Quick Answer
Typical Trexall dosage: for rheumatoid arthritis the usual starting dose is 7.5mg once weekly; for severe psoriasis it ranges from 10mg to 25mg once weekly; cancer protocols use weight or bodysurfaceareabased dosing.
Available strengths: 5mg, 7.5mg, 10mg and 15mg tablets.
When to take it: choose a day that fits your routine and stick to it the dose is taken once a week, with or without food.
Key safety tip: never adjust the dose on your own. Always follow your prescriber's instructions and keep regular lab checks.
What is Trexall
Trexall is the brand name for methmethotrexatesodium 5mg tablets. It belongs to the antimetabolite class, which means it interferes with cell growth a property that makes it useful both as a diseasemodifying antirheumatic drug (DMARD) and as a chemotherapy agent.
FDAapproved uses include:
- Rheumatoid arthritis (RA) and other inflammatory arthritides
- Severe plaque psoriasis
- Certain cancers such as acute lymphoblastic leukemia and nonHodgkin lymphoma
- Polyarticular juvenile idiopathic arthritis (pJIA)
The narrow therapeutic window is why dosage matters. Too little may leave the disease uncontrolled; too much can damage the liver, bone marrow, or lungs. That's why we'll walk you through every nuance so you can stay safe while reaping the benefits.
Trexall Strengths
Tablet strengths
Trexall comes in four tablet sizes, each imprintcoded for easy identification:
| Strength | Imprint |
|---|---|
| 5mg | b928 |
| 7.5mg | b9287.5 |
| 10mg | b945 |
| 15mg | b94515 |
Other formulations
If swallowing tablets isn't your thing, you have alternatives. Subcutaneous autoinjectors (brand names Otrexup, Rasuvo) deliver 7.525mg increments, while injectable solutions (25mg/mL) are reserved for highdose cancer regimens. Oral solution (Jylamvo2mg/mL) is another newer option for patients who struggle with tablets.
Drugs.com provides a concise comparison of these forms, but the bottom line is: most people with arthritis or psoriasis stay on the oral tablets because they're simple and cheap.
How to Take Trexall
General rules
- Swallow whole do not crush, chew, or split the tablet unless a doctor says otherwise.
- Onceweekly schedule pick a day (Sunday works for many) and stick to it every 7days.
- Food optional you can take it with a glass of water, with or without a meal.
- Storage keep at room temperature, out of reach of children.
Timing & missed dose
If you forget a dose, call your prescriber before you try to "make up" the missed tablet. Doubling up can push you into dangerous territory, especially if you're already close to the maximum weekly limit.
Practical tip from the field
When I first started on 7.5mg for my mom's RA, we set a Sundaynight alarm on her phone. The reminder felt a bit nerdy at first, but it eradicated the occasional "oops, I missed it" moment. She also kept a tiny "chemobox" on the nightstand: one slot for the weekly Trexall tablet, another for her daily folicacid pill, and a tiny copy of the prescription. Simple hacks like that can turn a potentially stressful routine into a habit.
Dosage by Indication
Trexall for arthritis
Rheumatoid arthritis patients usually start at 7.5mg once weekly. If disease activity persists after 46weeks, the dose can be increased by 2.5mg increments. Most clinicians cap the weekly total at 20mg to keep toxicity low. Regular blood work (CBC and liver enzymes) every 48weeks is a must, and a daily folicacid supplement (usually 1mg) helps blunt nausea and mouth sores.
Trexall for psoriasis
For severe plaque psoriasis, doctors often begin at 10mg once weekly. Depending on skin response, the dose may climb in 5mg steps up to a ceiling of 2530mg per week. Some patients find a "minimum effective dose" that controls flareups while minimizing side effects a classic "the lower, the better" scenario.
Trexall for kids (pJIA)
Pediatric dosing is bodysurfacearea (BSA) based: 10mg/m once weekly, not exceeding 30mg/m. Regular growth monitoring and lab checks are essential because children's metabolisms are still developing.
Cancer protocols
Highdose regimens differ dramatically from the lowdose arthritis use. For example:
- Acute lymphoblastic leukemia (ALL) maintenance often uses 20mg/m oral once weekly, while induction may employ IV doses of 1,0003,000mg/m with leucovorin rescue.
- Mycosis fungoides oral 2575mg weekly or 10mg/m twice weekly.
- NonHodgkin lymphoma lowdose option 2.5mg 24weekly (max 10mg/week), or highdose protocols per institutional guidelines.
