Trexall is the brand name for the drug Methotrexate, a chemotherapy drug used for treating several types of cancer, including non-Hodgkins lymphoma and acute lymphoblastic leukemia. It is also frequently used at low doses to help manage immune-mediated inflammatory disorders/

Trexall has multiple methods of action depending on the disease the drug is being used to treat. When used as a chemotherapy agent, Trexall primarily works as an antifolate antimetabolite, which blocks the specific protein, dihydrofolate reductase (DHFR), needed to make DNA. Trexall blocks the formation of folate, preventing the copying of DNA and the replication of cells. This mechanism slows or stops the ability of cancer cells to grow, divide, and spread throughout the body when Trexall is used as an immunosuppressant to aid in managing immune-mediated inflammatory disorders like psoriasis, rheumatoid arthritis, and juvenile idiopathic arthritis.

Trexall Efficacy


Trexall is used as a chemotherapy drug to help slow or stop the growth of the following types of cancer:

  • Breast Cancer
  • Breast Cancer — Male
  • Head and Neck Cancer
  • Non-Hodgkin’s Lymphoma
  • Acute Lymphoblastic Leukemia
  • Meningeal Leukemia
  • Osteosarcoma
  • Neoplasia — Estrogen Dependent
  • Trophoblastic Disease

Inflammatory Disorders

Trexall acts as a potent anti-inflammatory to aid in managing the following immune-mediated and  inflammatory disorders:

  • Collagen Vascular Disease
  • Autoimmune Disorder
  • Felty’s Syndrome
  • Psoriatic Arthropathy
  • Rheumatoid Lung
  • Juvenile Rheumatoid Arthritis
  • Psoriasis
  • Rheumatoid Arthritis
  • Mycosis Fungoides

Trexall Precautions and Warnings

Like all chemotherapy agents, the mechanism of action used to stop the growth of the cancer cells can also be detrimental to the body’s healthy cells.  Patients must strictly adhere to the prescribed dose ordered by their physician. Taking more than the recommended dosage or taking Trexall more frequently than prescribed can lead to serious health consequences or death.

Let your doctor know if you believe you may have any of the following health concerns:

  • You have had an allergic reaction to Trexall or another drug in the past
  • You have a history of alcoholism (regardless of the duration of your sobriety)
  • You have a history of cirrhosis or chronic liver disease
  • You have had any liver problems resulting in ascites (fluid in the abdomen)
  • You have had any lung issues resulting in pleural effusion (fluid in the lungs)
  • Your kidneys are compromised
  • You have had a stomach ulcer or ulcerative colitis
  • You have low blood cell counts
  • You are immuno-compromised or have a bone marrow disorder
  • You have undergone radiation treatments

Pregnancy, & Breastfeeding, & Children Special Precautions 

Women who are pregnant may be pregnant, plan to become pregnant, or are currently breastfeeding should not take Trexall as Trexall can cause severe injury or death to an unborn baby or nursing infant. Trexall may be modified for use in treating cancer during pregnancy, but this is rare, and it is more likely that your doctor will opt to choose a safer treatment option.

Trexall use by either the mother or the father can harm an unborn baby. Both men and women will need to take precautions to avoid any potential pregnancy while using Trexall.

Your doctor should be informed immediately if you or your partner do become pregnant while either one of you is using Trexall.

Trexall should never be administered to a child or anyone except the patient for whom it was prescribed.

Patients, caregivers, and household members should be aware that Trexall, a chemotherapy drug, can be absorbed through the skin and can cause adverse effects if handled without gloves. Keep your prescription bottle out of the reach of children.

Trexall Side Effects

Side effects are an unfortunate reality for all chemotherapy drugs. Trexall is no exception. Because Trexal is such a powerful drug, and some level of adverse symptoms are a normal part of the drug’s action, users must be aware of which side effects are a regular, expected response to the medication working as it should, and which might indicate a more severe health complication requiring urgent attention.

