Monitoring methotrexate

In those without risk factors for toxicity FBC, electrolytes, renal function, ALT and/or AST, and serum albumin should be measured at week 2 and then monthly for the first 3–6 months of treatment.

For those with risk factors for toxicity, more frequent monitoring is advised.

For any increase in dosing, additional monitoring is recommended at week 2, and then revert to standard monitoring.

Reference

1. Bechman K et al. The 2025 British Society for Rheumatology guideline for the prescription and monitoring of conventional synthetic disease-modifying anti-rheumatic drugs. Rheumatology, Volume 65, Issue 2, February 2026