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How does kidney impairment change methotrexate safety? Methotrexate is cleared mainly through the kidneys, so reduced renal function slows its elimination and raises blood levels. This increases the risk of toxicity, especially in older adults whose kidneys lose efficiency with age. Dose adjustments are routine when glomerular filtration rate falls below 60 mL/min, and the drug is usually avoided when GFR drops below 30 mL/min. What side effects become more common when kidneys cannot clear the drug properly? Accumulation of methotrexate leads to bone-marrow suppression, mucositis, and liver enzyme elevations. These effects are more severe in patients with low GFR. Bone-marrow suppression produces neutropenia and thrombocytopenia, which can<|eos|>
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