Trexall (Methotrexate) for Psoriasis

What Members Say Top Tips Side Effects FAQs

Trexall (methotrexate) is a prescription medication approved by the U.S. Food and Drug Administration (FDA) to treat adults with severe psoriasis.

What Members Say

MHT logo These insights are based on 2,184 comments about Trexall from MyPsoriasisTeam members. These are the experiences of a small number of people and are not meant to be medical advice.

Benefits:

Skin plaques often improve, and some members describe major clearing.
Joint pain, swelling, and stiffness sometimes improve with treatment.
Weekly dosing can feel manageable once a routine is established.

Considerations:

Nausea, stomach upset, mouth sores, headaches, and fatigue are common concerns.
Liver problems are a frequent reason for dose changes or stopping treatment.
Full benefit can take weeks, and some members see little or no relief.

How Trexall Works and How It’s Taken

Trexall is a type of medicine called a dihydrofolate reductase inhibitor. It blocks an enzyme involved in making and repairing DNA, affecting cells that divide quickly. The exact way Trexall works in psoriasis is not fully known.

Doctors prescribe Trexall when adults have severe psoriasis.

Trexall is taken by mouth as a tablet.

Typical Dosing for Psoriasis

The recommended dose is 10 milligrams to 25 milligrams by mouth once a week until there is an adequate response.

A doctor may gradually adjust the dose to get the best response. The dose should not exceed 30 milligrams per week.

After the best response is reached, the dose should be reduced to the lowest possible dosing schedule.

Folic acid or folinic acid is also given to help reduce the risk of side effects.

This information is based on prescribing information, but your healthcare provider may tailor your treatment plan. Always follow their guidance.

Top Advice From Members on Trexall

MHT logo These insights are based on 2,184 comments about Trexall from MyPsoriasisTeam members.

Members who use Trexall often say it helps to set realistic expectations, watch for side effects, and stay in close contact with your doctor. Many also mention that regular lab work, a consistent weekly routine, and asking about other psoriasis treatment options if pills are hard on the stomach can make treatment easier to manage.

1

Keep track of side effects after each dose.
“I experienced increased fatigue for several days following dosage. This did not lessen over time, but I learned to plan activities around receiving my dosage.”
2

Get blood work when your doctor orders it.
“The most important thing on methotrexate is getting regular liver profiles done. This helps monitor the side effects.”
3

Tell your doctor about side effects or lab changes right away.
“My doctor called me yesterday and once again lowered my methotrexate because my liver enzymes were high.”

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Trexall Side Effects

In clinical studies of adults taking Trexall for severe psoriasis, the most common side effects occurred in about 3 percent to 10 percent of people. These included:

Alopecia (hair loss)
Photosensitivity (sensitivity to sunlight)
Burning of skin lesions

Serious Side Effects and Warnings

Trexall can cause serious side effects that may require immediate medical attention. These include:

Embryo-fetal toxicity — Trexall can cause birth defects or fetal death.
Hypersensitivity reactions — Severe allergic reactions, including life-threatening anaphylaxis, can occur.
Myelosuppression — Low blood cell counts and bone marrow suppression can lead to infections, anemia, or bleeding.
Gastrointestinal toxicity — Severe stomach or intestinal problems, including severe diarrhea, bleeding, or intestinal perforation, can occur.
Hepatotoxicity — Serious liver damage, including fibrosis, cirrhosis, or liver failure, can occur.
Pulmonary toxicity — Lung problems, including interstitial pneumonitis, can cause cough, fever, or shortness of breath.
Dermatologic reactions — Serious skin reactions, including Stevens-Johnson syndrome or toxic epidermal necrolysis, can cause a widespread rash, blistering, or skin peeling.
Renal toxicity — Kidney problems, including acute kidney failure, can occur.
Serious infections — Severe bacterial, fungal, viral, or opportunistic infections can occur.
Neurotoxicity — Serious brain or nerve problems can cause confusion, weakness, speech changes, or seizures.
Secondary malignancies — New cancers, including lymphoproliferative disorders, can occur.
Tumor lysis syndrome (TLS) — This can occur in people with rapidly growing tumors.

Get medical help right away if you think you are having a serious reaction.

What To Know Before Taking Trexall

Before you start Trexall, your doctor will check your pregnancy status if you can become pregnant. Your doctor will also check your liver function, kidney function, and blood cell counts.

Tell your doctor if you have recently received or plan to receive a vaccine. Live vaccines are not recommended during Trexall treatment. Your doctor may update your vaccines before treatment based on current vaccine guidelines.

Tell your doctor if you have any allergies to methotrexate or any ingredients in Trexall.

Tell your doctor about all medicines you take, including prescription drugs, over-the-counter medicines, vitamins, and herbal products.

Before starting Trexall, tell your doctor about any of the following:

Trouble swallowing tablets
Kidney problems or dialysis
Liver problems
Alcohol use or changes in how much you drink during treatment
Ascites (fluid in your stomach area)
Pleural effusion (fluid around your lungs) or other lung problems
Plans for surgery with general anesthesia, including dental surgery
Stomach ulcers
Ulcerative colitis

Tell your doctor right away if you develop a fever or signs of infection during treatment.

Do not take Trexall for severe psoriasis if you are pregnant. Do not take it if you have had a severe allergic reaction to Trexall, including anaphylaxis.

Trexall is also FDA-approved to treat:

Acute lymphoblastic leukemia (ALL)
Mycosis fungoides (cutaneous T-cell lymphoma)
Relapsed or refractory non-Hodgkin lymphomas
Rheumatoid arthritis
Polyarticular juvenile idiopathic arthritis (pJIA)

If you miss a dose of Trexall, call your doctor for instructions about when to take your next dose.

Tell your doctor if you are planning a pregnancy.

Females who can become pregnant should use effective birth control during treatment and for six months after the final dose. Males with female partners who can become pregnant should use effective birth control during treatment and for three months after the final dose.

Do not breastfeed during treatment or for one week after the final dose.

Community FAQs

These answers are fact-checked by our editorial staff.

How effective is Trexall for psoriasis?

Trexall is an oral drug for psoriasis used to treat adults with severe psoriasis. The recommended dose is 10 milligrams to 25 milligrams by mouth once a week until there is an adequate response. After the best response is reached, the dose should be lowered to the lowest possible dosing schedule.

In studies of adults with psoriasis who took up to 25 milligrams per week for up to four years, researchers tracked side effects. However, the prescribing information does not state what percentage of people had an improvement in psoriasis. Folic acid or folinic acid is also given to help reduce the risk of side effects.

What happens if Trexall is taken during pregnancy for psoriasis?

Trexall should not be taken during pregnancy to treat psoriasis. It can cause serious harm to a developing fetus, including birth defects, miscarriage, growth problems, and fetal death. The prescribing information states that Trexall is contraindicated during pregnancy for noncancer conditions such as severe psoriasis.

If someone becomes pregnant or thinks they may be pregnant while taking Trexall for psoriasis, they should contact their healthcare provider right away.

What tests or monitoring are needed with Trexall for psoriasis?

People taking Trexall for psoriasis need monitoring before and during treatment. This includes liver tests, kidney function monitoring, and blood cell counts at baseline and periodically during treatment, with additional monitoring as clinically needed. If you can become pregnant, your pregnancy status should be checked before starting treatment.