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Otrexup

methotrexate
Used for Psoriasis, Rheumatoid Arthritis

Otrexup (methotrexate) is a disease-modifying antirheumatic drug (DMARD) that's used for certain autoimmune conditions. It can treat severe rheumatoid arthritis (RA), polyarticular juvenile idiopathic arthritis (pJIA), and severe psoriasis when other treatment options haven't worked well. Otrexup (methotrexate) is available as an autoinjector. The medication is injected under the skin once a week. Side effects include nausea and liver test changes.

Reviewed by:
reviewerKristianne Hannemann, PharmD
reviewerCydnee Ng, PharmD
Last reviewed on November 2, 2023
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What is Otrexup (methotrexate)?

What is Otrexup (methotrexate) used for?

  • Rheumatoid arthritis (RA) in adults
  • Polyarticular juvenile idiopathic arthritis (pJIA) in children
  • Psoriasis in adults

How Otrexup (methotrexate) works

Otrexup (methotrexate) is a medication that belongs under the drug class known as antimetabolites. It's also considered a disease-modifying antirheumatic drug (DMARD).

The way Otrexup (methotrexate) works to treat certain types of arthritis and psoriasis isn't fully clear. Research suggests that the medication helps lower the activity of the immune system to lessen inflammation. It might also help slow down the growth of skin cells.

Drug facts

Common BrandsOtrexup
Drug ClassAntimetabolite
Controlled Substance ClassificationNot a controlled medication
Generic StatusNo lower-cost generic available
AvailabilityPrescription only
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Side effects of Otrexup (methotrexate)

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

  • Change in liver lab test results
  • Nausea or vomiting
  • Diarrhea
  • Swelling or sores in the mouth
  • Burning of psoriasis skin lesions
  • Skin more sensitive to sunlight
  • Low platelet levels

Less Common Side Effects

  • Headache
  • Dizziness
  • Rash
  • Itchy skin
  • Hair loss
  • Low white blood cells

Note: Side effects listed here were reported by people who took either the oral or injectable version of methotrexate, including Otrexup.

Otrexup (methotrexate) serious side effects

Contact your healthcare provider immediately if you experience any of the following.

  • Severe allergic reaction: rash, trouble breathing, swelling in the face or throat
  • Severe skin reaction: blisters, peeling skin, sores in the mouth, fever
  • Lung problems: trouble breathing, cough, fever
  • Liver damage: stomach pain, nausea, yellowing of the skin or whites of the eyes, dark urine
  • Kidney problems: urinating less often than usual, itchy skin, bloody or foamy urine
  • Brain or nerve problems: seizures, headache, confusion, weakness on one side of the body, coordination problems, vision problems
  • Low blood cell counts: tiredness, easy bruising, blood in urine or stool, pale skin
  • Infection: fever, cough, pain while urinating, chills, muscle weakness, vomiting
  • Cancerous tumors

Source: DailyMed

The following Otrexup (methotrexate) side effects have also been reported

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

More common

Black, tarry stools

blood in the urine or stools

bloody vomit

diarrhea

joint pain

reddening of the skin

sores in the mouth or lips

stomach pain

swelling of the feet or lower legs

Less common

Back pain

bleeding, blistering, burning, coldness, discoloration of the skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, or warmth at the injection site

blurred vision

confusion

convulsions (seizures)

cough or hoarseness

dark urine

dizziness

drowsiness

fever or chills

headache

lower back or side pain

painful or difficult urination

pinpoint red spots on the skin

shortness of breath

unusual bleeding or bruising

unusual tiredness or weakness

yellow eyes or skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Hair loss, temporary

loss of appetite

nausea or vomiting

Less common

Acne

boils on skin

pale skin

skin rash or itching

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

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Pros and cons of Otrexup (methotrexate)

Pros

  • Only need to take once a week
  • Good option for people who have trouble swallowing pills
  • Conveniently stored at room temperature

Cons

  • Can make your skin more sensitive to the sun and raise your risk for sunburns
  • Many serious risks that affect many different parts of the body (e.g., lungs, liver, kidney, skin)
  • Can't use while pregnant or breastfeeding
pharmacist-tips-icon

