Does Methotrexate Cause Liver Damage?

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

Ask the experts

Please could you tell me the percentage of methotrexate users who develop liver damage. I currently take 7.5 mg per week and have done so for 6 years and my consultant wishes to do a liver biopsy (as I am a long term user of Methotrexate), which I am very reluctant to undergo. Can you suggest other medication which may help my sarcoidosis condition which does not affect the liver? I do not know who else to contact to ask these questions so would be grateful if you could please help.

Doctor's response

Liver damage from methotrexate is not common. It occurs in two forms, acute and chronic.

Acute liver toxicity is manifest by elevation of liver function blood tests, called transaminases. Elevation of liver function tests occurs in approximately 15% of patients. It is generally considered harmless when it is low-level and temporary. Persistent elevation of liver function tests can precede the appearance of cirrhosis or chronic liver toxicity. Cirrhosis can be fatal. Cirrhosis generally occurs infrequently and only after very long-term usage.

The risks of cirrhosis is increased with alcoholism, diabetes, obesity, and age.

Alternatives to methotrexate for sarcoidosis include colchicine and Plaquenil (hydroxychloroquine).

Thank you for your question.

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Reviewed on 1/11/2018