Before starting methotrexate therapy discuss the following with your physician:
•     A history of liver problems (especially hepatitis), stomach ulcer, alcohol use, kidney or lung problems, blood problems, human immunodeficiency virus (HIV) infection, or a positive tuberculin skin test or tuberculosis.
•      Any medications you are currently taking, but particularly sulfa drugs, other antibiotics (particularly those containing trimethaprim), NSAIDs, diuretics (water pills), probenecid (gout medication), and medications to treat seizures or diabetes.

While taking methotrexate:
•       Contact your physician promptly if you notice mouth sores, nausea or vomiting, black or tar-colored stools, fever or chills, sore throat, unusual bleeding or bruising, a change in skin or urine color, cough or shortness of breath, or a marked increase in fatigue.
•      Inform your physician, surgeon, or dentist that you are taking methotrexate well before he or she performs any medical procedure.
•      Never take this medication more than one day a week.
•      Alcohol ingestion is prohibited.
•      Take every precaution to avoid pregnancy.
•      Frequent liver function tests and blood tests to obtain complete blood counts are required. Blood tests for kidney function and urine studies may be requested periodically by your physician.

Pregnancy and breastfeeding
Methotrexate is an extremely dangerous medication for the fetus. It has been known to cause fetal death and birth defects. Women should avoid getting pregnant for at least one full menstrual cycle after stopping methotrexate. Men should wait at least three months after discontinuing methotrexate treatment before trying to father children. Do not breastfeed while taking methotrexate.
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