Underrecognized postdosing reactions to methotrexate in patients with rheumatoid arthritis

J Rheumatol. 1994 Jul;21(7):1224-6.


Objective: To report previously underrecognized postdosing side effects of methotrexate (MTX).

Methods: Over a one and a half year period, in 2 practices, all patients with rheumatoid arthritis (RA) receiving weekly MTX, and volunteering symptoms within a few hours of MTX dosing were carefully questioned concerning the nature of the postdosing reaction.

Results: Of 356 patients, 36 (10%) reported a previously underemphasized postdosing reaction consisting of arthralgias/myalgias, fatigue/malaise or both. Sixteen patients discontinued MTX primarily because of this side effect.

Conclusion: In these patient populations, postdosing reactions were the 2nd most common side effect (after gastrointestinal) leading to MTX withdrawal.

MeSH terms

  • Administration, Oral
  • Arthralgia / chemically induced
  • Arthritis, Rheumatoid / drug therapy*
  • Dose-Response Relationship, Drug
  • Fatigue / chemically induced
  • Female
  • Humans
  • Infusions, Parenteral
  • Male
  • Methotrexate / administration & dosage
  • Methotrexate / adverse effects*
  • Methotrexate / therapeutic use
  • Middle Aged
  • Muscular Diseases / chemically induced
  • Pain / chemically induced
  • Time Factors


  • Methotrexate