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Xatmep

methotrexate
Used for Leukemia
Used for Leukemia

Xatmep (methotrexate) is a medication that’s used to treat children with acute lymphoblastic leukemia (ALL). It’s also sometimes used to treat children with non-cancer conditions such as polyarticular juvenile idiopathic arthritis (pJIA) when other medications haven’t worked well enough. Xatmep (methotrexate) is an oral solution that you take by mouth once a week, though the specific dose depends on whether you’re taking it for cancer or a non-cancer condition. This medication can cause side effects such as nausea and low blood cell counts.

Last reviewed on December 6, 2023
basics-icon

What is Xatmep (methotrexate)?

What is Xatmep (methotrexate) used for?

How Xatmep (methotrexate) works

Xatmep (methotrexate) is an antimetabolite medication that helps treat acute lymphoblastic leukemia (ALL) and non-cancer conditions like arthritis.

  • For leukemia: Xatmep (methotrexate) works by blocking dihydrofolate reductase, a protein in your body that’s important for making DNA in cells and for cell growth. Since cancer cells grow much more quickly than healthy cells, the medication helps slow down cancer growth so the cancer can’t spread as well.

  • For non-cancer conditions like arthritis: We don’t know exactly how this medication works to treat non-cancer conditions like arthritis. But research suggests that, at lower doses, methotrexate helps lower the activity of the immune system to lessen inflammation.

Are you looking for information on methotrexate tablets (Trexall) or methotrexate injection instead?

Drug Facts

Common BrandsXatmep
Drug ClassAntimetabolite
Controlled Substance ClassificationNot a controlled medication
Generic StatusNo lower-cost generic available
AvailabilityPrescription only

More on Xatmep (methotrexate) essentials

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What are the side effects of Xatmep (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

  • Mouth sores
  • Nausea or vomiting
  • Diarrhea
  • Other stomach discomfort
  • Tiredness
  • Dizziness
  • Chills
  • Fever
  • Low white blood cell count
  • Infections
  • High liver enzyme levels

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.
  • Serious infections (from having low white blood cell counts): temperature of 100.4 degrees Fahrenheit, with or without other symptoms, such as chills, cough, muscle aches, very fast heartbeat, confusion
  • Low platelets: blood in urine or stool, nosebleeds, unexplained bruising or bleeding, bruising or bleeding that doesn’t go away
  • Serious lung problems: sudden cough, fever, and trouble breathing
  • Serious gut problems: sudden stomach pain, blood in stool
  • Serious liver problems: nausea, vomiting, tiredness, stomach pain or swelling, pale-colored stool, dark-colored urine, yellowing of the whites of the eyes or skin
  • Serious skin reaction: painful blisters, skin wounds, peeling skin, fever, sore throat, body aches
  • Allergic reaction: rash, trouble breathing, swelling of the mouth or around the eyes

Source: DailyMed

The following side effects have also been reported

Side effects that you should report to your care team as soon as possible:

  • Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
  • Dry cough, shortness of breath or trouble breathing
  • Infection—fever, chills, cough, sore throat, wounds that don't heal, pain or trouble when passing urine, general feeling of discomfort or being unwell
  • Kidney injury—decrease in the amount of urine, swelling of the ankles, hands, or feet
  • Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
  • Low red blood cell level—unusual weakness or fatigue, dizziness, headache, trouble breathing
  • Pain, tingling, or numbness in the hands or feet, muscle weakness, change in vision, confusion or trouble speaking, loss of balance or coordination, trouble walking, seizures
  • Redness, blistering, peeling, or loosening of the skin, including inside the mouth
  • Stomach bleeding—bloody or black, tar-like stools, vomiting blood or brown material that looks like coffee grounds
  • Stomach pain that is severe, does not go away, or gets worse
  • Unusual bruising or bleeding

Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):

  • Diarrhea
  • Dizziness
  • Hair loss
  • Nausea
  • Pain, redness, or swelling with sores inside the mouth or throat
  • Skin reactions on sun-exposed areas
  • Vomiting
pros-and-cons

Pros and cons of Xatmep (methotrexate)

thumbs-up

Pros

Taken by mouth once a week

Available as an oral solution for children who can’t swallow pills

Doesn’t typically cause hair loss

thumbs-down

Cons

Might raise your risk for infection

Often causes nausea and mouth sores

Requires frequent lab tests to check for side effects

pharmacist-tips

Pharmacist tips for Xatmep (methotrexate)

pharmacist
  • Take Xatmep (methotrexate) once a week. Choose a day of the week that’s easy to remember or use a reminder app on your phone to help. This medication isn’t meant to be taken every day; otherwise, it could lead to serious side effects.

