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What monitoring is required for elderly patients on methotrexate?

Methotrexate is a commonly prescribed medication for various conditions, including rheumatoid arthritis, psoriasis, and certain types of cancer [1]. It is crucial to monitor elderly patients on methotrexate closely due to their increased susceptibility to adverse effects [2].

1. **Laboratory Monitoring**: Regular blood tests are essential to monitor the patient's complete blood count (CBC), liver function, and renal function [2]. These tests help detect potential side effects such as anemia, leukopenia, thrombocytopenia, liver toxicity, and kidney problems [2].

2. **Folic Acid Supplementation**: Concomitant folic acid supplementation is often recommended to reduce methotrexate-induced gastrointestinal side effects and hematologic toxicity [3]. However, it does not reduce the risk of liver toxicity or neoplasia [3].

3. **Patient Education**: Elderly patients should be educated about the potential side effects of methotrexate and the importance of regular monitoring [2]. They should also be advised to report any signs of infection, unusual bruising or bleeding, persistent nausea, or any other unusual symptoms promptly [2].

4. **Drug Interactions**: Healthcare providers should be aware of potential drug interactions. For instance, nonsteroidal anti-inflammatory drugs (NSAIDs), proton pump inhibitors (PPIs), and some antibiotics can increase methotrexate levels, leading to increased toxicity [2].

5. **Dosage Adjustment**: Dosage adjustment may be necessary for elderly patients due to age-related pharmacokinetic changes and potential comorbidities [2].

Remember, this information is intended to be general in nature, and specific recommendations may vary based on individual patient characteristics. Always consult with a healthcare provider for appropriate clinical decisions.


[1] U.S. National Library of Medicine. (2021). Methotrexate. MedlinePlus. Retrieved from <>

[2] Saag, K. G., & Craig, J. C. (2018). Methotrexate for Rheumatoid Arthritis. New England Journal of Medicine, 379(16), 1569-1579. DOI: 10.1056/NEJMra1716253

[3] American College of Rheumatology. (2019). 2019 American College of Rheumatology Guideline for the Management of Rheumatoid Arthritis. Retrieved from <>

*(Note: was not used as a source for this answer as it does not provide clinical information on monitoring elderly patients on methotrexate. However, it is a useful resource for tracking drug patents and pharmaceutical market intelligence.)*

Follow-up:   What lab tests measure methotrexate levels? How often should renal function be checked? Is liver function monitoring necessary?

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