Crushing Methotrexate And CellCept Comparison

In our latest question and answer, the pharmacist discusses whether or not methotrexate can be crushed and how it compares to CellCept.

Feb 15, 2018

PlayingItSafe asked

What is the size of a methotrexate tablet? And, can the medication be crushed safely, if necessary, for a patient who has difficulty swallowing? Also, is it possible to compare the risks and side effects associated with this medicine vs. those associated with mycophenolate mofetil (cellcept)? We are hoping to make an informed decision regarding the two treatmment options, and appreciate any insight you can provide. 


Methotrexate is a relatively small tablet, however, it is a hazardous drug according to NIOSH. What this means is that it should be handled carefully and shouldn’t be crushed outside of a health care environment in most situations. Crushing the tablet could cause particles of the drug to reach other people, leading to potential side effects. Methotrexate could cause harm to people who are pregnant or breastfeeding for example. In the hospital setting, crushing methotrexate is usually only done in a controlled environment, such as an enclosed hood. Hopefully, the methotrexate tablet is small enough to swallow without having to crush or split.

Without knowing more specific information, it may be difficult to assess what the best treatment option would be in this case. Certainly discuss with your health care providers to better understand the risk and benefit of both of these therapies. In this case, both of these drugs can be beneficial in a variety of indications, however, there are significant risks that must be understood with either of these medications. Below, we will discuss some more information about methotrexate and mycophenolate (Cellcept).

Side Effects Of Methotrexate

First and foremost, it is important to understand that mistakes in methotrexate dosing can be fatal. The manufacturer recommends prescribing only from physicians who have knowledge and experience with this type of medication. It is extremely important to understand exactly how to take the methotrexate. For example, medication errors have occurred when rheumatoid arthritis patients have taken methotrexate daily instead of weekly. In fact, the maximum recommended dose for the treatment of rheumatoid arthritis is 20 mg. Dosing varies drastically depending on indication so caution is advised. Most side effects are dose dependent meaning the risk of side effects increase with higher doses over a longer period of time.

Potential adverse reactions are significant with methotrexate and include, but are not limited to:

  • Hair loss, photosensitivity, and skin reaction
  • Diarrhea, nausea, and vomiting
  • Elevated liver enzymes
  • Bone marrow suppression
  • Infections due to immune system suppression


Side Effects Of Mycophenolate

Similar to methotrexate, mycophenolate is a hazardous drug, causes immune system suppression, has serious pregnancy risks, and has potential to cause significant side effects. Mycophenolate should not be opened or crushed.

Potential adverse reactions include, but are not limited to:

  • Significant GI distress including abdominal pain, anorexia, constipation, diarrhea, nausea, and vomiting
  • Worsening kidney function
  • Weakness
  • Headache
  • Elevated liver enzymes
  • Infections due to immune system suppression


Both methotrexate and mycophenolate can be used in a variety of indications including rheumatoid arthritis. These medications do have a significant risk of side effects and must be well understood before starting therapy. Correct dosing and monitoring for side effects will be critical for both methotrexate and mycophenolate.

Source: Methotrexate package insert, Mycophenolate package insert

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