MTX works best on extensive psoriasis, erythrodermic and acute pustular psoriasis, physically disabling psoriasis of the palms and soles and psoriasis in the elderly. The majority of patients achieve significant or even complete clearing of their disease with MTX. The clearance or remission can last for a few weeks to a year or more after stopping therapy.

There are medical conditions and histories that may disqualify some patients from using MTX:

Women who are pregnant

Men or women who are trying to conceive a child (conception should be avoided during and for at least 12 weeks after discontinuing MTX therapy)

People who have blood disorders, including HIV/AIDS

People with an active peptic ulcer

People with severe anemia

People with cirrhosis of the liver

People with active hepatitis

People with significant liver or kidney abnormalities

People with active infectious disease

People who consume alcohol (beer, wine, liquor)

Patients who are unreliable

It is normally taken a once weekly basis. The starting dose is approximately 7.5 - 10 mg WEEKLY. The tablets take 2-3 weeks before you notice changes. If you cannot tolerate the drug orally, it can be given by injection.

It has several potential side effects. Some of the most common:

1 Nausea- especially when first used. The tablets can be divided up on the day of use to reduce this effect.

2 Mouth ulcers – this may be a sign of an excessive dose or a low white count. It can be treated with allopurinol mouthwash.

3 Blood problems from marrow suppression- we therefore watch blood counts before use and then at 2 weeks and then after 1 month and then 3 or 4 times yearly.

4 A potential for a type of liver cirrhosis - or inflammation with damage. This is a cumulative dose effect. And in the old days biopsies were done before using the tablets. It occurred more in high doses with Psoriasis patients. The biopsy is now no longer done as a routine and we now monitor certain liver tests before use and then at 2 weeks then after 1 month. After certain doses are reached a liver biopsy is advisable.

5.A type of pneumonitis - or inflammation of the lung like pneumonia.

6. Alopecia - or hair loss

7. It is contraindicated in pregnancy as birth defects have been described. Planning of pregnancy is essential, and the Methotrexate should be stopped 3 months before conception. This applies also to MALES as well as FEMALES.

The side effects are lessened by addition of FOLIC ACID VITAMIN B 5mg / day.

The side effects are INCREASED by USE of aspirin. Combining Methotrexate with certain drugs, such as Bactrim, may be deadly.

For the most severe cases, Methotrexate is used in combination with other drugs like Cyclosporin, or with phototherapy (ultraviolet lights). As with any potent drug, side effects are possible, but the effect on your life from the skin disease often outweighs the risk from the medication. In order to protect you from side effects, it is vital that you have regular blood tests to check your blood cell count and liver enzymes.