Methotrexate was discovered to be effective in clearing psoriasis in the 1950s and was eventually approved for this use by the FDA in the 1970s. Methotrexate is an immunosuppressant medicine that reduces activity in parts of the immune system involved in psoriasis.
How does it work?
Methotrexate works by reducing the activity of the immune system. It interferes with processes involved in the growth and multiplication of cells and reduces inflammation. In psoriasis, this helps reduce the excessive growth of skin cells and the inflammation that causes red, thickened and scaly plaques.
In low doses methotrexate can also affect the division of normal, healthy cells, and it has the potential to produce serious side effects. For this reason, treatment with methotrexate is usually only initiated by hospital specialists, and regular blood tests are needed to monitor for potential side effects.
Who can get it?
Methotrexate may be prescribed for adults with moderate to severe psoriasis when topical treatments and/or phototherapy have not controlled the condition sufficiently and systemic treatment is appropriate.
How is it used?
Jylamvo oral solution
For the treatment of severe psoriasis take 2.5-5mg test dose one week prior to therapy. Then 7.5mg once weekly, increasing gradually as necessary; maximum 25mg weekly. After desired response reduce gradually to lowest effective dose.
Maxtrex
For the treatment of severe psoriasis NICE recommends incremental dosing, for example starting at 5–10 mg once weekly. Dosage should be adjusted according to the patient's response and the haematological toxicity. The prescriber may specify the day of intake on the prescription.
Methofill
7.5mg by subcutaneous injection, increasing gradually depending on individual tolerance and disease activity up to a maximum weekly dose of 25mg. The dose should be individualised according to response, tolerability and monitoring. After desired response reduce gradually to lowest effective dose.
Methotrexate
Methotrexate is taken once a week. The dose is adjusted according to response and side effects, with the lowest effective dose used. Important: Methotrexate for psoriasis is taken ONCE A WEEK, not every day. Taking methotrexate every day instead of once a week can cause serious illness and can be fatal. Always follow the dose and day specified by your healthcare professional.
Methotrexate oral solution
The usual dose is 10mg – 25mg (5ml – 12.5ml) taken once weekly. The planned weekly dose can be administered as three divided doses over 24 hours. As necessary, the total weekly dose can be increased up to 25mg. Thereafter the dose should be reduced to the lowest effective dose according to therapeutic response which is most cases is achieved within 4 to 8 weeks.
Metoject
Take 7.5mg by subcutaneous injection once weekly increasing gradually depending on individual tolerance and disease activity. Maximum weekly dose 25mg. After desired response reduce gradually to lowest effect dose.
Nordimet
7.5mg by subcutaneous injection, increasing gradually depending on individual tolerance and disease activity up to a maximum weekly dose of 25mg After desired response reduce gradually to lowest effective dose.
Ziatal
7.5 mg by subcutaneous or intramuscular injection once a week increasing gradually according to response with a maximum weekly dose of 25mg. After desired response reduce gradually to lowest effect dose.
Important: Methotrexate for psoriasis is taken ONCE A WEEK, not every day. Taking methotrexate every day instead of once a week can cause serious illness and can be fatal. Always follow the dose and day specified by your healthcare professional.
What are the side effects?
Taking methotrexate can cause the following potential side effects:
- nausea and vomiting *
- diarrhoea
- mouth ulcers/stomatitis **
- headache
- tiredness
- changes in blood-cell counts
- increased susceptibility to infection
- liver problems
- kidney problems
- skin reactions/photosensitivity
- hair loss
- bruising/bleeding.
*Sometimes nausea can be helped by drinking milk or eating before taking the medication. Severe nausea may mean the dose is too high. Folic acid is often prescribed alongside methotrexate to help reduce some of its side effects, including effects on the mouth, stomach and blood cells. Your doctor or pharmacist will tell you how and when to take it. Do not change the dose or timing of folic acid without medical advice.
**Mouth ulcers can be a sign of methotrexate toxicity, but it doesn't necessarily mean that the dose is simply “too high”
Methotrexate can Methotrexate can cause serious bone-marrow suppression and liver toxicity, which is why regular blood monitoring is essential.
These side effects are generally manageable with careful monitoring and patient education.
Monitoring
You will need regular blood tests while taking methotrexate. These tests check your blood cells and how well your liver and kidneys are working. The dose may need to be changed or treatment stopped if the results show a problem. It is important to attend all monitoring appointments, even if you feel well.
Pregnancy and fertility
Methotrexate must not be taken during pregnancy. It can harm an unborn baby. If you are pregnant, planning a pregnancy or think you may be pregnant, speak to your doctor immediately. Methotrexate can also affect fertility in both women and men.
How do I get methotrexate?
Methotrexate is available on prescription and is usually started and monitored by a specialist healthcare professional experienced in treating psoriasis and using methotrexate.Further guidance
National Institute for Health and Care Excellence (NICE) guidance
Scottish Medicine Consortium guidance
All Wales Medicines Strategy Group
Department of Health,(Northern Ireland)
Methotrexate is known commercially as Jylamvo which is marketed in the UK by Intrapharm, Maxtrex which is marketed in the UK by Pfizer Ltd, Methofill which is marketed in the UK by Accord, Methotrexate oral solution which is marketed in the UK by Rosemont Pharmaceuticals Limited, Metoject which is marketed in the UK by Medac, Nordimet which is marketed in the UK by Nordic and Ziatal which is marketed in the UK by Nordic.
Reviewed: August 2026
Version ID: 2/MET/PST/08/26
