Methotrexate Injection for Inflammatory Bowel Disease (IBD)
What is methotrexate?
Methotrexate is a medicine used to treat
rheumatoid arthritis, psoriasis and several kinds
of cancer and IBD. When used for IBD, the dose
is lower than when taken for cancer.
Why am I taking methotrexate?
Your doctor may order methotrexate if you have
frequent flare ups of your disease and you cannot
take other medicines to control your IBD
disease. Methotrexate can reduce the damage to
your intestines and improve your quality of life.
What do I need to know?
ξ Methotrexate injection is given once a week.
It may take 4 to 8 weeks to work. You must
keep taking it every week even if you think it
is not helping.
ξ You will have blood tests when you start the
medicine, then again in 2, 4, 8 and 12 weeks.
If the tests are normal, your blood test will be
done every 3 months.
ξ It can increase your risk of infection. You
should have a working thermometer at home
in case you feel sick.
ξ You will need to take folic acid tablets when
you are on methotrexate. Your doctor will
order these for you.
ξ Both you and your partner must use birth
control at the same time. Stop taking this
medicine 6 months before you get pregnant.
Men also need to stop taking this medicine
before trying to conceive. This medicine can
cause birth defects.
ξ Do not breast feed while taking methotrexate.
ξ Do not drink alcohol or take more than 2000
mg of acetaminophen (Tylenol®) in a day.
ξ Do not take any herbal products that have
echinacea or cat’s claw.
ξ You should never be given a vaccination
with a live virus. Always talk to your doctor
before getting any vaccination.
What are common side effects?
ξ Muscle aches and a low grade fever for a
couple days after the injection. This should
get better as your body gets used to the
medicine. If you still have this after a couple
of injections, call your doctor.
ξ Mouth sores or bleeding of the gums. Use
soft toothbrushes and avoid forceful flossing
of your teeth. Rinsing your mouth with salt
water will help.
ξ Sensitivity to the sun. Always use strong
sunscreen (at least 45 SPF) and do not use a
ξ Nausea, vomiting, fatigue
When should I call my doctor right
ξ If you have a fever over 100.5 degrees.
ξ If you have chest pain, cough, or trouble
ξ If you get sores in your mouth or lips. The
dose of methotrexate may need to be
How should I store this medicine at
Methotrexate for injection comes in vials (small
bottles). Vials should be stored at room
temperature and kept away from light and heat.
Do not keep the medicine in the refrigerator or in
the bathroom cabinet. Keep all the medicine,
syringes, needles and supplies in a safe place
away from children and pets.
What supplies do I need to give the
injection and where can I get them?
The supplies can be bought at the drugstore or
wherever you get your medicines. If you have
questions, talk to your nurse about where or how
to get these supplies.
You will need these items for the injection:
1. Vial of methotrexate. The concentration
should be 25 mg/1 ml. Some vials can be
used for more than one injection. If the vial
has preservative in it you can use it for more
than one injection. If not, you will need to
throw it away after one use.
2. Syringe and needle. You may get syringes
with needles already attached.
3. Alcohol swabs.
4. Cotton balls.
5. Puncture proof container to dispose of the
syringe & needle. This can be an empty
Clorox bottle or coffee can.
How to give the methotrexate injection:
The nurse will teach you how to do the
1. Find an area in your home that is well-lit, flat
and quiet. You should have a work area that
is flat, such as a table.
2. Clean the table with soap/water or a mild
3. Wash and dry your hands. If someone else is
giving you the shot, they should wash/dry
their hands also, and wear gloves. This is a
very important step!
4. Gather all the supplies. Have a paper towel
handy in case of spills.
5. Select the site for the injection. Find a spot
you can “pinch an inch” of fat, such as the
stomach or thigh (see picture to the right).
If someone else is giving you the injection,
you can use the back of the arm. Avoid any
area that has a bruise, scars, redness, swelling
or visible veins. After you find the site you
will use, clean the area with an alcohol pad in
a circular motion. Allow the site to dry.
6. Prepare the vial. If using a new vial, pop off
the protective cap. Discard the cap; it will not
reattach. If you have used the vial for an
injection before, clean the top of the vial with
an alcohol swab. Let the top dry for about 10
7. Pull back on the plunger end up to ½ the
dosage you need (image A). Remove the cap
on the needle. Insert the needle into the vial.
Push the plunger to push the air into the vial
(image B). This will make it easier to
withdraw the medicine out of the vial.
8. Hold onto both vial and syringe. Turn the
vial & syringe upside down, keeping the
needle in the vial. The needle is now
9. Pull the plunger back to “draw” the
methotrexate into the syringe (image C).
Draw back slightly more than the dose you
need. If air bubble is seen, gently tap the
syringe with your finger. Push the plunger
up to get rid of any air. Push back in any
extra medicine to get the right dose.
10. With needle still in the vial, turn the
vial/needle right side up. Set the vial on the
11. Hold the syringe like a dart or pencil and
remove it from the vial.
12. With your other hand, “pinch an inch” of
skin (the spot you have cleaned earlier in #
13. Insert the needle all the way into the clean
spot straight into your skin like a dart.
14. Press down on the plunger until all the
medicine has been pushed out and into your
15. Remove the needle by quickly pulling it out
and away. You can now let go of the skin
fold. If a small drop of medicine or blood is
on your skin, use a cotton ball on the spot.
You can apply a little pressure but do not rub
16. Put the syringe into the sharps container you
are using (Clorox bottle or coffee can). Do
not put the cap back on the needle. Syringe
and needle should only be used one time.
After the injection:
17. Clean the top of the methotrexate vial with
an alcohol swab. Place all used alcohol
swabs, vials and cotton balls in the sharps
container. Close the lid on the container. (Do
not fill the container more than ¾ full.)
Supplies cannot be put in the regular trash.
18. Wash your hands with soap and water. If
someone gave you the injection, they should
also wash their hands after removing their
gloves. (Used gloves should also go in the
19. Store the methotrexate vial, syringes and
supplies in a safe place out of the reach of
children and pets.
20. Label container used for syringes and used
supplies as “Chemo Waste” on the outside.
It can be taken to the doctors’ office for
disposal. Tell them it is a container of used
needles & syringes used for methotrexate.
Your health care team may have given you this information as part of your care. If so, please use it and call if you have any
questions. If this information was not given to you as part of your care, please check with your doctor. This is not medical
advice. This is not to be used for diagnosis or treatment of any medical condition. Because each person’s health needs are
different, you should talk with your doctor or others on your health care team when using this information. If you have an
emergency, please call 911. Copyright © 3/2016 University of Wisconsin Hospitals and Clinics Authority. All rights reserved.
Produced by the Department of Nursing. HF#7883