Common Side Effects

  • Upper GI issues ranging from upset stomach to nausea and vomiting
  • Lower GI issues from cramping to diarrhea
  • Dizziness
  • Fatigue
  • Chills
  • Fever
  • Infection
  • Elevated Liver Enzymes
  • Low white blood cell count
  • Low platelet levels
  • Blisters or Ulcers in your Mouth
  • Bleeding, swollen gums
  • Photosensitivity
  • Hair Loss

Serious Side Effects

You will see a lot of cross-over, with many symptoms from the common side effects list also appearing on the severe side effects list below. In most cases, with most other classes of drugs, the symptoms in the list above would signify a profound side effect because they would be unexpected and have no likely cause. Because these side effects are common with chemotherapy drugs, it is necessary to assess them based on the larger context in which they occur.

In other words, fatigue may be a common side effect when taking Trexall. Still, fatigue accompanied by acute stomach pain in the upper-right quadrant of your abdomen, pale-colored stools, and dark-colored urine may indicate a severe liver issue, and you should contact your doctor immediately. The list below provides the grouping of symptoms that may indicate a severe side effect of Trexall.

Please get in touch with your healthcare provider immediately if you experience the following.

Serious infection

  • Temperature of 100.4 degrees Fahrenheit, with or without any of the following symptoms:
    • Chills
    • Cough
    • Muscle Aches
    • Rapid Heartbeat
    • Confusion
    • Swollen Lymph Nodes
    • Night Sweats
    • Weight Loss

Serious lung problems

  • Sudden cough
  • Fever
  • Difficulty Breathing
  • Sudden Chest Pain
  • Wheezing
  • Dry Cough
  • Cough With Mucous

Serious liver problems

  • Nausea,
  • Vomiting
  • Fatigue
  • Acute stomach pain in the upper-right quadrant of your abdomen
  • Pale-colored stool
  • Dark-colored urine
  • Jaundice (yellowing) of the eyes or skin
  • Swollen midsection
  • Loss of appetite
  • Weakness

Serious Kidney Problems

  • Producing Little or No Urine
  • Swelling in Feet or Ankles (Edema)
  • Acute, Stabbing Back Pain in the Lower Quadrant

Serious nervous system problems

  • Headache
  • Siff Neck
  • Confusion
  • Vision changes
  • Difficulty Talking
  • Difficulty Moving One Side of the Body
  • Seizure
  • Coma

Serious skin reactions

  • Painful Blisters
  • Skin Wounds
  • Peeling Skin
  • Fever
  • Excessive Redness
  • Unusual Warmth in a Particular Area
  • Ooozing Sores or Ulcerated Lesions

Serious allergic reactions

  • Rash
  • Hives
  • Difficulty Breathing
  • Difficulty Swallowing
  • Swelling of the Lips & Mouth
  • Swelling of the Eyelids
  • Burning Eyes
  • Blistering or Peeling Skin

Serious bleeding issue

  • Blood in Urine or Stool
  • Nosebleeds
  • Unexplained Bruising or Bleeding
  • Persistent Bleeding or Bruising that will not stop
  • Pale skin and gums
  • Cold Hands & Feet
  • Slow Capillary Refill Time (CRT)
  • Feeling Dizzy or Light-Headed
  • Skin That is Sensitive or Painful

Signs of Tumor Cell Breakdown

  • Fatigue
  • Weakness
  • Muscle Cramps
  • Nausea
  • Vomiting
  • Diarrhea
  • Very Rabid or Very Slow Heartrate
  • Tingling in Hands & Feet, and Around Mouth.

Drug Interactions With Trexall

Trexall interacts in potentially unpredictable or undesirable ways with many types of drugs . We have listed the most common drugs and drug classes below, but this listing is by no means exhaustive. Before taking any vitamin, supplement, or medication while taking Trexall, consult with your doctor to


When taking Trexall, the following list of commonly administered prescription or over-the-counter drugs should be used with caution and only after consulting a doctor. These drugs, when administered with Trexall, have a multiplier effect that may increase the potency of Trexall in the system, leading to potentially dangerous adverse effects.

