Which of the following are NOT considered signs of a serious side effect of methotrexate?

• A. Bleeding gums
• B. Haematuria
• C. Unexplained bruising
• D. Nausea, vomiting or diarrhoea

Answer: (D)

Methotrexate toxicity that requires urgent attention is usually due to bone marrow suppression and mucosal bleeding. Bleeding gums, haematuria, and unexplained bruising are clear signs that there may be cytopenia or mucosal damage affecting bleeding risk, which signals a potential serious adverse effect and needs prompt evaluation (often with a blood count and clinical review).

Nausea, vomiting or diarrhoea, while common with methotrexate, do not by themselves indicate a serious toxicity. They’re typically less alarming unless they are severe, persistent, or accompanied by other red flags. So, the statement describing GI upset as not a sign of a serious adverse effect is the best fit.