Main uses in hair loss: alopecia areata, discoid lupus, rarely pseudopelade and lichen planopilaris

What is Methotrexate?

  • Methotrexate is a pill which is used to “quiet down” the immune system. It is also used as a type of cancer treatment. 
  • Unlike many pills, methotrexate is used only once per week.

What is the dose of Methotrexate?

  • Your prescribing physician will advise you of the dose of methotrexate. Normally, the medication is used at a dose of 15-25 mg ONCE per week
  • Methotrexate is NOT used everyday
  • Another vitamin known as folic acid (5 mg) is used on the other days of the week (on the day that methotrexate is not used)

Who should NOT use Methotrexate?

Speak to your doctor if methotrexate might be right for you. Methotrexate should not be used in the following situations:

  1. Men who are trying to father a child
  2. Female patients who are pregnant, trying to become pregnant or breast feeding
  3. Patients who are trying to conceive a baby (women need to wait 1 month and men 3 months after stopping the methotrexate)
  4. Patients with liver diseases
  5. Patients with kidney diseases
  6. Patients who diabetes, obesity, alcoholism
  7. Patients with active infections in their body (including tuberculosis)
  8. Patients who have immune diseases and a weakened immune system
  9. Patients who have blood disorders
  10. Patients who are taking the following medications should not use methotrexate:
  • salicylates
  • sulfonamides
  • sulfonylureas
  • phenothiazine
  • phenytoin
  • barbiturates
  • chloramphenicol
  • tetracyclines
  • probenecid
  • dipyramidole
  • septra, sulfa drugs, dapsone
  • retinoids and alcohol         

What are the possible side effects of Methotrexate?

There are many "possible" side effects with methotrexate. Most individuals who take methotrexate feel good while taking the medication, with the exception of some nausea on the day the medication is taken. It is very important to speak to your prescribing physician and pharmacist about methotreate and possible side effects. 

  1. Lowered blood counts. Methotrexate can lower your blood counts and this will be closely followed in the first few weeks you start this medications. It is very important that you use methotrexate only ONCE per week and use folic acid on the other days. 
  2. Toxicity to the liver.  Methotrexate can be toxic to the liver.  For this reason, patients should not consume alcohol if they are prescribed methotrexate.  You will be asked to do blood tests to see if there is any evidence that your liver is being affected by methotrexate. However, all patients need to be aware that even with normal blood tests, it’s possible that the liver is still irritated.  Very rarely Methotrexate can cause scarring in the liver called cirrhosis. After 1-2 years of using this medication, it may be necessary to do a liver biopsy to see if there is scarring in the liver.  
  3. Lung toxicity. Methotrexate can be toxic to the lung.  This is not common, but patients should mention any shortness of breath or bothersome coughing to their doctor. 
  4. Sores in the mouth. Patients are asked to contact their doctor if sores develop
  5. Nausea, weight loss, diarrhea
  6. Headaches, tiredness, dizziness
  7. Cancers of the blood.  This is rare, but methotrexate has been associated with cancers of the blood called lymphomas
  8. Teratogenic.  Methotrexate can severely harm a developing baby. It’s important that women not conceive while either a male or female partner is using methotrexate.
  9. Sun sensitivity. Methotrexate may make patients more sensitive in the sun. They should be careful to limit sun and use a good sunscreen (SPF 30-60) while out in the sun.

What tests will be needed before taking Methotrexate?

You will need a panel of tests before starting methotrexate. These are the tests your doctor may order. Other tests might be ordered as well:

  1. Basic blood counts : CBC + differential
  2. Liver tests: LFTs (ALT, AST, ALP, bilirubin, albumin),  HbSAg, HbSAb, HCV, HAV
  3. Kidney tests: Creatinine, BUN, urinalysis
  4. Pregnancy tests if female

What tests will be needed after starting the Methotrexate?

To ensure that methotrexate is safe for you, you will have frequent blood tests in the first 2 months. It is very important that you do these tests. If your schedule is too busy to allow you to do these blood tests on a regular basis, your doctor  will not prescribe methotrexate.

REMEMBER: The decision to use methotrexate for your hair loss requires careful consideration.  Each patient must weigh the risks and benefits of the medication with the way their hair loss impacts their life. Many patients taking methotrexate do very well and have minimal side effects.  

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