Can You Stop Taking Methotrexate Cold Turkey? What You Need to Know

Methotrexate is a popular disease-modifying antirheumatic drug (DMARD) used to treat rheumatoid arthritis psoriatic arthritis and other inflammatory autoimmune conditions. Taken once weekly, often for years, methotrexate helps control overactive immune systems to reduce inflammation and prevent joint damage.

But what if you want to stop taking methotrexate? Can you quit methotrexate cold turkey? Or do you need to taper off slowly and carefully? Here’s what rheumatology experts say about safely discontinuing methotrexate.

What Happens If You Stop Methotrexate Suddenly?

Quitting methotrexate abruptly without your rheumatologist’s guidance can be risky. Sudden discontinuation may trigger a disease flare or other complications

“I would opt for slowly tapering it unless you are having some sort of side effect and need to be off of it quickly,” advises one Johns Hopkins rheumatologist.

Even if your symptoms seem under control, stopping methotrexate too fast could cause a flare. Tapering slowly allows your doctor to monitor you and make medication adjustments to prevent flares.

Why You Shouldn’t Quit Methotrexate Cold Turkey

There are a few key reasons rheumatologists recommend against suddenly stopping your weekly methotrexate:

• Disease flares – Methotrexate controls immune system overactivity that causes joint inflammation and damage. Quitting cold turkey removes this effect, allowing inflammation to recur.

• Medication dependence – Long-term methotrexate use causes your immune system to become dependent on the drug. Abruptly stopping can spur a reactive immune response.

• Lack of monitoring – Gradual tapering allows your rheumatologist to frequently assess disease activity. Quitting without medical supervision means missing important checks.

• No medication adjustment – Slow tapering gives your doctor time to modify treatments to prevent flares as methotrexate is lowered. Quickly stopping eliminates this option.

For these reasons, rheumatologists do not advise quitting methotrexate suddenly unless you experience severe side effects requiring quick discontinuation.

Signs Your Disease Is Flaring After Stopping Methotrexate

Be alert for possible flares when coming off methotrexate, even with careful tapering. Signs your condition is worsening include:

• Increased joint pain, swelling, or stiffness
• Redness, warmth, or tenderness in joints
• Morning stiffness lasting over 30 minutes
• Fatigue, weakness, or malaise
• Loss of appetite or unplanned weight loss
• Low-grade fever, chills, or sweating
• Numbness or tingling in hands or feet
• Heightened skin sensitivity or rash

Contact your rheumatologist promptly if your symptoms worsen after stopping or lowering your methotrexate dose. You may need medication adjustments or resuming your previous dose.

How To Safely Taper Off Methotrexate

To avoid flares and other problems, work closely with your rheumatologist to slowly taper your weekly methotrexate dose. Some helpful tapering tips include:

• Taper gradually over weeks or months, not days. This may mean small dose decreases every 1-2 months.

• Closely monitor symptoms and disease activity at each dose decrease.

• Take any other prescribed medications as directed, such as steroids or biologics, to help prevent flares.

• Use an NSAID short-term if prescribed by your doctor to ease symptom spikes.

• Report any flares or side effects immediately so your doctor can adjust the tapering schedule.

• Restart your previous methotrexate dose if your condition worsens and cannot be controlled with other treatments.

When Is Stopping Methotrexate Recommended?

In certain situations, your rheumatologist may recommend discontinuing methotrexate:

• If you experience persistent or severe side effects from the medication
• If methotrexate interacts with other new medications you require
• If you become pregnant or are planning to conceive
• If you achieve sustained disease remission or no longer need DMARD therapy
• If newer, more effective medications become available

But your dose should never be lowered or discontinued without guidance from your physician. Sudden discontinuation of the drug may put you at risk for a flare of your disease, so your doctor will want to monitor you appropriately.

The Takeaway

Quitting methotrexate cold turkey is not advised for people taking the medication long-term to control inflammatory arthritis. Abruptly stopping removes the anti-inflammatory effect of the drug which can lead to flares or other immune issues. Always work with your rheumatologist to create a gradual tapering schedule that allows for close monitoring and medication adjustments to prevent disease worsening. With a thoughtful tapering plan, you can safely discontinue methotrexate when needed.