Methotrexate is an anti-metabolite, used in cancer treatment and for rheumatoid arthritis and psoriasis. According to the American Cancer Society, or ACS, it works by stopping the cancer cells from using an essential nutrient, folic acid, to make new genetic material. Its actions stop the growth and multiplication of cancer cells. Methotrexate has several possible side effects that affect different organ systems in the body.
Digestive System
According to the Food and Drug Administration-approved drug label, blistering in the mouth and on the lips occurs commonly with methotrexate. The ACS reports that high doses of methotrexate may result in nausea and vomiting. Other not so common digestive side effects or adverse reactions are inflammation in the mouth and throat, blistering in the intestines with bleeding resulting in black tarry stools, melena and/or bloody vomiting. Pancreatitis and inflammation of the lining of the intestines have also been mentioned with the use of methotrexate.
Blood and Lymphatic System
Suppression of the bone marrow with reduction in all blood counts or specific blood cells is commonly seen with methotrexate. Thus, with methotrexate treatment, pancytopenia, agranulocytosis, anemia, thrombocytopenia, leucopenia and/or neutropenia are possibilities. Paradoxical eosinophilia and lymphoproliferative disease have also been mentioned in association with methotrexate treatment.
Opportunistic Infections
Immune suppression can lead to the development of opportunistic infections like pneumocystis carinii pneumonia, bacterial pneumonia and viral infections such as herpes simplex, cytomegalovirus and herpes zoster. Histoplasmosis, norcardiosis and cryptococcosis can also present in patients on methotrexate, according to the FDA’s labeling information.
Skin
Common side effects of methotrexate seen on the skin, according to MedlinePlus, are thinned or brittle hair, skin blisters, and acne. Other skin conditions seen with methotrexate treatment are photosensitivity, rashes and discolorations.
Urogenital System
According to the ACS, kidney damage is seen at high doses of methotrexate. This may present as azotemia, severe nephropathy, hematuria and/or proteinuria. Bloody or dark-colored urine can also result from kidney damage or from bladder inflammation. Infertility, transient oligospermia, defective egg or sperm production and menstrual problems are also possible side effects recorded by the FDA. Rarely, methotrexate also causes loss of libido and or impotence.
Respiratory System
Lung inflammation with or without scarring that causes cough and shortness of breath are seen in some patients on methotrexate. Lung collapse has been documented at high doses of methotrexate, according to the ACS.
Nervous System
Drowsiness, dizziness, headaches and blurred vision are seen in treatment with methotrexate. More severe side effects of a stroke-like state with paralysis, confusion, convulsions and coma are described by the ACS.
Other Side Effects
Liver damage with jaundice, elevated blood liver enzymes and reduced serum proteins is seen with methotrexate. Inflammation of the pericardium of the heart with pericardial effusion and increased clotting phenomena is also seen with methotrexate therapy. Nonspecific side effects of methotrexate noted on the FDA label are weakness, fatigue, abdominal discomfort, chills and fever.
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