Immunosuppressants are traditionally administered in sarcoidosis patients with contraindications for the use of glucocorticosteroids (GCS), or in those with serious adverse reactions on GCS, as well as in the cases of GCS-therapy resistance. Aim - to study the effectiveness and safety of methotrexate monotherapy in pulmonary sarcoidosis patients with either GCS contraindication or adverse reactions. We examined 33 patients with st. II pulmonary sarcoidosis, 20 men and 13 women, 23-67 years of age. In all cases a general physical examination; chest computed tomography and spirometry were performed. Oral methotrexate 10 mg once per week was administered to all patients. Blood tests, including total blood count with platelet count, blood chemistry (ALT, AST, bilirubin, creatinin) were done before the start of the therapy and monthly afterwards. Methotrexate monotherapy appeared to be effective in 24 (72,7%) study patients (clinical cure or regression of lung lesions). Adverse reactions were registered in 10 (30,3%) patients. In 1 case treatment was stopped because of the serious adverse event. As it was confirmed by our study results, methotrexate should be considered a medication of choice in pulmonary sarcoidosis patients with contraindications for use or adverse reactions to GCS. A research of combination therapy of methotrexate with first-line drugs should be continued.