What is methotrexate?
Methotrexate is a medicine that helps calm down the body’s immune system when it is being too “active.” In uveitis, this can help lower inflammation to protect vision and minimize the number of uveitis flare ups.
How is it given?
Methotrexate is usually taken once a week, not every day. Many people take it as a pill after food, and some people may take it as a shot under the skin if their doctor thinks that is better for them. Doctors often also give folic acid (a vitamin) to help the body handle methotrexate, and it should not be taken on the same day as methotrexate.
Is it safe?
Many people taking low-dose methotrexate do well, but it must be used carefully and watched closely. You need blood tests before starting and regularly after starting, because methotrexate can affect the liver and bone marrow (where blood cells are made). It is not recommended to drink alcohol while taking methotrexate. It is not safe in pregnancy or breastfeeding, so people who could get pregnant need to use strong birth control and talk with their doctor about family planning.
What to expect when taking methotrexate
Methotrexate works slowly, and it may take up to about 12 weeks to reach the best dose and notice improvement. Many times, you will take prednisone pills while the methotrexate levels build up over time. Some people feel sick to their stomach, get diarrhea, or get mouth sores, and you should tell your doctor if these happen. Call your doctor right away if you get warning signs like bad shortness of breath or a dry cough, yellowing of the eyes/skin, fever or chills, or easy bruising/bleeding, because these can be serious.
Low-dose methotrexate for uveitis is very different from the high doses used for cancer. In cancer treatment, much larger doses are used to kill fast-growing cancer cells, and these doses can cause many more and stronger side effects. Because the dose for cancer is so high, patients often need to stay in the hospital, get special medicine (like folinic acid), and have very close monitoring, while low-dose methotrexate for uveitis is usually taken at home with regular clinic checkups and blood tests.