Methotrexate blood level
Quick answer: This test measures the amount of methotrexate, a medicine used in some cancers and autoimmune conditions, in your blood. It is mainly used after high-dose treatment to check that the medicine is clearing safely and to guide rescue treatment.
- SampleBlood
- TakesA few minutes per sample, often repeated over several days
- Before the testThe sample is timed in relation to your dose; follow your treating team's timing.
How the test is done
- 1The sample is taken at set times after your methotrexate infusion
- 2Blood is drawn from a vein or an existing line
- 3The time of the sample is noted carefully
- 4Tests are repeated until the level falls to a safe range
What your results can mean
Reading your report
Your treating doctor compares the level with the expected level for the time since your dose.
If the result is outside the usual range
A level that stays high for the time since your dose can mean the medicine is clearing slowly, often because of kidney problems, dehydration or other medicines, and may need extra rescue treatment. A falling level shows the medicine is clearing as expected.
Who usually has this test
People receiving high-dose methotrexate for cancer, and occasionally people on lower doses who develop side effects.
Risks and aftercare
You may have repeated blood draws, so some bruising is possible; drink fluids as your treating team advises.
Names and options
Also called: serum methotrexate, MTX level
Listed by the hospital as
- METHOTREXATE, SERUM
Questions about this test
Why are methotrexate levels checked after high-dose treatment?
High-dose methotrexate must be cleared from the body within a certain time to avoid harm to the kidneys, liver and bone marrow. Levels guide how long rescue medicine, usually folinic acid, is needed.
Is a methotrexate level needed for weekly low-dose tablets?
Usually not. People on low weekly doses for arthritis or psoriasis are monitored with blood counts, liver and kidney tests instead. Levels may be checked if toxicity is suspected.
What can slow down methotrexate clearance?
Reduced kidney function, dehydration, fluid around the lungs or in the abdomen, and some other medicines can slow clearance. Your treating team watches for these closely.
Related tests
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This page explains each test in general terms so you know what to expect. It is not medical advice: your doctor decides which tests you need and what your results mean. Reference ranges differ between laboratories. Updated 4 November 2026.