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

When you hear methotrexate, a drug used to treat autoimmune conditions and certain cancers by slowing down overactive immune cells or fast-growing cells. Also known as MTX, it's one of the most commonly prescribed medications for rheumatoid arthritis and psoriasis, but it's also used in chemotherapy for leukemia and lymphoma. Many people take it daily or weekly without issues, but others face side effects that make them wonder if there’s a better option.

Methotrexate works by blocking folic acid, which cells need to multiply. That’s why it helps in conditions where the body’s immune system attacks itself—like rheumatoid arthritis—or when cancer cells grow too fast. It’s not a painkiller, but it reduces swelling and joint damage over time. People often mix it up with steroids or NSAIDs, but it’s different: it doesn’t just mask symptoms, it changes how the disease progresses. It’s also used off-label for conditions like Crohn’s disease and lupus, and sometimes paired with biologics to boost results. What most don’t realize is that even low doses for arthritis can cause serious side effects if not monitored—liver damage, lung issues, or low blood counts. That’s why regular blood tests are non-negotiable.

Alternatives to methotrexate exist, and they vary based on what you’re treating. For rheumatoid arthritis, drugs like leflunomide, a disease-modifying antirheumatic drug that works similarly but with different side effects or hydroxychloroquine, an antimalarial that’s gentler and often used in early-stage arthritis are common. For psoriasis, topical treatments or biologics like adalimumab might be preferred. In cancer, methotrexate is often part of a combo, but drugs like 5-fluorouracil, a chemotherapy agent that targets DNA synthesis differently might be used instead depending on the tumor type. The choice isn’t just about effectiveness—it’s about your liver health, kidney function, and whether you can handle weekly injections or pills.

What you’ll find in the posts below isn’t just a list of facts—it’s real-world comparisons. You’ll see how methotrexate stacks up against other drugs people actually use, what side effects are most common, how cost plays a role, and why some patients switch. There’s no one-size-fits-all answer, but the right info can help you ask better questions and make smarter choices with your doctor.