    • Make sure to get any lab tests that your provider orders. These tests help your provider check that the medication is safe for you. Some tests include those that check your blood cell counts and kidney, liver, and lung function.

      • Don’t start or stop any new medications without first talking to your provider or pharmacist. There are several medications you shouldn’t take with Xatmep (methotrexate) because they can raise your risk for side effects. Your provider or pharmacist can make sure all of your medications are safe to take.

        • Before you get any vaccines, tell your provider or pharmacist that you’re taking Xatmep (methotrexate). Some vaccines might not work as well for you during treatment. In particular, you should avoid getting live vaccines because of the risk of infection from the vaccine itself. Your providers can make sure you can get the vaccine.

          Tips on how to take Xatmep (methotrexate):

          • Be sure you know what your dose is and how to measure it out properly. Xatmep (methotrexate) doses are different for people who are taking it for cancer and for non-cancer conditions. Ask your provider or pharmacist if you’re not sure what dose you should take or how to measure the dose.

            • Always use the measuring device (such as an oral syringe or dosing spoon) that came with your medication. This helps make sure you take the correct dose of Xatmep (methotrexate). Using a teaspoon or other measuring spoon from home won’t be exact.

              • Xatmep (methotrexate) oral solution is a clear yellow or orange liquid. Contact your provider or pharmacist about what to do if the color looks different.

                • For non-cancer conditions like arthritis: Make sure you take only the dose that your provider recommends. Taking the medication at too high of a dose can lead to serious side effects. Your provider might recommend that you take folic acid supplements with Xatmep (methotrexate) to help manage side effects.

                  Tips on how to handle and store Xatmep (methotrexate):

                  • Ask your provider about the best way to handle Xatmep (methotrexate) safely. Since this medication is sometimes used for treating cancer, it can be harmful to people who handle or come in contact with it. Keep it in a safe place away from children and pets.

                    • Store Xatmep (methotrexate) oral solution in the refrigerator until its expiration date. You can also keep the medication at room temperature, but you can’t use it after 60 days at this temperature.

                      • If your medication expires or if you have leftover medication, ask your provider about how to throw it away. You might be able to bring it to the provider’s office or clinic for proper disposal.

                        More on Xatmep (methotrexate) tips

                        faqs

                        Frequently asked questions about Xatmep (methotrexate)