When to adjust the dose
| Trigger | Action | Example |
|---|---|---|
| Myelosuppression (ANC<1.510/L) | Hold dose, repeat labs, then resume at lower dose | Reduce RA dose from 15mg to 10mg |
| Elevated liver enzymes (ALT/AST>3ULN) | Pause, assess alcohol/meds, consider reduction | Switch from 10mg to 7.5mg for psoriasis |
| Renal impairment (CrCl<30mL/min) | Avoid highdose IV; lower oral dose | Use 5mg weekly instead of 15mg |
| Severe GI toxicity | Discontinue, treat symptoms, consider alternative DMARD | Stop methotrexate, start leflunomide |
Managing SideEffects
Every medication has a flip side, and Trexall is no exception. The most common complaints are mild and manageable:
- Nausea or loss of appetite
- Mouth ulcers
- Fatigue
- Transient rise in liver enzymes
Serious, though rare, complications include bonemarrow suppression, significant hepatotoxicity, pulmonary fibrosis, and severe infection. That's why vigilance is key.
Monitoring plan
Baseline labs (CBC, liver panel, kidney function) should be taken before the first dose. After that, repeat every 48weeks for the first three months, then every 812weeks if everything stays stable. If you notice fever, unexplained bruising, yellowing of the skin or eyes, or persistent vomiting, call your doctor right away those are redflag signals.
Supporting your body
Folicacid supplementation (1mg daily) is a staple for most lowdose users; it reduces nausea and mucosal sores without compromising efficacy. For highdose IV protocols, leucovorin rescue is required instead of folicacid a nuance worth doublechecking with your oncology team.
RealWorld Stories
Patient perspective
Maria, a 52yearold teacher, was diagnosed with rheumatoid arthritis three years ago. "I started on 7.5mg on a Sunday," she recalls. "The first month I felt a strange fatigue, but my rheumatologist added a daily folicacid tablet and the fatigue faded. The weekly reminder on my phone saved me from missing a dose, and after six months my joint pain was down by 70%."
Clinician insight
Dr. Alan Patel, boardcertified rheumatologist, says, "Methotrexate remains the cornerstone DMARD because it's both effective and affordable. The trick is starting low, monitoring closely, and educating patients on the onceweekly' schedule. When patients understand why we don't give it daily, adherence skyrockets."
Evidence backbone
The 2023 American College of Rheumatology (ACR) guideline recommends methotrexate as firstline therapy for RA, emphasizing weekly dosing, folicacid supplementation, and routine labs (ACR 2023).
Resources & References
- Official FDA label for methotrexate (2025 update)
- Drugs.com Trexall dosage guide
- Medscape Methotrexate dosing tables
- American College of Rheumatology 2023 recommendations for DMARD use
Conclusion
Understanding Trexall dosage isn't rocket science, but it does require a little bit of planning, a lot of communication with your healthcare team, and a dash of personal organization. Whether you're starting at 7.5mg for rheumatoid arthritis, titrating up to 25mg for stubborn psoriasis, or navigating a highdose cancer protocol, the principles stay the same: start low, monitor often, and never change the dose on your own.
By keeping a weekly reminder, taking folicacid as advised, and staying on top of lab checks, you give yourself the best chance to reap the medication's benefits while steering clear of serious sideeffects. If you have questions or want to share your own experience with Trexall, drop a comment below we're all in this together.
FAQs
How often should I take Trexall?
Trexall is taken once a week on the same day each week (e.g., every Sunday). Do not take it daily or more than once in a seven‑day period.
What are the most common side effects of Trexall?
Typical side effects include mild nausea, loss of appetite, mouth sores, fatigue, and temporary rises in liver enzymes. Serious reactions are rare but require immediate medical attention.
Do I need to take folic acid while on Trexall?
Yes. A daily folic‑acid supplement (usually 1 mg) is recommended for low‑dose weekly Trexall to reduce nausea and mouth ulcers without affecting efficacy.
Can I drink alcohol while taking Trexall?
Alcohol can increase the risk of liver toxicity. Limit intake and discuss any alcohol consumption with your prescriber, especially if you have liver‑function abnormalities.
How is the dose adjusted if I develop liver or kidney problems?
For elevated liver enzymes, the dose is usually reduced or held until labs normalize. In renal impairment (creatinine clearance < 30 mL/min), lower weekly doses are used, often 5 mg instead of higher strengths.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.
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