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The most common side effects of methotrexate are: gastrointestinal complaints such as bloating, nausea, vomiting and diarrhea. Rash, hair loss, headache and dizziness can also occur. Rare side effects include a slightly increased likelihood of infection such as flu, bronchitis, pneumonia and urinary tract infection, and liver function abnormalities (detected in blood tests). Shortness of breath or frequent coughing can be a sign of adverse effects on the lungs. Another rare side effect is a problem in the production of new blood cells. When this happens, you can experience stomatitis, a severely sore throat with fever, recurrent nose bleeds and bruises.
If a surgical procedure is planned, it may be advisable to stop methotrexate in the period starting one week before the operation, and ending one week after the operation. This depends on the type of surgery.

Contact your rheumatologist in case of:
- Rash
- Stomatitis
- Shortness of breath or frequent cough
- Severe sore throat in combination with fever
- Recurrent nose bleeds
- Recurrent bruising
- A planned surgical procedure

If you are experiencing heavy nausea, it is possible to switch to methotrexate injections . Your rheumatologist can discuss this with you. You can also stop using methotrexate. Note the day and reason why you stopped. In case of doubt, contact your rheumatologist.

The effect on fertility, pregnancy and breastfeeding
Current knowledge suggests methotrexate does not have an unfavorable effect on fertility of men or women. However, it can cause congenital malformations and increase the chance of miscarriage. That is why you cannot use methotrexate during pregnancy. Both men and women have to stop using methotrexate three months before planning a pregnancy. It is important to use reliable anticonception during this period. You may not use methotrexate during breastfeeding, because it is not known if methotrexate can harm the child.


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