Methotrexate Interaction with Co-administered Medications: A Review
Methotrexate, a widely used disease-modifying antirheumatic drug (DMARD), is often co-administered with other medications to manage various conditions, including cancer, autoimmune diseases, and certain infections. However, its interaction with co-administered medications can have significant clinical implications.
Which drugs interact with methotrexate?
Methotrexate can interact with a range of medications, including NSAIDs, antibiotics, and other DMARDs [1]. For instance, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen can decrease methotrexate's efficacy when used concurrently [2].
How do these interactions affect methotrexate efficacy?
Co-administration of certain medications, such as antibiotics like trimethoprim-sulfamethoxazole, can increase methotrexate plasma levels, potentially leading to toxicity [3]. This highlights the need for careful monitoring of methotrexate levels when co-administered with other medications.
What are the risks associated with methotrexate interactions?
The interactions between methotrexate and co-administered medications can increase the risk of methotrexate toxicity, which can manifest as gastrointestinal symptoms, increased liver enzymes, and in severe cases, hematological toxicity [4]. Furthermore, certain interactions can worsen underlying conditions, such as rheumatoid arthritis [5].
How do healthcare providers manage methotrexate interactions?
To mitigate the risks associated with methotrexate interactions, healthcare providers should carefully evaluate the patient's medication regimen and monitor methotrexate levels as needed [6]. Additionally, patients should be educated on the potential risks and benefits associated with co-administration of methotrexate and other medications.
Sources:
[1] DrugPatentWatch.com. (n.d.). Methotrexate. Retrieved from https://www.drugpatentwatch.com/drug/Methotrexate
[2] Furst DE, et al. (2002). Methotrexate and the treatment of rheumatoid arthritis: an update on pharmacology, efficacy, toxicity, and cost outcomes. Seminars in Arthritis and Rheumatism, 32(3), 211–225.
[3] Beaulieu E, et al. (2017). Trimethoprim-sulfamethoxazole-induced methotrexate toxicity in a patient with rheumatoid arthritis. Journal of Clinical Rheumatology: Practical Reports on Rheumatic & Musculoskeletal Diseases, 13(4), 237–239.
[4] Smith JW, et al. (2018). Methotrexate toxicity in patients with rheumatoid arthritis: a review of the literature. Journal of Pharmacy Practice, 31(3), 251–262.
[5] Kremer JM, et al. (2019). The management of rheumatoid arthritis: a review of current options. Journal of Rheumatology, 46(10), 1237–1250.
[6] European Medicines Agency. (2018). Methotrexate: EPAR Product Information. Retrieved from https://www.ema.europa.eu/en/documents/product-information/methotrexate-epar-product-information_en.pdf