Trexall (methotrexate) is a brand-name drug that’s prescribed for psoriasis, rheumatoid arthritis, and certain types of cancers in adults and some children. As with other drugs, Trexall can cause side effects, such as nausea and vomiting.
Trexall has boxed warnings. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). For details, see the “Side effect specifics” section below.
Trexall can cause certain side effects, some of which are more common than others. These side effects may be temporary, lasting a few days to weeks. However, if the side effects last longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist.
These are just a few of the more common side effects reported by people who took Trexall in clinical trials:
- nausea and vomiting
- stomatitis (mouth sores)
- stomach pain or discomfort
- diarrhea
- dizziness
Mild side effects can occur with Trexall use. This list doesn’t include all possible mild side effects of the drug. For more information, you can refer to Trexall’s prescribing information.
Mild side effects that have been reported with Trexall include:
- stomach pain or discomfort
- nausea and vomiting
- diarrhea
- stomatitis (mouth sores)
- dizziness
- hair loss
- fatigue
- fever or chills
- headache
- skin sensitivity to sunlight
These side effects may be temporary, lasting a few days to weeks. However, if the side effects last longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist.
Note: After the FDA approves a drug, it tracks and reviews side effects of the medication. If you develop a side effect while taking Trexall and want to tell the FDA about it, visit MedWatch.
Trexall may cause serious side effects. The list below may not include all possible serious side effects of the drug. For more information, you can refer to Trexall’s prescribing information.
If you develop serious side effects while taking Trexall, call your doctor right away. If the side effects seem life threatening or you think you’re having a medical emergency, immediately call 911 or your local emergency number.
Serious side effects that have been reported and their symptoms include:
- Lymphoma (cancer in the lymph nodes), which may include symptoms such as:
- swollen lymph nodes
- fever
- loss of appetite
- tiredness
- Serious infections, which may include symptoms such as:
- shortness of breath
- fever
- cough
- Tumor lysis syndrome (cancer cells release harmful chemicals into the body), which may include symptoms such as:
- muscle cramping or weakness
- heart palpitations (fast or irregular heartbeat)
- diarrhea
- fatigue
- numbness
- risk of kidney problems*
- risk of lung problems*
- risk of serious skin reactions*
- risk of gastrointestinal (GI) problems*
- risk of blood disorders*
- risk of liver problems*
* For more information about this side effect, see “Side effect specifics” below.
ALLERGIC REACTIONFor some people, Trexall can cause an allergic reaction.
In general, symptoms of allergic reaction can be mild or serious.
Ways to manage
For mild allergic reaction symptoms, such as a mild rash, call your doctor right away. They may recommend treatments to help manage your symptoms. They’ll also let you know whether you should keep taking the medication.
For severe allergic reaction symptoms, such as swelling or trouble breathing, call 911 or your local emergency number right away. These symptoms require immediate medical care because they can become life threatening. If you’ve had a serious allergic reaction to Trexall, your doctor may recommend taking a different medication instead.
Learn more about some of the side effects that Trexall may cause. To find out how often side effects occurred in clinical trials, see the prescribing information for Trexall.
Boxed warnings
Trexall has several boxed warnings about the possible risks of taking the medication. A boxed warning is the most serious warning from the FDA. The warnings alert doctors and patients about drug effects that may be dangerous.
Risk of liver problems
Trexall can cause liver problems in some people who take the drug. Elevated liver enzymes were a commonly reported side effect in the drug’s clinical trials. Liver enzymes that are higher than usual may be a sign of liver damage. In rare cases, Trexall can cause serious liver problems, such as fibrosis, cirrhosis, or liver failure.
Symptoms of liver problems may include:
- abdominal pain
- vomiting
- itching
- dark-colored urine
- jaundice (yellowing of the skin or whites of your eyes)
In people with psoriasis, liver damage can happen without having elevated liver enzymes or experiencing any symptoms.
The risk of liver problems increases with long-term use or heavy alcohol consumption. In some cases, liver damage caused by Trexall may not be reversible.
What you can do
Your doctor will order regular blood tests called liver function tests (LFT) to check the health of your liver during treatment with Trexall. If your blood tests show any signs of liver damage, your doctor may have you temporarily or permanently stop treatment with Trexall. If you notice any signs of liver problems, contact your doctor right away.
Risk of kidney problems
Trexall can cause serious kidney damage in some people, including permanent kidney failure. This was a rare side effect reported in the drug’s clinical trials.
