Trexall (methotrexate) is a brand-name oral tablet. It’s prescribed for certain kinds of cancer, arthritis, and psoriasis in adults and some children. The dosage varies depending on the condition Trexall is used to treat.
Specifically, Trexall is approved by the Food and Drug Administration (FDA) to treat:
- acute lymphoblastic leukemia (ALL) in adults and children as part of a combination therapy
- mycosis fungoides (a blood cell-related cancer that affects the skin) in adults, alone or as part of a combination therapy
- relapsed (recurring) or refractory (hard to treat) non-Hodgkin lymphoma in adults, as part of a combination therapy
- rheumatoid arthritis (RA) in adults
- polyarticular juvenile idiopathic arthritis (pJIA) in children
- severe psoriasis in adults
Trexall belongs to a drug class called antimetabolites. Trexall isn’t available in a generic version.
Keep reading for specific information about the dosage of Trexall, including its strengths and how to take the medication. For a comprehensive look at Trexall, see this article.
Note: This article describes typical dosages for Trexall provided by the drug’s manufacturer. When taking Trexall, always follow the dosage prescribed by your doctor.
Below is information about Trexall’s form, strengths, and dosages.
Trexall form
Trexall comes as an oral tablet.
Trexall strengths
Trexall comes in four strengths:
- 5 milligrams (mg)
- 7.5 mg
- 10 mg
- 15 mg
Typical dosages
For RA, pJIA, and psoriasis, your doctor will usually start by prescribing you a low dosage. Then they’ll adjust it over time to reach the amount that’s right for you. Your doctor will ultimately prescribe the smallest dosage that provides the desired effect.
The following information describes dosages that are commonly prescribed or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs. For more information about your specific dosage, talk with your doctor.
Dosage for acute lymphoblastic leukemia (ALL)
Doctors may prescribe Trexall to treat acute lymphoblastic leukemia (ALL). For this use, Trexall is typically taken with other drugs as part of maintenance cancer treatment. (Maintenance therapy is used to help prevent cancer from recurring.)
For ALL (and some conditions listed below), Trexall’s dosing is based on body surface area (BSA). Your doctor will use your height and weight to calculate your BSA. BSA is measured in square meters (m2). Trexall’s dosing is often shown as a certain number of milligrams (mg) per square meter of BSA (for example, 20 mg/m2).
If your doctor prescribes Trexall for your ALL, your starting dose will likely be 20 mg/m2. Typically, you’ll take this once weekly, on the same day every week.
After you start taking Trexall, your doctor will monitor you regularly. They’ll give you certain tests, such as an absolute neutrophil count and platelet count. Based on the results of these tests, they’ll likely adjust your dosage.
Dosage for mycosis fungoides
Trexall is approved to treat mycosis fungoides, alone or with other chemotherapy medications. For use alone, the recommended dosage is 25 mg to 75 mg once per week. You should take it on the same day every week.
For use in combination therapy, the recommended dosage is 10 mg/m2 twice per week. This dosing approach is called BSA-based dosing. For an explanation of this type of dosing, see the “Dosage for acute lymphoblastic leukemia (ALL)” section above.
Dosage for non-Hodgkin lymphoma
Trexall is used to treat certain cases of non-Hodgkin lymphoma as part of a combination therapy. Trexall’s recommended starting dose for this condition is 2.5 mg, usually taken 2–4 times per week.
The maximum recommended total weekly dosage for this condition is 10 mg per week.
Dosage for rheumatoid arthritis (RA)
The recommended starting dosage for treating rheumatoid arthritis (RA) is 7.5 mg once weekly, on the same day every week. Your doctor will assess how your RA responds to Trexall. Based on that assessment, they may increase your dosage until your RA is managed well.
Dosages over 20 mg weekly have a higher risk of serious side effects, including bone marrow suppression. If Trexall is being used to treat RA, your doctor may recommend that you take a folic acid supplement to help prevent side effects.
