Methotrexate (MTX) treats several cancers; product, route and indication matter.
- Confirm calendar.
- Overdose: emergency assessment.
- Funding disclosure does not establish independent efficacy.
Table of contents
- Evidence summary
- What it is and licensed uses
- How it works
- Care boundaries
- Supplements and supportive care
- Evidence limits
- Risks and urgent symptoms
- Interactions
- Pregnancy and breastfeeding
- Taking it safely
- Animal and laboratory evidence
- Funding: follow the money
- Frequently asked questions
- Sources and funding notes
Evidence summary
Independent comparative efficacy: unestablished.
| Question | Source role | Limits |
|---|---|---|
| Labels | UK; US | Regulatory, not independent comparisons. |
| Cancer regimens | AALL0232 | Intravenous combinations; author company ties. |
| Use frequency | England items | Not patients, oral cancer usage or global popularity. |
What it is and licensed uses
| Selected oral product | Licensed contexts |
|---|---|
| UK 2.5 mg tablet | Acute lymphoblastic leukemia (ALL)/Burkitt’s lymphoma; specified severe psoriasis/severe active adult rheumatoid arthritis. |
| US Trexall tablets | ALL maintenance; adult mycosis fungoides/relapsed or refractory non-Hodgkin lymphoma; inflammatory conditions. |
Amethopterin/MTX name the ingredient; foreign brand listings do not establish current stock or local approval.
How it works
This antifolate interferes with the synthesis of DNA needed for cell growth.
Care boundaries
Specialist support: ALL/lymphoma guides.
Supplements and supportive care
Evidence limits
The 2016 randomized trial compared intravenous combinations in high-risk B-ALL. Companion agents differed; early closure/crossover complicate interpretation. Both arms used oral maintenance: no oral-brand comparison.
NCI/COG grants coexisted with compensated author company ties. Outcomes are excluded from our independent verdict. Full disclosures.
Risks and urgent symptoms
Emergency: breathing difficulty/swelling. Urgent: fever, bleeding, mouth ulcers. Monitor blood/liver/kidneys.
Suspected overdose: emergency assessment immediately, even without symptoms.
Interactions
Check medicines/vaccines: interactions include trimethoprim/co-trimoxazole, NSAIDs, nitrous oxide. Others interact.
Pregnancy and breastfeeding
Pregnancy: contraindicated outside cancer; specialist cancer assessment.
| Selected product | After-treatment precautions |
|---|---|
| UK tablet | Contraception: during/six months after. No breastfeeding. |
| US Trexall | Contraception: during; women six/men three months after. No breastfeeding during/one week after. |
Taking it safely
UK information: weekly warnings; daily Burkitt’s treatment. Seek specialist clarification.
Autoimmune: weekly; cancer: specialist schedules. Confirm prescription.
Animal and laboratory evidence
Mechanism and laboratory findings cannot establish patient benefit, dose or equivalence. No animal outcome is used as clinical evidence here.
Funding: follow the money
Research funding at a glance
18 disclosure entries. The counts below summarize independence tiers explicitly assigned in this article. They count disclosures, not studies, funding amounts or evidence quality.
Consult this article’s source and funding notes for named funders, countries, relationships and exceptions where available. Institutional backing, researcher interests and trial sponsorship are separate questions. Public funding alone does not establish independence; commercial ties alone do not prove a claim false. This overview is not a new financial audit.
Income cannot identify page/trial payments. Private allocations unknown; counts ≠ quality.
Direct EBEWE stakes/intermediaries remain unknown; voting rights do not establish equity.
