate the medicine. Your doctor may reduce the dose if you have kidney or liver problem.
• To maximise the absorption, Methotrexate should be taken on empty stomach (an hour before food or 2 hours after food). However, if you experience stomach discomfort taking Methotrexate on empty stomach, you may take it with food. If you vomit within a few hours of taking Methotrexate, do not take another dose. Make a note and let your doctor know if this happens again the following week.
• Drink plenty of water (preferably at least 8 glasses of water per day, unless otherwise advised by your doctor) while you are taking Methotrexate.
• Methotrexate tablets should be swallowed whole, with a glass of water. The tablets should not be crushed or chewed.
• However, for people who are unable to swallow tablets whole, your pharmacist may advise you to soak the tablets in water for a few minutes before grinding them  to minimise the inhalation of medicine powder. Talk to your pharmacist for further details if you have difficulty swallowing.
• Rarely, your doctor may prescribe Methotrexate injection to replace the oral tablet to achieve better result. It is to be given via injection under the skin (subcutaneously) of your stomach, thigh or upper outer arm. You or your carer should receive training on how to inject Methotrexate from your doctor, pharmacist or specialty nurse prior to attempting the administration on your own. Always remember to rotate the injection site.
• You may start to see improvement within a few weeks, but it may take up to 3 months to experience its full benefit.

If you forget to take a dose, take it as soon as you remember if this is within two days of the scheduled dose. For example, scheduled dose is on Monday, you remember on Wednesday, take Methotrexate on Wednesday and return to Monday schedule the next week.

Otherwise, skip the forgotten dose and continue with your regular dosing schedule. For example, scheduled dose is on Monday, you remember on Friday, skip dose and take usual dose next Monday.

Do not take a double dose to make up for the forgotten dose.

Keep away from children;#Keep in a cool, dry place, away from direct sunlight;#Store at room temperature;#

Methotrexate should not be disposed of via wastewater or household waste. Consult your pharmacist or specialty nurse on disposal measures for unused medicines. You may bring the unused medicines to the pharmacy or clinic for proper disposal.

If you have further questions about Methotrexate, please call ______________________ (office number) to discuss with your doctor / pharmacist / specialty nurse (please circle as appropriate).