Dosage for psoriasis
The recommended dosage for treating psoriasis is 10 mg to 25 mg. You’ll likely take this once weekly, on the same day every week, until your psoriasis improves. Your doctor will assess how your psoriasis responds to Trexall. Based on that assessment, they may slowly increase your dosage until your psoriasis is well treated.
The maximum recommended dosage of Trexall for psoriasis is 30 mg per week. Once your psoriasis is managed, your doctor will decrease your dosage to the lowest dosage that still manages it.
If Trexall is being used to treat psoriasis, your doctor may recommend that you take a folic acid supplement to help reduce side effects.
Children’s dosage
Trexall is approved to treat children with polyarticular juvenile idiopathic arthritis (pJIA) and children with acute lymphoblastic leukemia (ALL) as part of a combination therapy.
Dosage for polyarticular juvenile idiopathic arthritis (pJIA)
Trexall is used to treat pJIA. The recommended starting dosage is 10 mg/m2 once weekly, on the same day every week. (This dosing approach is called BSA-based dosing. For an explanation of this type of dosing, see the “Dosage for acute lymphoblastic leukemia (ALL)” section above.)
Your child’s doctor will assess how the pJIA responds to Trexall. They may increase the dosage of Trexall until the pJIA improves.
Dosages over 30 mg/m2 weekly have a higher risk of serious side effects, including bone marrow suppression. If Trexall is being used to treat pJIA, your child’s doctor may recommend folic acid to avoid side effects.
Dosage for acute lymphoblastic leukemia (ALL)
The dosage for ALL is tailored to each child by their doctor. It’s based on BSA and other factors, such as their body’s response to Trexall. The starting dosage and an explanation of BSA-based dosing can be found in the “Dosage for acute lymphoblastic leukemia (ALL)” section above. Always give your child Trexall according to the instructions of their doctor.
Talk with your child’s doctor if you have any questions about their dosage.
Long-term treatment
Trexall is typically used as a long-term treatment for RA, pJIA, and psoriasis. If you and your doctor determine that Trexall is safe and effective for you, you’ll likely take it long term.
For cancer treatment, how long you take Trexall depends on many factors. These include the cancer type, how Trexall affects you, and whether it works as intended.
Before you start taking Trexall, your doctor will discuss your treatment plan with you. Talk with them if you have questions about how long you can expect to take Trexall.
The Trexall dosage your doctor prescribes may depend on several factors, including:
- your age
- your height and weight (which determine your body surface area, or BSA)
- how your body responds to Trexall
- the type and severity of the condition you’re taking Trexall to treat
- other medications you take and conditions you have
- side effects you may have with Trexall
- your liver and kidney function
Dosage adjustments
There are a few situations in which your doctor may need to adjust your Trexall dosage.
If you take other medications: Your doctor may need to adjust your Trexall dosage if you take certain medications with Trexall. This is because there are risks to using certain medications with Trexall, as outlined in the “Boxed warning” section above. These medications include various antibiotics, over-the-counter medications, and other drugs. To learn what drugs may interact with Trexall, see this article.
If you have side effects: Your doctor may adjust your dosage in case of certain side effects from Trexall. Trexall can cause many side effects, including problems with your bone marrow, blood cells, liver, and kidneys. (See the “Boxed warning” section for more information.) Your doctor may change your dosage to maintain certain blood counts. And your doctor may lower your dosage if you have or develop bone marrow suppression, liver damage, kidney problems, or other side effects.
Be sure to tell your doctor about all medications you take and any health conditions you have. And try to keep all appointments for regular testing. Your doctor may need to adjust, pause, or stop your treatment with Trexall based on the results of these tests. Your doctor can tell you more.
Trexall comes as an oral tablet that you swallow whole. If you can’t swallow tablets, tell your doctor. Trexall is not recommended for people who can’t swallow tablets.
