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Methotrexate for the neurologist
  1. Aaron Jesuthasan1,
  2. Aravindhan Baheerathan2,
  3. Stephen Auger2,
  4. Rachel Dorsey2,
  5. Robina Coker3,
  6. Nowlan Selvapatt4,
  7. Stuart Viegas2
  1. 1Department of Neurology, Addenbrooke's Hospital, Cambridge, UK
  2. 2Department of Neurology, Charing Cross Hospital, London, UK
  3. 3Department of Respiratory Medicine, Hammersmith Hospital, London, UK
  4. 4Department of Hepatology, St Mary's Hospital, London, UK
  1. Correspondence to Dr Aaron Jesuthasan, Addenbrooke's Hospital, Cambridge, UK; aaronjesuthasan{at}


The use of methotrexate in clinical practice has expanded significantly in recent years, as an effective chemotherapeutic agent as well as disease-modifying treatment for conditions such as rheumatoid arthritis, psoriasis and Crohn’s disease. It is also used as a steroid-sparing agent for a range of inflammatory diseases of the central and peripheral nervous systems. Clinical neurologists must, therefore, know how to start and uptitrate methotrexate, its monitoring requirements and its potential toxicities. This review aims first to explore the evidence base for using methotrexate in various neurological diseases and second to discuss important practicalities around its use, ensuring its safe application and appropriate monitoring.


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  • X @RobinaCoker1

  • Contributors AJ: initial draft of the manuscript and subsequent revisions. AB: initial draft of the manuscript and subsequent revisions. SA: review of manuscript and figure creation. RD: specialist neurological pharmacy input. NS: specialist hepatology input and review. RC: specialist respiratory input and review. SV: responsible for care of patient described, concept for paper, review of paper and specialist input on neuromuscular diseases section. AJ and AB contributed equally to the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned. Externally peer reviewed by James Lilleker, Manchester, UK.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.