  • Antibiotics (Penicillins, Sulfas, Tetracyclines, and Salicylates, Neomycin, and most others)
  • Aspirin and Nonsteroidal Anti-inflammatory Drugs
  • Hepatotoxic Drugs, i.e., Tylenol (Acetaminophen), and Alcoholic Beverages
  • Oral Anticoagulants (Blood Pressure Medications)
  • Acid Reflux Medication (Proton Pump Inhibitors)
  • Nephrotoxic products i.e. Aleve (Naproxen)
  • Hydroxychloroquine (found in Plaquenil)
  • Theophylline
  • Gout medication (Probenecid)
  • Nitrous Oxide (Laughing Gas)


In addition to the lengthy list of adverse drug interactions, patients should consult a doctor before getting any vaccine. They should avoid getting live vaccines if at all possible.

The most common live vaccines include:

  • Adenovirus Vaccine, Live
  • Dengue Tetravalent Vaccine, Live
  • Ebola Zaire Vaccine, Live
  • Flu (influenza) vaccine (nasal formulation)
  • Influenza Virus Vaccine, Live
  • Measles
  • Mumps
  • Poliovirus Vaccine, Live
  • Rubella (MMR)
  • Rotavirus
  • Smallpox Monkeypox Vaccine
  • Smallpox Vaccine
  • Typhoid
  • Yellow fever
  • Varicella (chickenpox)
  • Zoster (shingles)

Trexall Strength & Dosages 

Strength Dosage
5 mg Tablet 1 tablet by mouth once weekly


as prescribed

7.5 mg Tablet 1 tablet by mouth once weekly


as prescribed

10 mg Tablet 1 tablet by mouth once weekly


as prescribed

15 mg Tablet 1 tablet by mouth once weekly


as prescribed

 Trexall Strengths & Dosages

Trexall is available in 5mg, 7.5mg, 10mg, and 15mg oral tablets

For most conditions, Trexall is prescribed as a once-weekly oral tablet. However, this dosage can vary depending on the individual’s unique health profile, the severity and type of illness, and other variables. Some conditions may require a short burst of daily doses followed by a rest period to flush the drug from your system before another burst of daily administration. Your doctor will likely try to use the lowest dosage schedule possible to treat your condition, as higher strengths and more frequent doses increase the risk and severity of side effects.

It is vitally important that you follow your medical provider’s instructions meticulously. Read all labels, medication guides, and instruction sheets, and use the medication precisely as directed.

When using Trexall as an immunosuppressant to treat rheumatoid arthritis and other inflammatory disorders, oral tablets are commonly used to maintain well-managed symptoms. Recent studies have shown that an initial subcutaneous injection of methotrexate used as an induction may result in better outcomes when treating to control an active rheumatoid arthritis presentation. This is most evidenced at doses of 15mg or more significant.

Trexall Alternatives

Generic methotrexate 2.5 mg tablets are available. Methotrexate is also distributed and administered under other trade names: Folex PFS, Jylamvo, Otrexup, Rasuvo, RediTrex, Rheumatrex Dose Pack, and Xatmep. Different brand names are formulated and dispensed for different purposes, so not all brands of methotrexate are interchangeable.
Generic methotrexate is available in the following formulations:

  • Oral Suspension (Xatmep)
  • Subcutaneous Injectables (Otrexup, Rasuvo, and RediTrex)
  • Intravenous Injectable

Trexall FAQs

Trexall is a complex and powerful drug that can be very effective in precise doses as part of a managed medical treatment plan. You should consult your prescribing physician or medical provider for any questions and concerns about your Trexall medication protocol.

Is Trexall Chemotherapy?

Trexall is a chemotherapy drug. Chemotherapy drugs are notable for their ability to target and disrupt the reproduction of malignant DNA. This prevents the cancer cells from replicating and spreading throughout the body. While Trexall is effective at stopping the reproduction of cancer cells, it does so at a cost. Trexall is what is known as a non-selective drug. This means that its adverse action is not targeted at only cancerous cells, and some collateral damage will be inflicted on healthy, non-cancerous cells as well. This is an everyday reality for the majority of chemotherapy drugs.