Be sure to take Trexall exactly as your doctor tells you. This is essential, as death can result from taking Trexall incorrectly. Here are tips on taking Trexall safely:
- For most conditions, Trexall is typically taken once per week (not every day). Be sure to take Trexall according to your doctor’s instructions.
- You can take Trexall with or without food.
- Don’t crush, chew, or cut Trexall tablets unless your doctor tells you to do so.
- Avoid handling Trexall tablets as much as possible. Ask your doctor for more information on how to best handle, store, and dispose of Trexall.
- Folic acid can interact with Trexall if Trexall is being used to treat cancer.
If you have questions about how to take Trexall, talk with your doctor or pharmacist.
ACCESSIBLE DRUG LABELSSome pharmacies offer labels with large print, braille, or a code you scan with a smartphone to convert text to speech. If your local pharmacy doesn’t have these options, your doctor or pharmacist might be able to recommend a pharmacy that does.
If you miss a dose of Trexall, call your doctor for guidance. They’ll tell you when to take your next dose of Trexall. Do not take two doses to make up for the missed one.
To help make sure that you don’t miss a dose, try using a medication reminder. This may mean setting an alarm or putting a note somewhere that you’ll see it. You can also download a reminder app on your phone.
Don’t take more Trexall than your doctor prescribes. Taking more can lead to harmful effects or overdose. Fatal overdoses have occurred with Trexall. Trexall overdose requires medical treatment right away, so seek help immediately.
Effects of an overdose
Some overdose effects of Trexall can include:
- blood count problems that may be severe
- bone marrow suppression
- nausea and vomiting
- mouth sores
- ulcers or bleeding in the digestive tract
- kidney failure
- sepsis or septic shock (stages of a severe reaction to infection)
If you take more than the recommended amount of Trexall
Call your doctor right away if you believe you’ve taken too much Trexall. Another option is to call America’s Poison Centers at 800-222-1222 or use its online tool. If you have severe symptoms, immediately call 911 or your local emergency number, or go to the nearest emergency room.
Below are some frequently asked questions about Trexall.
Is the dosage of Trexall similar to the dosage of Enbrel?
No. While some of the uses of Trexall (methotrexate) and Enbrel (etanercept) overlap, the dosages of these drugs have few similarities:
- Trexall comes as tablets taken by mouth. Enbrel is given by subcutaneous injection.
- The dose in milligrams for each drug differs. This is because they contain different active ingredients.
- Both drugs use weekly dosing for RA, psoriasis, and pJIA. However, Enbrel has a starting dose of twice weekly for adults with plaque psoriasis.
Your doctor will prescribe the drug and dosage that’s right for you. To learn more about how these drugs compare, talk with your doctor.
How long does it take for Trexall to start working?
Generally, Trexall starts working in a matter of weeks. For RA and pJIA, most people notice improvements 3–6 weeks after starting treatment with Trexall. Some people have noticed improvements later, up to 12 weeks after the beginning of treatment.
Similarly, with psoriasis, most people notice improvement in their symptoms within weeks. However, seeing the most benefit may take months of treatment.
It’s harder to notice the effects of Trexall on cancer. Your doctor will need to monitor you with regular tests during your treatment. The results of these tests will help your doctor determine whether (and how quickly) Trexall is working to treat your cancer.
Talk with your doctor if you have questions about what to expect with Trexall treatment.
The dosages in this article are typical dosages provided by the drug’s manufacturer. If your doctor recommends Trexall for you, they will prescribe the dosage that’s right for you. Always follow the dosage that your doctor prescribes.
As with any drug, never change your dosage of Trexall without your doctor’s recommendation. If you have questions about the dosage of Trexall that’s best for you, talk with your doctor.
Besides learning about dosage, you may want other information about Trexall. These additional articles might be helpful:
- More about Trexall: For information about other aspects of Trexall, refer to this article.
- Details about cancer, rheumatoid arthritis, and psoriasis: For details about these conditions, see our cancer hub, our rheumatoid arthritis hub, or our psoriasis hub.
Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.