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Rasuvo

methotrexate
Used for Psoriasis, Rheumatoid Arthritis
Used for Psoriasis, Rheumatoid Arthritis

Rasuvo (methotrexate) is a disease-modifying antirheumatic drug (DMARD) that treats rheumatoid arthritis (RA), polyarticular juvenile idiopathic arthritis (pJIA), and severe psoriasis when other treatment options haven't worked well. It's a once-weekly injection under the skin on the stomach or thigh. The medication can potentially cause many side effects in different parts of your body, so you'll need regular lab tests done so your provider can monitor you. Rasuvo (methotrexate) isn't safe during pregnancy because it can harm unborn babies.

Reviewed by:
reviewer
Kristianne Hannemann, PharmD
reviewer
Cydnee Ng, PharmD
Last reviewed on November 2, 2023
BasicsSide effectsPros & consPharmacist tipsFAQsWarningsDosageInteractionsCostContraindicationsAlternativesLatest newsReferencesPricesMedicare
basics-icon

What is Rasuvo (methotrexate)?

What is Rasuvo (methotrexate) used for?

  • Rheumatoid arthritis (RA) in adults

  • Polyarticular juvenile idiopathic arthritis (pJIA) in children

  • Psoriasis in adults

How Rasuvo (methotrexate) works

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

Are you looking for information on methotrexate tablets, RediTrex (methotrexate), or Otrexup (methotrexate) instead?

Drug Facts

Common BrandsRasuvo
Drug ClassAntimetabolite
Controlled Substance ClassificationNot a controlled medication
Generic StatusNo lower-cost generic available
AvailabilityPrescription only
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What are the side effects of Rasuvo (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

Other 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 Rasuvo.

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

More on Rasuvo (methotrexate) side effects

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10 Side Effects of Methotrexate You Should Know About

Written by Emmeline C. Academia, PharmD, BCOP

The following 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.

pros-and-cons

Pros and cons of Rasuvo (methotrexate)

thumbs-up

Pros

A good option for those who have trouble swallowing pills

Only need to take it once a week

Available as a prefilled autoinjector

Conveniently stored at room temperature

thumbs-down

Cons

Must get lab tests done regularly to check for side effects

Can make your skin more sensitive to the sun and raise your risk for sunburns

Not available as a lower-cost generic

Can't use while pregnant or breastfeeding

pharmacist-tips

Pharmacist tips for Rasuvo (methotrexate)

pharmacist

  • Rasuvo (methotrexate) is injected under the skin once a week. Pick a day of the week that's easy for you to remember. Mark your calendar or use a reminder app on your phone to help you remember to take the medication. This medication isn't meant to be used every day; otherwise, it could lead to serious and fatal side effects.

    • During treatment, be sure to get all of your lab tests and scans as instructed by your provider to check that Rasuvo (methotrexate) is safe for you. This medication can cause many side effects in different parts of your body that the tests and scans can help detect.

      • Rasuvo (methotrexate) can make you feel dizzy or tired. Make sure you know how the medication affects you before driving or operating machinery.

        • Before you get any vaccines, tell your provider that you're taking Rasuvo (methotrexate). Some vaccines (e.g., live vaccines) might work less 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 Rasuvo (methotrexate):

          • Don't try to inject Rasuvo (methotrexate) until you've been trained by a healthcare provider. Make sure you understand the Instructions for Use. Ask your provider if you have any questions.

            • Before each time you use Rasuvo (methotrexate), check that the solution in the viewing window looks yellow to brown and is free of particles. Air bubbles are normal. Otherwise, use another autoinjector.

              • Carefully follow the instructions to use the Rasuvo (methotrexate) autoinjector. Remove the yellow cap when you're ready to inject. Then, inject the medication under the skin of your stomach or thigh. Make sure to avoid injecting the medication within 2 inches of your belly button or into skin that's bruised, tender, scarred, scaly, red, or hard.

                • You'll know that you've injected the full dose of Rasuvo (methotrexate) when you see that there's no more liquid left inside the viewing window. Contact your provider or pharmacist if there's medication left.

                  • Each Rasuvo (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.

                    faqs

                    Frequently asked questions about Rasuvo (methotrexate)

