Methotrexate for Treating Inflammatory Bowel Disease

October 28, 2021by Health Desk

Multiple medications are used to treat Inflammatory Bowel Disease (IBD). Some medications, such as steroids, control symptoms and achieve remission. Others are used to maintain remission, such as biologics and immunosuppressants. Methotrexate is used for Crohn’s Disease to maintain remission. It is usually preferred if the joints are involved with Crohn’s disease. Methotrexate is shown to be highly effective in the treatment of inflammatory Arthritis. It is less likely to be used for Ulcerative Colitis.

Methotrexate is an immune suppressant, which suppresses or weakens the immune system when necessary. Methotrexate causes the release of a molecule, called adenosine, which blocks other chemicals that promote inflammation. Because of this, it is used in inflammatory conditions, such as rheumatoid arthritis, Crohn’s disease, and Psoriasis.

Methotrexate also blocks folate, a form of vitamin B, that is used by cancer cells to multiply and grow. Because of this ability, it is used in certain cancers. The dosage used to treat cancer is extremely high compared to the dosage for autoimmune conditions. The side effects of Methotrexate at doses typically used for the treatment of autoimmune disease are rarely life-threatening.

Methotrexate, a slow-acting medication, may take 2-3 months before your symptoms improve. You can take it in tablet form or by injection.

Folic acid supplement

Some of the most common side effects of methotrexate are:

  • Nausea, vomiting and upset stomach
  • Mouth soreness
  • Headache
  • Fatigue or malaise
  • Impaired ability to concentrate
  • Skin rashes often on the elbows and knees
  • Fever
  • Hair loss

Folic acid is a vitamin that is generally prescribed to help reduce the possible side effects of Methotrexate, such as nausea, vomiting, fatigue, and soreness of the mouth.

No methotrexate and pregnancy

Tests or check-ups done before starting methotrexate

  • Before starting treatment, tests are done on liver, kidney and lung functions. Complete blood count is also checked. Methotrexate can affect blood count and cause liver and lung problems. Methotrexate may not be prescribed if your bone marrow, liver or kidneys are not functioning properly.
  • If you haven’t had chicken pox or shingles, your doctor may check if you are immune to them. You may be given a vaccine to protect from these before taking Methotrexate. 
  • Methotrexate can be harmful to an unborn baby. If you are a female, a pregnancy test is completed before starting the treatment. Methotrexate blocks folate, which is needed for the development of the unborn baby. Its deficiency may cause serious birth defects, called neural tube defects. Neural tube defects can affect the spine, spinal cord or brain.

Some things to know or do while taking Methotrexate

  • Tell all your healthcare providers you are taking this drug, including your dentist and pharmacist.
  • Talk to your doctor regarding folic acid supplements to counteract common side effects.
  • Because Methotrexate suppresses immunity, you may be more prone to infections. Wash your hands often. Stay away from people with infections, colds or flu. Check with your doctor if you have symptoms, such as fever, chills, flu-like signs, painful sore throat, ear or sinus pain, mouth sores, cough, excess phlegm or a change in phlegm color, pain when urinating, or a wound that does not heal.
  • Methotrexate can lower the number of blood platelets, which are necessary for proper blood clotting. Be careful when using a regular toothbrush, dental floss or toothpicks. Check with your medical doctor before having any dental work done.
  • Be careful not to cut yourself when you are using sharp objects. Avoid contact sports or other activities where bruising or injury could occur. Check with your doctor right away if you have unusual bleeding or bruising, black, tarry stools, blood in your urine or stools, or pinpoint red spots on your skin.
  • Talk with your doctor before getting any vaccines.
  • You may sunburn more easily while on Methotrexate. Avoid sun, sunlamps and tanning beds. Use sunscreen, and wear clothing and eyewear that protects you from the sun.
  • Methotrexate may affect fertility by causing low sperm count. This may lead to the inability to father a child. Check with your doctor on this.
  • Call your doctor right away if you miss a menstruation period, have unprotected sex, or think that your birth control has not worked, because of the harmful effects of Methotrexate on an unborn baby. Women are advised to avoid getting pregnant for at least 6 months after stopping this medication. It is also important that men who are taking Methotrexate and have female partners use an effective form of birth control during treatment and for at least 3 months after the last dose.
  • Avoid drinking alcohol while taking this medication. Alcohol and Methotrexate can interact and affect your liver.
  • There is evidence that immunosuppressants, such as Methotrexate, may also slightly increase the risk of Lymphoma (cancer of lymphocytes, infection-fighting cells). Because of this, it is important to have regular blood tests throughout the time you are taking Methotrexate. Talk with your doctor if you experience unusual bleeding, bruising, weakness, swollen lymph nodes in the neck, underarms, or groin, raised bumps with pus on the skin, weight loss, or red, scaly patches.
  • Methotrexate may cause Fibrosis and inflammation of the lungs. Check with your doctor if you experience shortness of breath, cough or other respiratory symptoms.
  • Methotrexate may cause liver problems. Check with your doctor right away if you are experiencing nausea, vomiting, yellow eyes or skin, pain or tenderness in the upper stomach, pale stools, dark urine or loss of appetite.
  • It is important to avoid a class of medications, called Sulfonamides (Sulfasalazine, Sulfamethoxazole or Sulfonylurea class of Diabetic medications). Interactions with Methotrexate could cause unexpected side effects.
  • It is advisable to talk to your doctor if you are planning to take non-steroidal anti-inflammatory drugs such as aspirin or ibuprofen. These can interact with Methotrexate.

When deciding to take this medication, assess the benefits and risks with your doctor. Please follow all the instructions. Your doctor will check your progress during regular office visits to make sure Methotrexate is working properly and check for unwanted side effects. It is particularly important to keep all the appointments with your doctor. Do not take other medications while taking Methotrexate unless they have been discussed with your doctor.