There are many ways to help reduce nausea caused by methotrexate. Reducing the dose,
changing its route of administration (pills versus subcutaneous injections), and splitting the
dose if given orally, may be proposed by your pediatric rheumatology care team. Other
suggestions may include giving it at bedtime during the weekend so it does not affect school
participation. Pediatric rheumatologists often prescribe medications to relieve nausea (for
example; dimenhydrinate, and ondansetron). These measures will usually help the majority of
children dealing with this side effect.

Sometimes, if nausea becomes significant and non-responsive to the measures listed
above, the pediatric rheumatologist may decide to stop methotrexate and discuss other
therapeutic options with the parent/child. We would suggest speaking with your
pediatric rheumatology care team about your concerns.