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Methotrexate and nonsteroidal antiinflammatory drug interactions
1Department of Pharmacy, University Medical Center, Jacksonville, FL.
The Annals of Pharmacotherapy
|February 1, 1992
Summary
Coadministration of methotrexate (MTX) and nonsteroidal anti-inflammatory drugs (NSAIDs) can lead to serious adverse events like renal failure and pancytopenia. While not all patients experience this drug interaction, the exact circumstances remain unclear.
Area of Science:
- Pharmacology
- Toxicology
- Drug Interactions
Background:
- Investigating the potential for clinically significant drug interactions between methotrexate (MTX) and nonsteroidal anti-inflammatory drugs (NSAIDs).
- Evaluating a case of hematologic toxicity from concurrent MTX and flurbiprofen administration.
Observation:
- Review of published case reports detailing adverse events such as acute renal failure and pancytopenia during combined MTX and NSAID use.
- Analysis of pharmacokinetic studies examining MTX and NSAID interactions.
Findings:
- Potential mechanisms include reduced MTX clearance, protein displacement, competition for renal excretion, or impaired hepatic metabolism.
- Pharmacokinetic studies generally show no statistically significant differences, though one noted altered metabolite levels with aspirin.
- Numerous case reports indicate potential problems, but specific triggers for this drug interaction are not well-defined.
Implications:
- Clinically significant interactions between MTX and NSAIDs are possible, though not universal.
- Further research is needed to define the precise conditions under which these adverse events occur.
- Caution is advised when coadministering MTX and NSAIDs due to potential severe toxicities.