| Source | Country | Funding / owner | Tier | Credibility / possible bias |
|---|---|---|---|---|
| Sandoz 2025 annual report | Basel, Switzerland; Austria / UK | Medicine sales, equity and borrowing; dated holders. | Tier 4 | D. Reporting duties; possible corporate presentation. |
| Sandoz H1 2026 report | Switzerland | Medicine sales, bonds and undrawn credit facility. | Tier 4 | D. Reporting duties; possible corporate presentation. |
| UK SmPC | Austria / UK | EBEWE Pharma Ges.m.b.H. Nfg.KG holder; Sandoz contact; sales. | Tier 4 | D. Regulatory accuracy; possible sales bias. |
| UK patient card | UK | Product risk material; payments unknown. | Tier 4 | D. Safety duties; possible commercial framing. |
| Trexall label | US / Czech Republic | Teva Women’s Health LLC labeler; Teva Czech Industries makes for Teva Pharmaceuticals; Czech group subsidiary; labeler equity unknown. | Tier 4 | D. Label duties; possible sales bias. |
| NCI methotrexate overview | Bethesda, US | Congressional appropriation; Gift Fund; page payments unclosed. | Tier 2 | B provisional. Public accountability; possible institutional framing. |
| NCI drug dictionary | Bethesda, US | Congressional appropriation; Gift Fund; page payments unclosed. | Tier 2 | B provisional. Public accountability; possible institutional framing. |
| NCI budget | Bethesda, US | Congressional appropriation. | Tier 2 | B provisional. Budget accountability; possible political framing. |
| NCI Gift Fund | Bethesda, US | Private gifts permitted; allocations unclosed. | Tier 2 | B provisional. Disclosure duties; possible donor emphasis. |
| MHRA dosing warning | UK | DHSC support and fee-funded regulator; alert payments unclosed. | Tier 2 | B provisional. Public safety duties; possible regulatory framing. |
| MHRA 2025/26 accounts | UK | Industry fees, customer charges and DHSC support. | Tier 2 | B provisional. Reporting duties; possible institutional presentation. |
| Teva 2025 SEC 10-K | Israel / US | Medicine sales, equity, bonds and undrawn credit facility. | Tier 4 | D. Audited reporting duties; possible corporate presentation. |
| Teva subsidiary list | Israel / Czech Republic / US | Listed commercial group; subsidiaries named, exact labeler chain unclosed. | Tier 4 | D. Filing duties; possible selective disclosure. |
| Teva 2026 proxy | Israel | Equity holders; issuer-paid audit fees. | Tier 4 | D. SEC disclosure duties; possible management framing. |
| COG AALL0232 original | US / Australian authors | NCI/COG grants; five authors disclosed company ties. | Tier 2 | C. Methods/disclosures permit scrutiny; possible career/commercial influence. |
| England PCA workbook | UK; England data | NHSBSA public finance and service income; dataset payments unclosed. | Tier 2 | B provisional. Statistical accountability; possible coverage bias. |
| PCA methodology | UK; England data | NHSBSA public finance and service income. | Tier 2 | B provisional. Published definitions; possible coverage bias. |
| NHSBSA accounts | Newcastle, UK | DHSC/public finance, service fees and repayment routes. | Tier 2 | B provisional. Reporting duties; possible institutional presentation. |
Frequently asked questions
Does MTX mean methotrexate?
Yes. It abbreviates the same ingredient.
Do England items show global popularity?
No: 41,023 injection-code items versus 2,236,642 separate rheumatic-code items. Items are not patients or diagnoses.
Did AALL0232 compare oral brands?
No. It compared intravenous combinations.
Do author company ties identify trial funding?
No. Disclosed author relationships are distinct from NCI/COG study grants.
Does a government source guarantee independence?
No. Funding and possible institutional bias still require scrutiny.
Sources and funding notes
Selected UK/US oral guidance; other products remain open. Financial disclosures do not audit page payments.
- Sandoz 2025 annual report — Selected governance/finance; voting rights differ from equity.
- Sandoz H1 2026 report — Selected unaudited H1 finance; not product receipts.
- UK tablet SmPC — September 2024: oral licence/safety.
- UK patient card — July 2020; weekly nononcology use, not new licences.
- Trexall label — June 2026: label/patient insert.
- NCI methotrexate overview — January 2025; broad ingredient uses, not every tablet licence.
- NCI drug dictionary — Names/mechanism; not availability or licensing.
- NCI budget — May 2026; enacted funding separate from requests.
- NCI Gift Fund — August 2025; authority, not named page sponsorship.
- MHRA dosing warning — September 2020; weekly autoimmune versus cancer schedules.
- MHRA 2025/26 accounts — Selected funding and financial statements; no complete audit.
- Teva 2025 SEC 10-K — Selected audit/finance; not Trexall receipts.
- Teva subsidiary list — December 2025; significant subsidiaries, not all entities.
- Teva 2026 proxy — Selected March 2026 ownership, audit fees and related parties.
- COG AALL0232 original — 2016; complete article and figures; outcomes excluded here.
- England PCA workbook — 2025/26; two chemical codes and all 119 presentations.
- PCA methodology — June 2026; community items exclude hospital-pharmacy dispensing.
- NHSBSA accounts — Selected institutional finance; dataset payments unclosed.
Educational research reviewed 5 October 2026. Follow the exact medicine leaflet and urgent clinician instructions. Diagnosis and treatment require a qualified clinician.
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