Methotrexate Tablet Side Effects in Pakistan

Methotrexate side effects — a complete guide. From common effects to serious warnings — everything you need to know is on this page. See a doctor immediately if any serious symptom appears.

Compiled by the PakVita Editorial Team · AI-assisted drafting with editorial review · Sourced from DRAP, WHO, BNF · Last updated: 2026-06-17

Side Effects

Quick Answer

Common side effects of Methotrexate include nausea, mouth ulcers, fatigue, and elevated liver enzymes. Serious effects include hepatotoxicity, pulmonary toxicity, myelosuppression, and teratogenicity. Regular monitoring (CBC, LFTs, creatinine) is necessary.

Side Effects at a Glance

Common

Nausea (mahtli) — can be reduced by taking folic acid and taking after food
Mouth ulcers / stomatitis
Fatigue (thakawat)
Elevated liver enzymes

Serious — See a Doctor

Severe hepatotoxicity / cirrhosis
Pulmonary toxicity / methotrexate lung
Myelosuppression / pancytopenia
Severe mucositis
Teratogenicity — ABSOLUTELY CONTRAINDICATED in pregnancy (Category X)
Opportunistic infections (from reduced immunity)
Renal toxicity (kidney damage)

When to See a Doctor Immediately

Shortness of breath or dry cough (pulmonary toxicity — see a doctor immediately)
Severe mouth ulcers or internal swelling (severe mucositis)
Unusual bruising, bleeding, or paleness
Jaundice (piliya) or severe abdominal pain (hepatotoxicity)
Signs of infection: high fever, cough, burning urination (immunosuppressed patient)
Pregnancy or attempting pregnancy — see a doctor immediately

Methotrexate Tablet Side Effects (Nuksanat)

Methotrexate is a high-alert medicine. Regular monitoring and close supervision by a doctor are necessary. Common and serious side effects are listed below.

Common Side Effects (Aam Nuksanat)

Nausea (mahtli) — can be reduced by taking folic acid and taking after food
Mouth ulcers / stomatitis
Fatigue (thakawat)
Elevated liver enzymes — monitoring necessary

Monitor these side effects and inform your doctor.

Serious Side Effects (Sanjeedah Nuksanat)

Severe hepatotoxicity / cirrhosis — jaundice, abdominal pain — see a doctor immediately
Pulmonary toxicity / methotrexate lung — dry cough, difficulty breathing — see a doctor immediately
Myelosuppression / pancytopenia — unusual bruising, bleeding, paleness — get a CBC immediately
Severe mucositis — severe mouth ulcers — contact a doctor immediately
Teratogenicity — ABSOLUTELY CONTRAINDICATED in pregnancy (Category X)
Opportunistic infections — from reduced immunity — see a doctor immediately for fever or infection

When to See a Doctor (Kab Doctor Se Milna Zaroori Hai)

Shortness of breath or dry cough — see a doctor immediately
Severe mouth ulcers — contact a doctor immediately
Unusual bruising, bleeding, or paleness — get a CBC immediately
Jaundice or severe abdominal pain — hepatotoxicity
High fever or signs of infection — serious in an immunosuppressed patient
Pregnancy or attempting pregnancy — see a doctor immediately

Reporting Side Effects

If you notice any unexpected side effect, report it on the DRAP pharmacovigilance portal: https://www.dra.gov.pk/pharmacovigilance

Side Effects Summary Table

Type	Side Effect	Action
Common	Nausea	Folic acid + take after food
Common	Mouth ulcers	Inform your doctor
Common	Elevated LFTs	Continue monitoring
Serious	Hepatotoxicity	See a doctor immediately
Serious	Pulmonary toxicity	See a doctor immediately — emergency
Serious	Myelosuppression	Get a CBC immediately + see a doctor
Serious	Teratogenicity	Absolutely contraindicated in pregnancy

The information in this guide is for educational purposes only. Contact your doctor or pharmacist for any side effect.

Frequently Asked Questions

Methotrexate ke sabse common side effects kya hain?

The most common side effects of Methotrexate include nausea (mahtli), mouth ulcers (stomatitis), fatigue, and rising LFTs. Taking folic acid 5mg weekly (on a different day) can reduce these.

Methotrexate jigar ko kaise affect karta hai?

Methotrexate damages the liver with cumulative dose. Therefore regular monitoring of LFTs is necessary. Avoid alcohol completely.

Methotrexate lungs ko kaise affect karta hai?

Methotrexate can cause pulmonary toxicity (methotrexate lung) — presenting as dry cough and difficulty breathing. If these symptoms occur, see a doctor IMMEDIATELY — delay in treatment can be dangerous.

Kya Methotrexate khoon ko affect karta hai?

Yes — Methotrexate can cause bone marrow suppression (myelosuppression) which can reduce CBC values (platelets, WBC, RBC). Therefore regular monitoring of CBC is necessary. See a doctor immediately for unusual bleeding or bruising.

Methotrexate se pregnancy mein kya hoga?

Methotrexate is a Category X teratogen — it causes serious harm to the foetus and can cause miscarriage. Absolutely contraindicated in pregnancy. Women: no conception for 3 months after stopping; Men: for 6 months after stopping.

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Sources

DRAP Registered Products Database — Drug Regulatory Authority of Pakistan
WHO Model List of Essential Medicines, 23rd ed. (2023) — World Health Organization
British National Formulary (BNF) — BMJ Group & Pharmaceutical Press

Medical disclaimer

This page is for educational use only and does not replace professional medical advice. Always confirm diagnosis, dose, and interactions with a qualified doctor or pharmacist before starting or changing any medicine.