Is Trexall a Steroid?

Trexall is not a steroid, though steroids may be used in conjunction with Trexall as part of an anti-inflammatory, immunosuppressant treatment plan. Steroids are designed to mimic the powerful natural hormones produced by the human body, and certain varieties of steroids are a potent means to reduce inflammation quickly. However, steroids are merely symptom reducers. They do not cure the underlying disease; when taken long-term, they can cause adverse side effects. Steroids are generally used as a short-term solution to alleviate the inflammation and resulting discomfort associated with active rheumatoid arthritis or psoriasis, while Trexall or another treatment works to interrupt the disease process.

Will My Hair Fall Out While Taking Trexall?

Hair loss (Alopecia) is a possible side effect of Trexall use. Trexall blocks the production of the folate vital to cancer cell reproduction. However, folate is also essential to hair follicle cell reproduction and health. The good news is hair loss is relatively uncommon at the lower dose ranges used to treat rheumatoid arthritis and psoriasis. According to the Arthritis Foundation, roughly 1% to 3% of patients who use the drug to treat arthritis will experience hair loss. Psoriasis patients reported around 3% to 10% of Trexall users experienced hair loss. However, hair loss becomes more common at the higher doses used to treat most cancers.

Can I Take Folic Acid to Help Prevent Hair Loss While Taking Trexall?

There has been a fair amount of interest around supplementing B-Complex with bio-available folic acid to replenish the folate being sapped by the Trexall regime. So far, studies have been largely inconclusive. Researchers are pretty confident that taking a folic acid supplement can’t hurt, meaning it will not undermine your Trexall treatment program. However, there is not yet any solid evidence that it makes a difference in terms of reduced hair loss or hair regrowth.

Can I Drink Alcohol While Taking Trexall?

Trexall can cause severe toxicity, and patients who are taking Trexall are often closely monitored for signs of kidney or liver damage, as there is a significant risk of both. Patients who are taking Trexall will need to abstain from drinking alcohol to avoid multiplying the risk of liver toxicity and damage. Additionally, if you are a heavy or frequent drinker, you must have a conversation with your doctor and discuss any increased risk. Your doctor may request additional tests to ensure your liver is healthy enough to process Trexall properly.

Is it Safe to Get a Vaccine While Taking Trexall?

Some vaccinations may be safe while taking Trexall, and others are not. It would be best to talk with your doctor before taking any vaccine, especially before starting or during Trexall treatment. Trexall may make some vaccines less effective, meaning you may not have adequate protection from any circulating virus. Additionally, live vaccines should not be taken under any circumstances while using Trexall. Live vaccines coupled with Trexall’s impact on the body’s immune system can result in a live vaccine causing a severe infection with the dangerous viral agent you were trying to protect yourself from.

How Much Does Trexall Cost In America?

Though prices will vary depending on region, supplier, strength, and quantity, the retail price for 30 tablets of 5mg Trexall is around $560. Of course, this price will likely be lowered considerably with health insurance coverage.

Is there a generic of Trexall?

In some cases, doctors may be able to prescribe the generic Methotrexate, which is considered among the most affordable treatment options for rheumatoid arthritis. When more potent treatment is needed for arthritis treatment, generic Methotrexate is often paired with biologics, a shared secret weapon for getting control of hard-to-treat ailments. In these case, methotrexate may be used in tandem with adalimumab (Humira), etanercept (Enbrel), and infliximab (Remicade).

IMPORTANT NOTE: The information provided here is for educational purposes only and is not intended to serve as medical advice, diagnosis, or treatment recommendations. It should not be taken as an endorsement of any specific medication or treatment. Individual health conditions and responses to treatment can vary greatly; therefore, this information should not be seen as a guarantee of safety, suitability, or effectiveness for any particular individual. Always consult with a healthcare professional for personalized medical advice and before making any decisions regarding your health or treatment plans.

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