                    How long does it take for Rasuvo (methotrexate) to work?
                    Everyone responds to Rasuvo (methotrexate) differently. For rheumatoid arthritis and juvenile arthritis, most people see an improvement in symptoms within 3 to 6 weeks of starting Rasuvo (methotrexate). It can take up to 12 weeks to see the full effect of the medication for some people. And for psoriasis, most people start seeing improvements in their skin after about 4 to 6 weeks of treatment, though it might take up to 6 months for the skin to completely clear. In general, your provider will typically start Rasuvo (methotrexate) at a low dose, see how you tolerate the medication, and then adjust the dose if needed. Talk with your provider about how well Rasuvo (methotrexate) is working for you.
                    What's the difference between Rasuvo (methotrexate) and Otrexup (methotrexate)?
                    Both Rasuvo (methotrexate) and Otrexup (methotrexate) are once-weekly injections that treat RA, pJIA, and psoriasis. They both contain methotrexate as the active ingredient and work the same way. The two medications are also autoinjectors that can be easy to use with training. The main difference is that Rasuvo (methotrexate) is available in more strengths than Otrexup (methotrexate). Talk with your provider to find out which option is right for you.
                    Can you drink alcohol while taking Rasuvo (methotrexate)?
                    It's best to avoid drinking alcohol while you're taking Rasuvo (methotrexate). Alcohol can put you at risk for some serious side effects from the medication, such as liver problems. Talk with your provider about your alcohol consumption during treatment with Rasuvo (methotrexate). Your provider can give you guidance on how to lessen the amount you drink and stop altogether.
                    Is Rasuvo (methotrexate) a cure?
                    No. Rasuvo (methotrexate) can help lower inflammation, relieve symptoms, and slow the progression of your condition. But it won't cure arthritis or psoriasis. Once you stop taking the medication, it's possible that your symptoms can come back or get worse.
                    Is Rasuvo (methotrexate) safe to use during pregnancy?
                    No, Rasuvo (methotrexate) isn't safe to use during pregnancy because it can cause serious harm to unborn babies. For this reason, you can't use this medication if you're pregnant. If you can have children, you'll need to take a pregnancy test before you start treatment. Also, if you or your partner can become pregnant, use reliable birth control whenever you have sex while you're taking Rasuvo (methotrexate). Continue to avoid pregnancy for at least 6 months (for females) and for at least 3 months (for males) after the last dose. Tell your provider right away if you think you're pregnant.
                    Can I breastfeed while I'm using Rasuvo (methotrexate)?
                    It's recommended that you don't breastfeed during treatment with Rasuvo (methotrexate) and for 1 week after your last dose. In studies, mothers who took methotrexate by mouth had low amounts of the medication in their breast milk. It isn't known what effects this has on a breastfed baby or on milk supply. But because of the serious risks of the medication, it's best to avoid breastfeeding while you're taking Rasuvo (methotrexate). Talk with your provider about other ways to feed your baby, like with formula.
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                    What are the risks and warnings for Rasuvo (methotrexate)?

                    Rasuvo (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.

                    risk-warning

                    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 Rasuvo (methotrexate) | Taking Rasuvo (methotrexate) for a long time | Taking NSAIDs | Considered obese | Fluid buildup in the body (e.g., stomach, lungs) | Older age

                      Rasuvo (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

                      risk-warning

                      Severe allergic and skin reactions

                      Rarely, Rasuvo (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-warning

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

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

                        Rasuvo (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.

                        risk-warning

                        Harm to unborn babies

                        • Risk factors: Pregnancy

                          Rasuvo (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.

                          risk-warning

                          Possible infertility (not able to have children)

                          It's possible for Rasuvo (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-warning

                          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 Rasuvo (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.

                          risk-warning

                          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 Rasuvo (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.

                          More on Rasuvo (methotrexate) warnings

                          Methotrexate: Toxicity: headache pills on nightstand 1312767704.jpg

                          The Signs of Methotrexate Toxicity and How It’s Treated

                          Written by Sonja Jacobsen, PharmD, BCPS, BCOP
                          dosage

                          Rasuvo (methotrexate) dosage forms

                          Typical dosing for Rasuvo (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

                          Interactions between Rasuvo (methotrexate) and other drugs

                          Rasuvo (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 Rasuvo (methotrexate). Please note that only the generic name of each medication is listed below.

                          More on Rasuvo (methotrexate) interactions

                          drug interaction methotrexate

                          8 Methotrexate Interactions You Should Know About

                          Written by Emmeline C. Academia, PharmD, BCOP

                          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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                          How much does Rasuvo (methotrexate) cost?

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                          Rasuvo (brand)
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                          contraindications-icon

                          Rasuvo (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 Rasuvo (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)

                          alternatives

                          What are alternatives to Rasuvo (methotrexate)?

                          There are a number of medications that your doctor can prescribe in place of Rasuvo (methotrexate). Compare a few possible alternatives below.
                          Rasuvo (methotrexate)
                          Used for:

                          • Rheumatoid arthritis (RA) in adults

                          • Polyarticular juvenile idiopathic arthritis (pJIA) in children

                          • Psoriasis in adults

                          $532.92 Lowest GoodRx priceView Prices
                          Enbrel (etanercept)
                          Used for:

                          • Rheumatoid arthritis (RA)

                          • Plaque psoriasis (PsO) and psoriatic arthritis (PsA)

                          • Ankylosing spondylitis (AS)

                          • Childhood arthritis (polyarticular juvenile idiopathic arthritis, JIA)

                          $7418.24 Lowest GoodRx priceView Prices
                          Methotrexate (Trexall)
                          Used for:
                          $188.05 Lowest GoodRx priceView Prices

                          References

                          Best studies we found

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

                          Czarnecka-Operacz, M., et al. (2014). The possibilities and principles of methotrexate treatment of psoriasis - The updated knowledge. Advances in Dermatology in Allergology.

                          Gupta, A., et al. (2018). Tumor lysis syndrome. Journal of the American Medical Association Oncology.

                          View All References (6)

                          El-Esawy, F. M., et al. (2022). Methotrexate mechanism of action in plaque psoriasis: Something new in the old view. The Journal of Clinical and Aesthetic Dermatology.

                          Hagihara, M., et al. (2018). Methotrexate-associated intravascular large B-cell lymphoma in a patient with rheumatoid arthritis: A very rare case. Internal Medicine.

                          Medexus Pharma, Inc. (2020). Patient information: Rasuvo® (ruh-SOO-voh) (methotrexate) injection, for subcutaneous use.

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

                          OrthoInfo. (2022). Juvenile arthritis. The American Academy of Orthopaedic Surgeons.

                          Yan, M. K., et al. (2022). Association between low-dose methotrexate exposure and melanoma: A systematic review and meta-analysis. Journal of the American Medical Association Dermatology.

                          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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