Yes. 39 FDA-approved labels for Methotrexate carry a boxed warning, and its subject is embryo-fetal toxicity, hypersensitivity reactions, and severe adverse reactions methotrexate. A boxed warning is the most serious warning the FDA requires on a prescription label. It is applied to the drug and to the situations in which it is used, not to any particular person taking it.
What the warning says
Below is how the Methotrexate warning opens on one specific label, identified underneath it. Of the 25 Methotrexate labels sampled, 19 carried materially different wordings and this was the most common, used by 3 of them.
WARNING: EMBRYO-FETAL TOXICITY, HYPERSENSITIVITY REACTIONS, and SEVERE ADVERSE REACTIONS Methotrexate Tablets can cause embryo-fetal toxicity, including fetal death. For non-neoplastic diseases, Methotrexate Tablets is contraindicated in pregnancy. For neoplastic diseases, advise females and males of reproductive potential to use effective contraception [see Contraindications (4) , Warnings and Precautions (5.1) , Use in Specific Populations (8.1 , 8.3) ]. Methotrexate tablets is contraindicated in patients with a history of severe hypersensitivity reactions to methotrexate, including anaphylaxis [ Contraindications (4) , Warnings and Precautions (5.2) ].
METHOTREXATE, Coupler LLC, label version effective 27 February 2025. Opening of the warning; read the full label on DailyMed.Why the wording differs between manufacturers
There is no single official text of a boxed warning. The FDA sets what a warning must cover, and each manufacturer writes its own label within that. Of the 25 Methotrexate labels sampled for this page, 19 carried materially different wordings of the same warning, and the version quoted above was used by 3 of them.
The hazard does not change between those 19 versions. Only the sentences do, which is why a refill from a different manufacturer can carry warning text that reads differently without anything about Methotrexate or its risks having changed.
Methotrexate is dispensed under 39 current FDA labels despite this warning, which is the point worth holding onto: a boxed warning is a disclosure requirement, not a verdict. What a boxed warning does and does not mean sets out the distinction.
Common questions
Does Methotrexate have a black box warning?
Yes. 39 FDA-approved labels for Methotrexate carry a boxed warning, and its subject is embryo-fetal toxicity, hypersensitivity reactions, and severe adverse reactions methotrexate. A boxed warning is the strongest warning the FDA requires on a prescription label, and it is applied to the drug, not to any individual taking it.
What does the Methotrexate boxed warning say?
The wording is set by each manufacturer within FDA requirements, so it varies. In the version quoted on this page, taken from a label effective 27 February 2025, the warning concerns embryo-fetal toxicity, hypersensitivity reactions, and severe adverse reactions methotrexate. The full text is linked so the exact version can be read rather than summarised.
Does the Methotrexate boxed warning mean the drug is unsafe or being withdrawn?
No. It means the FDA requires the risk of embryo-fetal toxicity, hypersensitivity reactions, and severe adverse reactions methotrexate to be communicated prominently so prescribers weigh it explicitly. Methotrexate remains FDA-approved and is dispensed under 39 current labels. A boxed warning is a disclosure requirement, not a judgement that a drug should not be used.
Why do different pharmacies show different warning text for the same drug?
Because each manufacturer writes its own label within the FDA's requirements. Of 25 Methotrexate labels sampled here, 19 carried materially different wordings of the same warning. The hazard described is the same; the sentences are not. This is a common source of confusion when a prescription is refilled with a different manufacturer's product.
Should I stop taking Methotrexate because of this warning?
This page does not answer that and cannot. The warning about embryo-fetal toxicity, hypersensitivity reactions, and severe adverse reactions methotrexate is written for a prescriber deciding whether Methotrexate suits a particular patient, and stopping a prescribed medicine carries its own risks that this page knows nothing about. Raise it with the prescriber or a pharmacist, who can see the whole picture.
Where this page's information comes from
The quotation above is from one Methotrexate label, linked below by its DailyMed set identifier so the exact version can be opened rather than taken on trust. The figure of 39 labels, and the count of 19 distinct wordings among 25 sampled, were computed from the openFDA labelling API on 30 August 2026.
- METHOTREXATE prescribing information, Coupler LLC, effective 27 February 2025.
- openFDA drug labelling API, the source of the label counts and variant counts on this page.
Labels are revised over time. The version linked above is the one this page was written against, and a newer revision may differ. Counts reflect the labels present in openFDA on the retrieval date.