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antimetabolite which inhibits dihydrofolate reductase, an enzyme essential for the synthesis of purines and pyrimidines

''Indications''
    rheumatoid arthritis
    psoriasis
    acute lymphoblastic leukaemia

''Adverse effects''
    mucositis
    myelosuppression
    pneumonitis
    pulmonary fibrosis
    liver cirrhosis

''Pregnancy''
    women should avoid pregnancy for at least 3 months after treatment has stopped
    also men using methotrexate need to use effective contraception for at least 3 months after treatment

''Prescribing methotrexate''
    high potential for harm
    taken weekly, rather than daily
    FBC, U&E and LFTs need to be regularly monitored (baseline, weekly till stabilised then 2-3/12thly)
    folic acid 5mg once weekly should be co-prescribed, taken more than 24 hours after methotrexate dose
    the starting dose of methotrexate is 7.5 mg weekly 
    only one strength of methotrexate tablet should be prescribed (usually 2.5 mg)
    avoid prescribing trimethoprim or cotrimoxazole concurrently - increases risk of marrow aplasia