Interactions

Drug-Drug

• The following drugs may hematologic toxicity of methotrexate: high-dose salicylates, NSAIDs, oral hypoglycemic agents (sulfonylureas), phenytoin , tetracyclines, probenecid, trimethoprim/sulfamethoxazole, pyrimethamine, and chloramphenicol

• hepatotoxicity with other hepatotoxic drugs including azathioprine, sulfasalazine, and retinoids

• nephrotoxicity with other nephrotoxic drugs

• bone marrow depression with other antineoplastics or radiation therapy

• Radiation therapy risk of soft tissue necrosis and osteonecrosis

• May antibody response to live-virus vaccines and risk of adverse reactions

• risk of neurologic reactions with acyclovir (IT methotrexate only)

• Asparaginase may effects of methotrexate

• Concomitant use with echinacea and melatonin may interfere with immunosuppression

• Caffeine may efficacy of methotrexate, similar effect may occur with guarana

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