Pharmacist tips for Otrexup (methotrexate)

pharmacist
  • Otrexup (methotrexate) is injected once a week. Choose a day of the week that's easy for you to remember. You can also mark your calendar or use a reminder app on your phone so you don't forget. This medication isn't meant to be used every day; otherwise, it could lead to serious and fatal side effects.
  • Your provider will monitor you closely during treatment because Otrexup (methotrexate) can cause many side effects in different parts of your body. Make sure to get all of your lab tests and scans done on time so your provider can check that the medication is safe for you.
  • Otrexup (methotrexate) can make you feel dizzy or tired. Be sure you know how this medication affects you before you drive or operate machinery.
  • Otrexup (methotrexate) can make your skin more sensitive to the sun, raise your risk for sunburns, and even make previous sunburns come back. Try to avoid direct sun exposure. When you go outside, wear sunscreen and clothes that protect your skin. Tell your provider if you get a sunburn or have painful skin while you're taking this medication.
  • Before you get any vaccines, tell your provider that you're taking Otrexup (methotrexate). Some vaccines (e.g., live vaccines) might not work as well while you're taking this medication. Your providers can make sure the vaccine you're getting is safe for you.

Tips on how to use Otrexup (methotrexate):

  • Don't try to inject Otrexup (methotrexate) until you've been trained by a healthcare provider. Become familiar with the Instructions for Use, and ask your provider if you have any questions.
  • The Otrexup (methotrexate) autoinjectors are designed so you can't see the needle. It's normal if you don't see it when you're using the autoinjector, and you'll still get the full dose of your medication.
  • Before each time you use Otrexup (methotrexate), check that the solution in the viewing window looks yellow and is free of particles. Air bubbles are normal. Otherwise, use another autoinjector device.
  • Carefully follow the instructions to use the Otrexup (methotrexate) autoinjector device to inject the medication under the skin of your stomach or thigh. You'll know that you've injected the full dose of medication once you see that the viewing window is half blocked with a red flag. Contact your provider or pharmacist if it isn't.
  • Each Otrexup (methotrexate) autoinjector is meant for one-time use, so don't try to reuse it. After you've used an autoinjector, place it in a special sharps container for disposal. Don't throw it away in the trash. This helps prevent needle-stick injuries.
faq-icon

Common questions about Otrexup (methotrexate)

For rheumatoid arthritis and juvenile arthritis, Otrexup (methotrexate) can usually start to work within 3 to 6 weeks. Symptoms can continue to improve for the next several months. For psoriasis, you can start seeing improvements in your skin after about 4 to 6 weeks of treatment. It might take up to 6 months for your skin to completely clear. Follow up with your provider and discuss how well Otrexup (methotrexate) is working for you.

Inject Otrexup (methotrexate) under the skin on your stomach or thigh. Don't inject it within 2 inches of your belly button or into skin that's bruised, tender, scarred, scaly, red, or hard. Follow up with your healthcare provider if you have questions about how to inject Otrexup (methotrexate).

Ask your provider whether you can take ibuprofen (Advil) while you're using Otrexup (methotrexate). NSAIDs, such as ibuprofen (Advil), might interfere with how well your body gets rid of Otrexup (methotrexate) from its system. This can potentially cause the medication to build up in your body and raise your risk for side effects. In general, it's recommended to ask your provider or pharmacist before taking any new medications with Otrexup (methotrexate) to make sure they're safe to take together.

You should avoid drinking alcohol while you're taking Otrexup (methotrexate). Alcohol can raise your risk of some serious side effects from the medication, such as liver problems. Speak with your provider about your alcohol consumption during treatment with Otrexup (methotrexate). Your provider can give you guidance on how to lessen the amount you drink and stop altogether.

It's possible to take Otrexup (methotrexate) if you have kidney problems, but your provider will want to follow up with you more often. Otrexup (methotrexate) gets removed from your body through your kidneys. So when your kidneys don't work well, the medication might build up in your body and raise your risk for serious side effects. Depending on your kidney problem, your provider might lower your dose of Otrexup (methotrexate) or recommend a different medication to keep you safe.

