What anti-inflammatory can you take with methotrexate?
Methotrexate can interact with some anti-inflammatories (especially nonsteroidal anti-inflammatory drugs, or NSAIDs), mainly through effects on kidney function and methotrexate levels. Because of that, the safest choice depends on your dose of methotrexate, kidney function, and other medicines you take.
Are NSAIDs like ibuprofen or naproxen safe with methotrexate?
Some NSAIDs may be used with methotrexate in certain situations, but they can raise the risk of methotrexate toxicity in people who are higher risk (for example, older adults, people with kidney disease, dehydration, or high-dose methotrexate). The key issue is that NSAIDs can reduce methotrexate clearance in the body.
Because of the potential for harm, you should check with your prescriber or pharmacist before starting NSAIDs, even if they are over-the-counter.
What about “strong” anti-inflammatories or prescription pain medicines?
Other anti-inflammatory pain medicines can also interact with methotrexate. In general, don’t start new prescription anti-inflammatories (or steroid medicines like prednisone) without your rheumatology prescriber’s guidance, since the overall treatment plan may change.
What’s usually considered safer for pain or inflammation while on methotrexate?
For many people on methotrexate, acetaminophen (paracetamol/Tylenol) is often the first option for pain or fever because it does not work the same way NSAIDs do and is less likely to affect methotrexate levels. Still, keep within recommended dosing limits and avoid stacking multiple products that contain acetaminophen.
When you should get medical advice urgently
Stop and seek prompt medical help if you take methotrexate and develop signs that could fit methotrexate toxicity, such as mouth sores, unusual bruising/bleeding, severe nausea/vomiting, diarrhea, fever/infection symptoms, or marked tiredness.
Quick questions that determine the safest option for you
Tell your clinician/pharmacist:
- Your methotrexate dose (and whether it is weekly)
- Your kidney function status (or whether you have kidney disease)
- Your age
- Any other medicines (especially diuretics/water pills, antibiotics like trimethoprim-sulfamethoxazole, or other drugs that affect kidneys)
- Whether you’re treating rheumatoid arthritis, psoriasis, or something else
If you share your methotrexate dose and what anti-inflammatory you were considering (ibuprofen? naproxen? diclofenac? celecoxib?), I can help you think through the usual safety considerations to discuss with your pharmacist or prescriber.