Methotrexate can cause severe and sometimes fatal adverse effects including kidney and liver failure. Monitoring for signs of edema (kidney damage) and jaundice (liver damage) are important to ensure minimal adverse effects are experienced. NSAIDs should not be taken due to the risk for GI damage and bone marrow suppression. Acid reflux or gastrointestinal distress may be a sign of GI toxicity and should be reported immediately, not treated with over-the-counter antacids. A dry cough can indicate pneumonitis, which can be fatal if it is not addressed immediately. A productive cough may indicate infection, so this should be reported immediately as well.