                        Is Xatmep (methotrexate) chemotherapy?
                        Xatmep (methotrexate) is considered chemotherapy when it’s used at higher doses to treat acute lymphoblastic leukemia (ALL). Like other traditional chemotherapy, the medication kills cells that are growing quickly, including healthy cells and cancer cells. At high doses, Xatmep (methotrexate) specifically works to treat cancer by blocking a protein in your body that’s important for cells to grow and divide. But as a result, the medication can cause side effects such as nausea, diarrhea, and mouth sores because it also affects fast-growing, healthy cells. Keep in mind that Xatmep (methotrexate) is also used at lower doses to treat non-cancer conditions such as polyarticular juvenile idiopathic arthritis.
                        Is Xatmep (methotrexate) a disease-modifying antirheumatic drug (DMARD)?
                        Xatmep (methotrexate) is considered a disease-modifying antirheumatic drug (DMARD) when it’s used at lower doses to treat inflammatory conditions such as polyarticular juvenile idiopathic arthritis. As a DMARD, the medication helps lower the activity of the immune system. This prevents the immune system from attacking a certain part of the body, such as your joints. It helps lower inflammation (swelling), relieve symptoms, and slow the progression of the inflammatory condition.
                        What medications should I not take with Xatmep (methotrexate)?
                        Avoid or be careful using medications that can interact with Xatmep (methotrexate) because they can raise your risk for side effects. Some medications that can interact with Xatmep (methotrexate) include certain antibiotics like amoxicillin and Bactrim (sulfamethoxazole / trimethoprim). In addition, be careful using NSAIDs like ibuprofen (Advil) and aspirin. Keep in mind that taking folic acid supplements with Xatmep (methotrexate) might make the medication work less well for treating cancer. Before you start Xatmep (methotrexate), tell your providers about all your medications so they can review your medication list and check that Xatmep (methotrexate) is safe for you to take. Don’t start any new medications without first talking to your provider once you start treatment.
                        Can I take Xatmep (methotrexate) if I have kidney problems?
                        It depends. Xatmep (methotrexate) mainly leaves your body through your kidneys. So, people with kidneys that don’t work as well tend to keep the medication in their bodies longer, which can raise the risk for side effects. Additionally, Xatmep (methotrexate) itself can cause kidney damage. Talk to your provider about whether it’s safe for you to take Xatmep (methotrexate) if you have kidney problems. When you take Xatmep (methotrexate), your provider will check your kidney health often during treatment with lab tests.
                        Is Xatmep (methotrexate) safe in pregnancy?
                        No, Xatmep (methotrexate) isn’t safe during pregnancy. Based on studies and the way the medication works, it can cause harm to an unborn baby. If you or your partner can become pregnant, you should use effective birth control while you’re taking Xatmep (methotrexate). Continue using birth control for 6 months after the last dose for females or for 3 months after the last dose for males. Contact your provider right away if you or your partner gets pregnant while you’re taking Xatmep (methotrexate).
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                        What are the risks and warnings for Xatmep (methotrexate)?

                        Xatmep (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

                        Low blood cell counts

                        Xatmep (methotrexate) can cause low blood cell counts, particularly in people taking the medication at doses for cancer treatment. When your red blood cells are low, you might feel more tired. And when your platelets are low, you’re at risk for bleeding. In addition, low white blood cells put you at risk for serious and life-threatening infections.

                        Your provider will check your blood cell counts before you start Xatmep (methotrexate) and every so often during treatment. Your provider will pay close attention to your white blood cell counts. If your counts are too low, your provider might make adjustments to your treatment to give your body time to make new blood cells.

                        It’s important to lower your risk of getting sick by washing your hands often and avoiding crowds. Check your temperature regularly, and call your provider right away if your temperature is 100.4 degrees Fahrenheit or higher.

                        risk-warning

                        Serious infections

                        People who take Xatmep (methotrexate) have a higher risk of getting sick, particularly from opportunistic infections (infections that usually only happen when the immune system is weak). Sometimes, providers prescribe additional medications, such as antibiotics and antiviral medications, to prevent infections. Contact your provider right away if you feel sick, such as having a fever, muscle aches, night sweats, severe tiredness, cough, or trouble breathing. You might need to start taking a lower dose or stop Xatmep (methotrexate) altogether if you develop a serious infection during treatment.

                        risk-warning

                        Kidney damage and higher risk for side effects

                        Xatmep (methotrexate) can harm the kidneys, sometimes causing kidney failure. Your risk for side effects might also be higher if you have kidney problems. Your provider will order blood tests often to check your kidney health, typically before you start Xatmep (methotrexate) and periodically during treatment. Your provider will examine your kidneys closely if your blood test results are abnormal.

                        risk-warning

                        Damage to the digestive tract

                        • Risk factors: Peptic ulcer disease | Ulcerative colitis | Also taking NSAIDs

                          Sometimes, Xatmep (methotrexate) causes vomiting, diarrhea, mouth sores, stomach bleeding, or tears in the gut. People taking this medication for arthritis who are also using NSAIDs are at even higher risk for serious gut problems; be careful using NSAIDs if they’re part of your treatment plan. Seek medical help right away if you have sudden stomach pain or bloody stool.

