Optimising the use of methotrexate

Methotrexate is effective for the induction of remission and prevention of relapse in Crohn s disease, and some data suggest efficacy in ulcerative colitis as well. It is a valuable asset in the physician s armamentarium if used appropriately. For induction, 25 mg per week, given parenterally, should generally be used. Many side effects can be prevented or managed with adequate folate supplementation or by dose reduction. Safety is optimized by screening of patients prior to initiation of treatment and by vigilant monitoring in the long term. While best avoided in women of child-bearing capacity, there is little evidence to support restricted use in men. Methotrexate should be considered as an alternative to thiopurines for the treatment of inflammatory bowel disease.