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Lack of significant interaction between low dose methotrexate and ibuprofen or flurbiprofen in patients with

K J Skeith1, A S Russell, F Jamali

  • 1Rheumatic Disease Unit, University of Alberta, Edmonton, Canada.

The Journal of Rheumatology
|August 1, 1990
PubMed

Insights

Low dose methotrexate (MTX) combined with NSAIDs like ibuprofen or flurbiprofen showed no significant pharmacokinetic interactions in rheumatoid arthritis patients. This study suggests concurrent use may be safe, contrary to some product recommendations.

Area of Science:

  • Pharmacology
  • Rheumatology
  • Drug Interactions

Background:

  • Low dose methotrexate (MTX) is a common treatment for rheumatoid arthritis.
  • Current recommendations often advise against combining MTX with nonsteroidal anti-inflammatory drugs (NSAIDs) due to potential adverse interactions.
  • Previous reports suggest pharmacokinetic interactions between MTX and NSAIDs.

Purpose of the Study:

  • To investigate the pharmacokinetic interaction between low dose methotrexate (MTX) and commonly used NSAIDs (ibuprofen and flurbiprofen).
  • To evaluate the effect of concurrent NSAID use on MTX serum levels and pharmacokinetic parameters.

Main Methods:

  • A study involving six rheumatoid arthritis patients receiving oral or parenteral MTX (10-25 mg/dose).
  • Patients were administered MTX with and without ibuprofen (2400 mg/day) or flurbiprofen (300 mg/day) for six weekly doses.
  • Serum MTX levels were analyzed using radioimmunoassay (RIA) at frequent intervals to determine pharmacokinetic indices.

Main Results:

  • No significant observable interactions were found between MTX and either ibuprofen or flurbiprofen.
  • Key pharmacokinetic parameters, including area under the curve per unit dose, Cmax, Cmax/dose, Tmax, and serum half-life, were not significantly influenced.
  • The route of MTX administration (oral vs. parenteral) did not significantly affect these pharmacokinetic indices when combined with NSAIDs.

Conclusions:

  • Concurrent administration of low dose methotrexate with ibuprofen or flurbiprofen does not appear to cause significant pharmacokinetic interactions in rheumatoid arthritis patients.
  • These findings may challenge existing product recommendations advising against this drug combination.
  • Further research could support revised guidelines regarding MTX and NSAID co-administration.

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