Introduction: Methotrexate (MTX) is a widely used immunosuppressive drug. Though being safe, it has some non-fatal and fatal side effects. Granulocyte-monocyte colony stimulating factor (GM-CSF) a hemopoietic growth factor, is an upcoming preventive and therapeutic modality to curb harmful effects of bone marrow suppressive drugs.Case series: Herein, we narrate three cases of acute MTX toxicity. Two of these presented with cutaneous ulcerative lesions while one presented with only constitutional symptoms. Two patients had derailed liver function tests while one had altered renal function tests. All showed pancytopenia.GM-CSF was given in two cases which responded well, whereas one succumbed to death before administration.Conclusion: Pre-treatment and periodic monitoring; strict avoidance of self-administration are of utmost importance when patient is on MTX. GM-CSF needs exploration in MTX toxicity treatment, and could be a pivotal drug in prevention of fatality in presence of pancytopenia.

Keywords: Methotrexate; Adverse Drug Reaction; Ulceration; Pancytopenia; Self-Medication.