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Generic name: MTX, Emthexate, Methoblastin, Rheumatrex, amethopterin
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Interstitial pneumonitis has been reported in a limited number of patients receiving infliximab concomitantly with a stable dosage of methotrexate. Taking methotrexate and alcohol together may increase the risk of liver injury. Methotrexate, especially at higher doses or with prolonged treatment, has been associated with hepatotoxicity including acute hepatitis, chronic fibrosis, necrosis, cirrhosis, and liver enzyme elevations. Methotrexate elimination is reduced in patients with impaired renal function, ascites, or pleural effusions. Patients treated with concomitant methotrexate had a lower rate of antibody development than patients on Humira monotherapy (1% versus 12%). Leucovorin given at the appropriate time rescues bone marrow and gastrointestinal cells from methotrexate but has no apparent effect on pre-existing methotrexate nephrotoxicity. Leucovorin may limit methotrexate action on normal cells by competing with methotrexate for the same transport processes into the cell. In patients receiving concomitant methotrexate, the incidence was 6% compared to 26% with Humira monotherapy. However, elderly patients are more likely to have age-related renal function impairment, which may require adjustment of dosage in patients receiving leucovorin as a rescue from the effects of high-dose methotrexate. MANAGEMENT:  The use of methotrexate in combination with other potentially hepatotoxic agents (e. Such patients require especially careful monitoring for toxicity, and require dose reduction or, in some cases, discontinuation of methotrexate administration.

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