How it is administered

Methotrexate is available in several forms and can be administered in different ways:

• Oral tablets or oral solution: Taken by mouth, usually once weekly. Tablets are commonly 2.5 mg each, and oral solutions are available for those who have difficulty swallowing tablets.
• Injection: Can be given as an intravenous (IV), intramuscular (IM), subcutaneous (under the skin), or intrathecal (into the spinal fluid) injection. The route and dose depend on the specific disease and treatment plan.

Your healthcare provider will determine the best form and dosing schedule for your condition.

How it works

Methotrexate works by blocking an enzyme called dihydrofolate reductase. This enzyme is important for making DNA and other substances that cells need to grow and divide. By blocking this enzyme, methotrexate interferes with the ability of cells—especially rapidly dividing cells like cancer cells—to reproduce.

In blood cancers such as lymphoma and leukemia, methotrexate helps slow or stop the growth of abnormal cells. It is particularly effective against cells that multiply quickly, which is why it is used in various chemotherapy regimens. Methotrexate also affects normal rapidly dividing cells, which can lead to some of its side effects. The medication is sometimes used in combination with other drugs to enhance its effectiveness and to target cancer cells in different ways.

Who Should take it

Methotrexate is used to treat several types of cancers, including certain blood cancers. For blood cancers, it is indicated for:

• Acute lymphoblastic leukemia (ALL): Used in both adults and children as part of a combination chemotherapy maintenance regimen.
• Non-Hodgkin lymphoma: Used in adults (including relapsed or refractory cases) as part of a combination chemotherapy regimen.
• Mycosis fungoides (cutaneous T-cell lymphoma): Used in adults as a single agent or as part of a combination chemotherapy regimen.

Methotrexate may also be used for other cancers and some autoimmune diseases, but for blood cancers, it is a key part of many treatment protocols. Your doctor will decide if methotrexate is appropriate for your specific type and stage of cancer.

Who should not take it

Methotrexate should not be taken by:

• Pregnant women (for non-cancer indications), as it can cause serious harm to the unborn baby.
• People with a history of severe allergic reactions to methotrexate.
• Patients with severe liver disease, severe kidney disease, or significant blood disorders unless the benefits outweigh the risks and close monitoring is possible.

If you are of childbearing potential, effective contraception is required during and after treatment (6 months for females, 3 months for males). Always inform your healthcare provider about any allergies, current medications, and health conditions before starting methotrexate.

Commonly used with

Methotrexate is often used in combination with other chemotherapy drugs as part of a treatment regimen for blood cancers. For example:

• In acute lymphoblastic leukemia (ALL), it is combined with drugs such as vincristine, prednisone, and asparaginase.
• In non-Hodgkin lymphoma, it may be used with drugs like cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP regimen), or with other agents depending on the specific protocol.

Leucovorin (folinic acid) is sometimes given after methotrexate to help reduce side effects and protect normal cells.

Commonly tested with

Methotrexate is commonly tested with other chemotherapy agents in clinical trials for blood cancers. These may include:

• Vincristine
• Prednisone
• Asparaginase
• Cyclophosphamide
• Doxorubicin
• Rituximab (for certain lymphomas)

It is also tested with supportive medications like leucovorin (for rescue therapy) and with various anti-nausea medications to manage side effects. The specific combination depends on the type of cancer and the treatment protocol being studied.