No. You can't take Otrexup (methotrexate) during pregnancy because it can cause serious harm to unborn babies. Before starting treatment, your provider will have you take a pregnancy test if you can have children. In addition, if you or your partner can become pregnant, make sure to use birth control whenever you have sex while you're taking Otrexup (methotrexate). Continue to avoid pregnancy for at least 6 months (for females) and for at least 3 months (for males) after the last dose. Contact your provider right away if you think that you're pregnant during treatment.

It's recommended that you don't breastfeed while you're taking Otrexup (methotrexate) and for 1 week after your last dose. In studies of mothers who took methotrexate by mouth, low amounts of the medication were found in breast milk. It's unclear what effects this has on a breastfed baby or on your milk supply. But because of the serious risks of the medication, it's best to avoid breastfeeding while you're taking Otrexup (methotrexate). Speak with your healthcare provider about other ways to feed your baby, like using formula.

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warnings-icon

Risks and warnings for Otrexup (methotrexate)

Otrexup (methotrexate) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

Serious damage to different parts of the body

  • Risk factors: Peptic ulcer disease | Ulcerative colitis | Heavy alcohol use | Kidney or liver problems| | Diabetes | Higher doses of Otrexup (methotrexate) | Taking Otrexup (methotrexate) for a long time | Taking NSAIDs | Considered obese | Fluid buildup in the body (e.g., stomach, lungs) | Older age

Warning Icon Otrexup (methotrexate) can cause many serious problems all over the body that can be fatal. It can put stress on your lungs, digestive tract, liver, kidneys, skin, and nervous system.

These problems can happen at any time during treatment, so your provider will follow up with you often. Your provider might also order various lab tests, tissue samples (biopsies), or scans to help check for these problems. Most symptoms can be treated if they're recognized early.

Get medical help right away if you have any of the following symptoms. Lung problems: trouble breathing, cough Digestive tract problems: diarrhea, vomiting, stomach pain, mouth pain or inflammation Liver problems: yellowing of your skin or whites of the eyes, pain in the right side of your stomach, dark urine, vomiting Kidney problems: swelling in your feet or ankles, little or no urine Nerve problems: changes in vision, not able to move one side of your body, confusion, seizure

Severe allergic and skin reactions

Warning IconRarely, Otrexup (methotrexate) can cause life-threatening allergic reactions and skin reactions. Get medical help right away if you have trouble breathing, swelling in your face or throat, rash, blisters, peeling skin, red skin, mouth sores, muscle aches, or fever.

Risk of infections, bleeding, and anemia due to low blood cells

  • Risk factors: Blood problems | Current infection | Weak immune system

Warning IconOtrexup (methotrexate) can affect your bone marrow and cause your body to make fewer blood cells. This can cause many side effects. It can raise your chance of bleeding and make you more likely to have anemia and get infections. Your healthcare provider will probably ask to have your blood drawn periodically during treatment to check your blood cell counts. Talk to your provider right away if you suddenly have muscle weakness, unexplained bruising or bleeding, or develop a fever.

Harm to unborn babies

  • Risk factors: Pregnancy

Warning Icon Otrexup (methotrexate) can cause life-threatening harm to an unborn baby if it's taken during pregnancy. For this reason, avoid taking this medication if you're pregnant. If you or your partner can become pregnant, it's important for you to use birth control whenever you have sex during treatment. Continue to avoid becoming pregnant for at least 6 months (for females) and for at least 3 months (for males) after the last dose. Talk to your provider about other options if you become or would like to become pregnant.

Possible infertility (not able to have children)

It's possible for Otrexup (methotrexate) to make it harder for you to have children (a loss of fertility, or infertility). This medication has been linked to low sperm count and menstrual problems. This might not be reversible, so it's important that you discuss the risks with your healthcare provider if you're considering having children in the future.

