Side Effect	Ways to Reduce Side Effects
More Common______________________________________________________________
Methotrexate can cause gastrointestinal upset, fatigue, or even flu-like symptoms in some people. If it occurs, it is usually the day or two after you have taken your methotrexate.	1) What day of the week do you take methotrexate?. Eg. Is Friday the best day for you so you don't feel unwell at work? 2) Take your methotrexate around supper time, so its effect may be gone by morning. 3) The injection route may be more tolerable than tablets.
Methotrexate can cause painful sores in the mouth.	1) The injection route may be more tolerable than tablets 2) Folic Acid supplementation as prescribed by your rheumatologist reduces this risk.
Rare______________________________________________________________________
Methotrexate can decrease your blood counts and/or irritate your liver	1) Your rheumatologist will provide you will a requisition for monthly bloodwork to check your blood counts and liver. While rare, if there is a problem, your rheumatologist will usually see it in your bloodwork well before you notice any problems. Make sure you always get your bloodwork. 2) Minimize your alcohol intake, as both alcohol and methotrexate can irritate your liver. For most people, 1-2 drinks/week is still safe. Make sure your doctor knows if you have a problem with your blood cells or liver.
Effect on the kidneys	1) At the low doses used to treat inflammatory arthritis, methotrexate does not usually harm the kidneys. 2) Rheumatologists may include a blood test to check your kidney function as methotrexate is excreted through the kidneys; if your kidneys are not working properly, your rheumatologist may need to decrease or stop methotrexate.
Methotrexate can cause inflammation or even scarring in the lungs	1) This is fortunately rare, but very serious. Let your rheumatologist know right away if you have a cough that isn't going away or increasing difficulty with your breathing. If this happens, your rheumatologist will likely stop your methotrexate. 2) Keep in mind, some rheumatic conditions such as rheumatoid arthritis can also cause lung problems. In fact, this is probably more common and which methotrexate may help prevent.
Pregnancy miscarriages or malformations	1) You should not become pregnant if you are on methotrexate. It is recommended that both males and females should be off methotrexate for at least 3 months prior to conceiving.  Contraception is strongly encouraged. 2)Mothers should not nurse if on methotrexate as it can enter the breast milk.
Medication Interactions	1) Avoid Sulpha based drugs (e.g. Bactrum, Septra) as they may increase methotrexate levels in your body to a toxic level. 2) Older data suggested NSAIDs (e.g. ibuprofen, naproxen) should be avoided with methotrexate. This is no longer true as many patients. In fact, it is very common to be taking methotrexate and an NSAID at the same time.
More infections	Although poorly studied, there may be a small increased risk of developing infections, particularly if used in combination with steroids.
Risk of Cancer	There is a small but increased cancer risk, particularly lymphoma, for patients taking methotrexate. It may - but not always - regress on its own if methotrexate is stopped. This risk is likely no greater than the increased risk of cancer in poorly controlled rheumatoid arthritis itself.