Blood Bone marrow depression, leukopenia, thrombocytopenia, anaemia, hypogammaglobulinaemia, haemorrhage from various sites, septicaemia. Alimentary system Gingivitis, pharyngitis, stomatitis, anorexia, vomiting, diarrhoea, haematemesis, melena, gastrointestinal ulceration and bleeding, enteritis, hepatic toxicity resulting in acute liver atrophy, significant elevations of liver enzymes, necrosis, fatty metamorphosis, periportal fibrosis, or hepatic cirrhosis. Vaginitis, vaginal ulcers, cystitis and haematuria. Infrequently an acute or chronic interstitial pneumonitis, often associated with blood eosinophilia, may occur and deaths have been reported. Acute pulmonary oedema has also been reported after oral and intrathecal use.
Pulmonary fibrosis is rare.
Central nervous system Headaches, drowsiness, blurred vision, aphasia, hemiparesis and convulsions have occurred possibly related to haemorrhage or to complications from intra-arterial catheterization. Convulsion, paresis, Guillain-Barre syndrome and increased cerebrospinal fluid pressure have followed intrathecal administration. Other reactions related to, or attributed to the use of methotrexate, such as pneumonitis, metabolic changes, precipitation of diabetes, osteoporotic effects, abdominal changes in tissue cells, and even sudden death have been reported. Following intrathecal methotrexate Adverse reactions are generally classified into three groups, acute, subacute and chronic. Acute Chemical arachnoiditis manifested by headache, back or shoulder pain, rigidity in the nape of the neck, and fever.