Risk of cancer

Some people who took low-dose methotrexate by mouth developed certain types of cancer and tumors, such as skin cancers and blood cancers. The risk for cancer with Otrexup (methotrexate) can't be ruled out. Tell your provider if you have an unexplained fever, feel very tired, have swollen lymph nodes in your neck or armpits, or spots or moles on your skin that seem unusual.

Tumor lysis syndrome

Taking methotrexate might cause a serious condition called tumor lysis syndrome (TLS) in people who have certain cancers or tumors. Typically, people who are prescribed Otrexup (methotrexate) for arthritis or psoriasis have a low chance of developing TLS unless they have a known or undiagnosed tumor. Call your provider right away if you have nausea, vomiting, low appetite, tiredness, side pain, muscle cramps, a pounding chest, dark urine, or less urination. These can be symptoms of TLS.

dosage-icon

Otrexup (methotrexate) dosage

The average cost for 1 package of 4 injections of 20mg/0.4ml of Otrexup (methotrexate) is $530.40 with a free GoodRx coupon. This is 49.73% off the average retail price of $1,055.20.
packagePackage
DosageQuantityPrice as low asPrice per unit
4 injections of 10mg/0.4ml1 package$530.40$530.40
4 injections of 15mg/0.4ml1 package$530.40$530.40
4 injections of 20mg/0.4ml1 package$530.40$530.40
4 injections of 25mg/0.4ml1 package$530.40$530.40
4 injections of 12.5mg/0.4ml1 package$530.40$530.40
4 injections of 17.5mg/0.4ml1 package$530.40$530.40
4 injections of 22.5mg/0.4ml1 package$530.40$530.40
syringeSyringe
DosageQuantityPrice as low asPrice per unit
10 mg/0.4ml5 syringes$385.63$77.13
12.5mg/0.4ml4 syringes$768.52$192.13
15mg/0.4ml5 syringes$1,311.66$262.33
17.5mg/0.4ml4 syringes$768.52$192.13
20mg/0.4ml5 syringes$959.09$191.82
22.5mg/0.4ml4 syringes$768.52$192.13
25mg/0.4ml5 syringes$962.73$192.55

Typical dosage for Otrexup (methotrexate)

  • Rheumatoid arthritis in adults: The typical starting dose is 7.5 mg injected under the skin once a week.
  • Polyarticular juvenile idiopathic arthritis in children: The dose is based on body surface area (BSA), which takes into account weight and height. The typical starting dose is 10 mg/m2 injected under the skin once a week.
  • Psoriasis in adults: The typical starting dose ranges from 10 mg to 25 mg injected under the skin once a week.

Your provider might slowly raise your dose based on how well the medication is working for you.

interactions-icon

Interactions between Otrexup (methotrexate) and other drugs

Otrexup (methotrexate) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Otrexup (methotrexate). Please note that only the generic name of each medication is listed below.

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

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Otrexup (methotrexate) contraindications

Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Otrexup (methotrexate) will not be safe for you to take.

  • Currently pregnant
  • Alcohol use disorder
  • Liver problems
  • Weak immune system
  • Blood problems (e.g., low platelets, low white blood cells, anemia)
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What are alternatives to Otrexup (methotrexate)?

There are a number of medications that your doctor can prescribe in place of Otrexup (methotrexate). Compare a few possible alternatives below.
Otrexup (methotrexate)
Used for:
  • Rheumatoid arthritis (RA) in adults
  • Polyarticular juvenile idiopathic arthritis (pJIA) in children
  • Psoriasis in adults
$385.63Lowest GoodRx priceView prices
Used for:

Cancer:

Non-cancer conditions:

$12.10Lowest GoodRx priceView prices
Used for:
$277.00Lowest GoodRx priceView prices

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References

Best studies we found

Antares Pharma, Inc. (2019). Otrexup (methotrexate) injection, for subcutaneous use [package insert].

Antares Pharma, Inc. (2023). Otrexup- methotrexate injection, solution [package insert]. DailyMed.

Benjamin, O., et al. (2023). Disease-modifying antirheumatic drugs (DMARD). StatPearls.

GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.

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