Methotrexate

How Hard Is It to Find Methotrexate in Stock?

Methotrexate injection has been on the FDA Drug Shortage Database since March 13, 2023 — and remains listed as of 2026. The shortage primarily affects injectable formulations (25 mg/mL vials), while oral tablets (2.5 mg) are generally available at most retail pharmacies. Availability of the injectable varies significantly by manufacturer, vial size, and region.

Patients needing preservative-free injectable methotrexate for cancer treatment face the greatest challenge. Fresenius Kabi and Hikma have been the most consistent suppliers; Accord, Teva, and Pfizer have experienced intermittent back orders or allocation. For patients on oral methotrexate for arthritis or psoriasis, availability is generally good at most major pharmacy chains.

If you're struggling to find methotrexate at your local pharmacy, medfinder calls pharmacies near you and identifies which ones have your specific medication and dosage in stock — typically delivering results within 24 hours.

Who Can Prescribe Methotrexate?

Methotrexate is not a controlled substance and has no DEA scheduling restrictions. Any licensed prescriber — physician, nurse practitioner, or physician assistant — can prescribe it. However, due to its complex toxicity profile, monitoring requirements, and boxed FDA warnings, prescribing is typically initiated by specialists experienced with the drug.

Rheumatologists: Primary prescribers for rheumatoid arthritis, psoriatic arthritis, lupus, and other inflammatory conditions

Dermatologists: Prescribe for severe psoriasis and other dermatologic conditions

Oncologists/Hematologists: Manage high-dose chemotherapy regimens for leukemia, lymphoma, and solid tumors

Pediatric oncologists: Manage methotrexate for childhood ALL and pediatric JIA

Primary care physicians (PCPs): May manage maintenance therapy once a specialist has established the diagnosis and treatment plan

Nurse practitioners (NPs) and physician assistants (PAs): Commonly manage refills and monitoring in rheumatology and dermatology practices

Telehealth prescribing is available for stable, established patients with recent labs on file. New patients typically require an in-person evaluation and baseline blood work before a first prescription can be issued. The American College of Rheumatology and American Academy of Dermatology provide specialty finder tools to locate in-network prescribers.

Is Methotrexate a Controlled Substance?

No. Methotrexate is not a controlled substance. It is not scheduled by the DEA under the Controlled Substances Act. Any licensed physician, nurse practitioner, or physician assistant can prescribe it without a special DEA registration number.

Because methotrexate is not a controlled substance, there are no restrictions on the number of refills per prescription and no specific prescription record-keeping requirements beyond standard prescription tracking. Prescriptions can be called in, faxed, or sent electronically. Early refills are at the pharmacist's and prescriber's discretion and are not governed by DEA rules.

Despite not being a controlled substance, methotrexate has significant safety requirements due to its toxicity profile. It requires regular laboratory monitoring (CBC and liver function tests), has multiple boxed FDA warnings, and is absolutely contraindicated in pregnancy. Patients should not take it without ongoing medical supervision.

Common Side Effects of Methotrexate

These side effects are frequently reported, especially early in treatment. Most can be reduced with folic acid supplementation (1 mg daily) and often improve over time:

Nausea and upset stomach (most common; often occurs the day after dosing)

Fatigue and tiredness ("methotrexate hangover")

Mouth sores (mucositis/stomatitis)

Loss of appetite

Headache and dizziness

Hair thinning (typically less severe than chemotherapy doses)

Photosensitivity (increased sun sensitivity)

Serious Side Effects — Seek Medical Attention Immediately

Hepatotoxicity: Liver fibrosis and cirrhosis with long-term use; monitor with regular LFTs; avoid alcohol

Pulmonary toxicity (methotrexate pneumonitis): New dry cough, fever, shortness of breath — call your doctor immediately

Bone marrow suppression: Unusual bruising, bleeding, or infection; detected via CBC monitoring

Renal toxicity: Kidney damage, especially at high doses or with NSAID use; monitor creatinine

Embryo-fetal toxicity: Absolutely contraindicated in pregnancy; causes birth defects and fetal death

Severe skin reactions: Stevens-Johnson syndrome and toxic epidermal necrolysis (rare but life-threatening)

Final Thoughts on Methotrexate

Methotrexate remains one of the most important medications in rheumatology and oncology. It has a 70+ year track record, robust clinical evidence for rheumatoid arthritis and multiple cancers, and a low cost when available. For most patients on oral methotrexate, it is affordable and accessible.

The injectable shortage that began in March 2023 continues to affect some patients, particularly those needing preservative-free formulations for cancer treatment. Planning ahead — starting your search 2–3 weeks before you run out, checking multiple pharmacies, and maintaining an open conversation with your provider about contingency plans — is the best strategy.

If you're having trouble finding methotrexate at a pharmacy near you, medfinder can call local pharmacies and identify which ones have your specific formulation in stock — saving you hours of frustration and helping ensure you never miss a dose.