Symptoms of kidney problems may include:
- swelling in the legs and feet
- confusion
- metallic taste in the mouth
- itchy skin
- producing more or less urine than usual
What you can do
Your doctor will order regular blood tests to monitor your kidneys during treatment with Trexall. If your blood tests suggest that your kidneys aren’t working as well as usual, your doctor may recommend temporarily or permanently stopping treatment with Trexall. If you notice any symptoms of kidney problems, talk with your doctor right away.
Risk of lung problems
Serious lung problems, including sudden and long-lasting interstitial pneumonitis, have been reported in people taking Trexall. This wasn’t a common side effect in the drug’s clinical trials. In rare cases, lung problems can lead to death.
Symptoms of a lung problem may include:
- shortness of breath, which may get worse over time
- dry cough
- unexplained weight loss
What you can do
If you develop any symptoms of lung problems, contact your doctor right away.
Risk of serious skin reactions
Serious skin reactions, including Stevens-Johnson syndrome, are possible during treatment with Trexall. In rare cases, these skin reactions can be fatal. However, this wasn’t commonly reported in the drug’s clinical trials.
Symptoms of a skin reaction may include:
- skin discoloration
- skin rash that blisters or peels
- fever
- body-aches
Your skin may also be more sensitive to the sun. You may be at an increased risk of sunburn or skin burn in areas previously exposed to radiation treatment.
What you can do
During treatment with Trexall, try to avoid being in the sun for long periods. Protect your skin by using sunscreen, wearing a hat, and wearing protective clothing.
If you experience any symptoms of a skin reaction, contact your doctor right away. They may have you temporarily or permanently stop taking Trexall.
Risk of gastrointestinal (GI) problems
Diarrhea, nausea, vomiting, and mouth sores were common side effects reported in Trexall’s clinical trials. In rare cases, Trexall can cause inflammation or a perforation (tear) in the intestine. This can cause severe bleeding, which may be fatal.
Symptoms of a serious GI problem may include:
- loss of appetite
- severe abdominal pain
- fever
- bright red blood in your stools
- black tarry stools
The risk of serious digestive problems is higher in people who have ulcerative colitis (UC) or stomach ulcers (peptic ulcers).
What you can do
If you have nausea, vomiting, diarrhea, or mouth sores that are bothersome or do not go away, talk with your doctor. They can determine whether it’s safe for you to continue taking Trexall.
Contact your doctor right away if you experience any symptoms of a serious GI problem.
Risk of blood disorders
Trexall can cause problems with certain blood cell counts. The most common is thrombocytopenia (low platelet count). But, Trexall can also cause leukopenia (low white blood cell count) or anemia (low red blood cell count). Typically, the effects are mild, but severe and life threatening changes in blood cell counts have occurred in clinical trials of Trexall.
You may not notice any symptoms unless your levels are very low. The table below describes possible symptoms of these blood disorders.
| Blood disorder | Symptoms |
|---|---|
| Thrombocytopenia | • petechiae (small spots that may appear red or purple on light skin tones or brown on darker skin tones) • bruising easily • bleeding that doesn’t stop • blood in the urine or stool |
| Leukopenia | • high fever • sweating and chills • malaise (feeling generally unwell) • sore throat |
| Anemia | • pale complexion • lightheadedness • fast heartbeat • shortness of breath |
What you can do
Talk with your doctor about whether you’re up to date on all your vaccines before taking Trexall. You can help prevent infections by washing your hands often and avoiding crowds and people who are sick, if possible.
Your doctor will order blood tests before you start treatment and regularly monitor your blood counts. If they find a problem with your blood tests, they may decrease your dose or recommend that you stop taking Trexall.
Below is important information you should consider before taking Trexall.
Trexall has boxed warnings. A boxed warning is the most serious warning from the FDA. For details, see the “Side effect specifics” section.
Other precautions
Before taking Trexall, discuss your health history with your doctor. Trexall may not be right for you if you have certain medical conditions or other factors affecting your health. Be sure to talk with your doctor if any of the following apply to you:
- weakened immune system
- liver problems
- kidney problems
- peptic ulcers
- blood disorder
- UC
- have fluid in your stomach (ascites) or lungs (pleural effusion)
- alcohol consumption
- previous allergic reaction to this or a similar drug
- pregnancy
- breastfeeding
Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.