MTW NHS Trust West Kent CCG

Drug Status Key

  • Preferred
  • Second Line
  • Third Line
  • Specialist Initiation
  • Hospital Only
  • Not Approved for Formulary

Cytotoxic responsive malignancy

Important safety information

The CSM advice has warned that there have been reports of blood dyscrasias and liver cirrhosis with low dose methotrexate. A full blood count, renal function and LFTs should be done before starting treatment and repeated weekly until the patient is stabilised. Thereafter monitor 2-3 months. Patients should be advised to report all symptoms suggestive of infection, especially sore throat and also signs of liver toxicity, e.g. nausea, vomiting, abdominal discomfort, dark urine.

Drug safety update

August 2023: Methotrexate: advise patients to take precautions in the sun to avoid photosensitivity reactions

 September 2020: Methotrexate once-weekly for autoimmune diseases: new measures to reduce risk of fatal overdose due to inadvertent daily instead of weekly dosing

 December 2014: Mercaptamine and mercaptopurine: confusion between drug names

NG100: Rheumatoid arthritis in adults: management, updated October 2020

 CG153: Psoriasis: assessment and management, September 2017

Mercaptopurine/Methotrexate for inflammatory bowel disease should be initiated by a specialist and used according to NICE guidelines and local shared care guidelines. Mercaptopurine for inflammatory bowel disease and methotrexate for severe Crohn's disease are unlicensed uses.

Also refer to the Kent and Medway position statement for prescribing oral methotrexate.

Not licensed for use in severe ulcerative colitis and Crohn's disease

Pack Price
25 tablet £9.42

Note: when used to treat active rheumatoid arthritis, severe Crohn's disease and severe psoriasis the dose is a WEEKLY dose. To avoid error it is recommended that:

  • the patient is carefully advised of the dose, the frequency and the reasons for taking methotrexate and any other co-prescribed medication e.g. folic acid
  • only one strength of methotrexate tablet is prescribed and dispensed (usually 2.5mg)
  • the prescription and the dispensing label clearly show the dose and the frequency of administration
  • the patient is warned to report immediately the onset of any feature of blood disorders, liver toxicity and respiratory effects
  • See drug safety update Sept 2020 (link above) for further advice
Pack Price
100 tablet
24 tablet
28 tablet
Pack Price
35 ml £114.00
Pack Price
1 pre-filled disposable injection £12.87
Pack Price
1 pre-filled disposable injection £13.26
Pack Price
1 pre-filled disposable injection £14.35
Pack Price
1 pre-filled disposable injection £14.41
Pack Price
1 pre-filled disposable injection £15.25
Pack Price
1 pre-filled disposable injection £15.56
Pack Price
1 pre-filled disposable injection £16.11
Pack Price
1 pre-filled disposable injection £16.13
Pack Price
1 pre-filled disposable injection £16.50
Pack Price
1 vial £72.63
Pack Price
1 vial £85.00