What are the risks of taking methotrexate?

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Will methotrexate affect vaccinations?

If you’re on methotrexate it’s recommended that you avoid live vaccines such as yellow fever. Your GP will discuss the possible risks and benefits of any vaccinations with you.

If you're in your 70s and are offered shingles vaccination (Zostavax) you should seek advice from your rheumatology team – you may be able to have the vaccine if you are on low-dose methotrexate.

Pneumovax (which gives protection against the commonest cause of pneumonia) and yearly flu vaccines don’t interact with methotrexate.

Can I drink alcohol while on methotrexate?

You should only drink alcohol in small amounts. It's recommended that you keep well within national guidelines (2–3 units per day for women and 3–4 units per day for men). In some cases your doctor may advise even less (e.g. no more than 4 units per week). This is because methotrexate and alcohol can interact and may damage your liver. You should discuss this with your doctor.

Does methotrexate affect fertility or pregnancy?

Methotrexate can affect fertility and is likely to be harmful to the baby if taken during pregnancy. However, you can still have a successful pregnancy if you stop taking methotrexate in plenty of time before trying for a baby.

Both men and women using this drug should take contraceptive precautions as it can also affect sperm and thus affect any fertilised egg. After stopping methotrexate you should continue using contraception for at least 3 months, and some doctors advise up to 6 months. You should talk to your doctor as soon as possible if you’re planning a family, or if you become pregnant while taking methotrexate.

Does methotrexate affect breastfeeding?

You shouldn’t breastfeed if you’re on methotrexate. The drug may pass into the breast milk and could be harmful to your baby.

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