                          risk-warning

                          Liver damage

                          • Risk factors: Heavy alcohol use | Personal or family history of liver problems | Diabetes | High cholesterol | Considered obese | Older age

                            Some people taking Xatmep (methotrexate) have developed liver problems, including cirrhosis or liver failure. These liver problems can be severe, permanent, and even life-threatening. Talk to your provider about the benefits and risks of taking this medication if you have liver problems.

                            Your provider will order blood tests to check your liver health before you start Xatmep (methotrexate) and periodically during treatment; high liver enzyme levels on your results can suggest liver damage. Let your provider know if you have symptoms of liver damage, such as nausea, tiredness, stomach pain, or yellowing of the whites of the eyes or skin. You might need to pause Xatmep (methotrexate) while your provider examines your liver health.

                            risk-warning

                            Lung problems

                            Some people who’ve taken Xatmep (methotrexate) have experienced a serious lung problem called interstitial lung disease (ILD). These lung problems can sometimes be permanent or life-threatening. Call your provider right away if you have a sudden or worsening cough, trouble breathing, or fever. You’ll probably need to do pulmonary function tests and scans to check how healthy your lungs are.

                            risk-warning

                            Allergic reactions and skin problems (including skin burns)

                            • Risk factors: Previous radiation

                              Some people who take Xatmep (methotrexate) can have allergic reactions to the medication, including anaphylaxis. Sometimes, the medication can also cause severe and potentially life-threatening skin reactions that happen with or without infection, such as Stevens-Johnson syndrome or toxic epidermal necrolysis (TEN).

                              Tell your provider right away if you develop painful blisters, skin wounds, peeling skin, trouble breathing, or swelling of the mouth or around the eyes. These can be signs of a serious reaction to the medication that needs immediate medical attention.

                              Xatmep (methotrexate) can also make your skin more sensitive to the sun, raise your risk for sunburns, and even make previous sunburns or skin burns from radiation come back. Try to avoid sun exposure when possible. If you’re going outdoors, wear sunscreen with an SPF of at least 30 and clothes that protect your skin. Let your provider know if you get a sunburn or have painful skin while you’re taking this medication.

                              risk-warning

                              Harm to unborn baby

                              Xatmep (methotrexate) can cause harm to an unborn baby and pregnancy loss (miscarriage) when it’s taken during pregnancy. For this reason, you can’t take this medication for non-cancer conditions if you’re pregnant.

                              In general, it’s best to avoid becoming pregnant while you’re taking Xatmep (methotrexate). If you or your partner can get pregnant, you should use effective birth control during treatment. Continue using birth control for another 6 months after the last dose for females or another 3 months after the last dose for males. Let your provider know right away if you or your partner becomes pregnant while you’re taking Xatmep (methotrexate).

                              risk-warning

                              Changes to your ability to have children (infertility)

                              Taking Xatmep (methotrexate) might affect your fertility, which is your ability to have children in the future. This medication has been linked to low sperm count and menstrual problems, and it’s unclear whether these changes are reversible. Talk to your provider if you have concerns.

                              risk-warning

                              Risk for new cancers

                              Some people who took Xatmep (methotrexate) developed new cancers. Some people reported getting cancers affecting their white blood cells (lymphoproliferative disease) even at low doses of Xatmep (methotrexate); the new cancer improved when they stopped the medication in these cases. During treatment, your provider will routinely check for signs of new cancers from your lab tests and your symptoms. Follow up with your provider for any new, unusual symptoms. You might need to pause your treatment while your provider looks into it.

                              risk-warning

                              Higher risk for side effects if you have extra body fluid

                              • Risk factors: Fluid buildup in the stomach area or lungs

                                Xatmep (methotrexate) can build up in pockets of fluid in the body. The medication can stay in your body longer if you’ve been told that you have extra fluid buildup in your body, such as around your stomach (ascites) or your lungs. This can put you at risk for worse side effects from Xatmep (methotrexate). Your provider will check for any extra fluid in your body and manage or treat it before you start Xatmep (methotrexate).

                                risk-warning

                                Risks with radiation therapy

                                People taking Xatmep (methotrexate) who are also doing radiation treatment are at higher risk for tissue and bone damage. Talk to your provider if you’re concerned about getting radiation with Xatmep (methotrexate).

