Oxford Paediatric and Adolescent Rheumatology Centre
Methotrexate and Nausea
Why does my child feel sick after Methotrexate?
One of the most commonly reported side effects of methotrexate is an unpleasant sensation in the
mouth or stomach. Some describe this as nausea, or a metallic taste, as a “feeling at the back of the
throat”, while others can feel tired and unwell after the drug. It occurs in about 1 in 10 children. It is not
dangerous and does not mean the methotrexate is more likely to cause other side effects.
However, it can become a quite a problem for the small number of children who learn, through no fault
of their own, to anticipate nausea or tummy pain and feel sick even before taking the methotrexate.
Others become increasingly nauseated and sick after taking the medication. This can upset them for a
day or so after the weekly dose – becoming quite an issue for them on a weekly basis.
It occurs more often in children who are anxious about their treatment. Some symptoms (e.g. fast
heart rate, light-headedness, increased saliva, etc) are more related to anxiety than to the medication.
So our treatment is also aimed at reducing the child’s anxiety.
What can be done to help?
First, don’t expect nausea to be a problem. Remember only a few children suffer with this and it can
be worse on suggestion. We recommend that you take a positive and consistent approach to the
medication, providing a routine so it’s given at the same time on the same day each week. This helps
children understand what is expected of them and reduces anxiety.
Timing
For some children giving methotrexate just before bed is best, since your child is asleep at the most
likely time of nausea. Yet others find it is best given just before school or some activity to take their
mind off it.
Medication
This helps with nausea. Weekly folic acid helps prevent nausea and increasing to six days a week can
help combat persistent nausea. We don’t really know why, but this can be a very effective approach.
Other drugs called anti-emetics can be prescribed.
Disguise the taste
This can be achieved by giving methotrexate with food or a drink, but let your child know what you are
doing. Try:
• something enjoyable such as sticking it in a jelly bean or fruit pastille.
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Oxford Paediatric and Adolescent Rheumatology Centre
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Other tips
sucking an ice cube or sugar free ice pop afterwards.
sucking a sugar-free mint.
Ginger, lemon and peppermint which also help to relax the stomach
when nausea or sickness has occurred try:
• small frequent meals
• something to sip e.g. clear, cold fluids sipped slowly through a straw
• avoid forcing your child to eat if they don’t want to - let them set the pace
Should I hide the methotrexate in food or drink?
Please do not do this as it will lead to problems later on. Your child will find out sooner or later and
may be extremely upset over the loss of trust. Honesty between the team, parents and child is vital to
long term care.
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