                                More on Xatmep (methotrexate) warnings

                                dosage

                                Xatmep (methotrexate) dosage forms

                                The average cost for 16 ml of 2.5mg/ml of Xatmep (methotrexate) is $320.56 with a free GoodRx coupon. This is 16.57% off the average retail price of $384.20.
                                ml of oral solution
                                Ml of oral solution
                                DosageQuantityPrice as low asPrice per unit
                                2.5mg/ml16 ml$320.56$20.04

                                Typical dosing for Xatmep (methotrexate)

                                Your provider will calculate the dose based on your body size or body surface area (BSA, in m2 units), which takes into account height and weight.

                                • Acute lymphoblastic leukemia (ALL): The typical starting dose is 20 mg/m2 by mouth once a week. The provider will adjust the dose based on your child’s lab test results.

                                • Polyarticular juvenile idiopathic arthritis (pJIA): The typical starting dose is 10 mg/m2 by mouth once a week. Your child’s provider will adjust the dose based on how well the medication is working to relieve symptoms and on any side effects.

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                                contraindications-icon

                                Xatmep (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 Xatmep (methotrexate) will not be safe for you to take.
                                • Previous severe allergic reaction to methotrexate

                                • Currently pregnant (only if taking for non-cancer conditions)

                                images

                                Xatmep (methotrexate) images

                                yellow-orange - Xatmep 2.5mg / mL Solution
                                This medicine is Yellow-Orange Oral Solution.yellow-orange - Xatmep 2.5mg / mL Solution

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                                References

                                Best studies we found

                                Al-Quteimat, O. M., et al. (2014). Practical issues with high dose methotrexate therapy. Saudi Pharmaceutical Journal.

                                American Cancer Society. (2019). How chemotherapy drugs work.

                                American Cancer Society. (2019). Targeted therapy safety.

                                View All References (19)

                                American Cancer Society. (2019). Chemotherapy safety.

                                American Cancer Society. (2024). Anemia (low red blood cell counts).

                                American Cancer Society. (2024). Neutropenia (low white blood cell counts).

                                American Cancer Society. (2024). Thrombocytopenia (low platelet count).

                                Arthritis Foundation. (n.d.). Juvenile idiopathic arthritis (JIA).

                                Azurity Pharmaceuticals, Inc. (2022). Xatmep- methotrexate solution [package insert]. DailyMed.

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

                                Brockow, K., et al. (2015). Guideline for the diagnosis of drug hypersensitivity reactions: S2K-Guideline of the German Society for Allergology and Clinical Immunology (DGAKI) and the German Dermatological Society (DDG) in collaboration with the Association of German Allergologists (AeDA), the German Society for Pediatric Allergology and Environmental Medicine (GPA), the German Contact Dermatitis Research Group (DKG), the Swiss Society for Allergy and Immunology (SGAI), the Austrian Society for Allergology and Immunology (ÖGAI), the German Academy of Allergology and Environmental Medicine (DAAU), the German Center for Documentation of Severe Skin Reactions and the German Federal Institute for Drugs and Medical Products (BfArM). Allergo Journal International.

                                Burris, H. A., 3rd, et al. (2010). Radiation recall with anticancer agents. The Oncologist.

                                Centers for Disease Control and Prevention. (n.d.). What you need to know: Neutropenia and risk for infection.

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

                                Hafner, J., et al. (2023). Intestinal perforation. StatPearls.

                                Hanoodi, M., et al. (2023). Methotrexate. StatPearls.

                                Justiz Vaillant, A. A., et al. (2023). Lymphoproliferative disorders. StatPearls.

                                Leukemia & Lymphoma Society. (n.d.). Acute lymphoblastic leukemia.

                                National Human Genome Research Institute. (2024). DNA replication

                                Rahman, N. M., et al. (2023). Pleural effusion. Merck Manual Consumer Version.

                                Sepkowitz, K. A. (2002). Opportunistic infections in patients with and patients without acquired immunodeficiency syndrome. Clinical Infectious Diseases.

                                Shah, N. J., et al. (2023). Acute liver failure. 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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