Amiodarone Adverse Effect an increased risk of methotrexate toxicity (leukopenia, thrombocytopenia, anemia, nephrotoxicity, mucosal ulcerations)Clinical Management Patients receiving methotrexate and amiodarone concurrently should be closely monitored for signs of methotrexate toxicity.
Amoxycillin Adverse Effect methotrexate toxicityClinical Management Avoid the concurrent use of methotrexate and amoxicillin if possible.
Ampicillin Adverse Effect an increased risk of methotrexate toxicityClinical Management Avoid the concurrent use of methotrexate and penicillin if possible. If concomitant therapy is unavoidable, consider decreasing the methotrexate dose.
Aspirin Adverse Effect methotrexate toxicity (leukopenia, thrombocytopenia, anemia, nephrotoxicity, mucosal ulcerations)Clinical Management In general, do not administer Aspirin within 10 days of high-dose methotrexate (ie, doses used in cancer therapy). If concomitant administration is necessary, monitor closely for toxicity.
BacampicillinAdverse Effect an increased risk of methotrexate toxicityClinical Management Avoid the concurrent use of methotrexate and penicillin if possible. If concomitant therapy is unavoidable, consider decreasing the methotrexate dose.
Benzathine PenicillinAdverse Effect an increased risk of methotrexate toxicityClinical Management Avoid the concurrent use of methotrexate and penicillin if possible. If concomitant therapy is unavoidable, consider decreasing the methotrexate dose.
Benzyl Penicillin Adverse Effect an increased risk of methotrexate toxicityClinical Management Avoid the concurrent use of methotrexate and penicillin if possible. If concomitant therapy is unavoidable, consider decreasing the methotrexate dose.
CarbenicillinAdverse Effect an increased risk of methotrexate toxicityClinical Management Avoid the concurrent use of methotrexate and penicillin if possible. If concomitant therapy is unavoidable, consider decreasing the methotrexate dose.
Celecoxib Adverse Effect methotrexate toxicity (leukopenia, thrombocytopenia, anemia, nephrotoxicity, mucosal ulcerations)Clinical Management In general, do not administer NSAIDS within 10 days of high-dose methotrexate (ie, doses used in cancer therapy).
CotrimoxazoleAdverse Effect an increased risk of methotrexate toxicity (myelotoxicity, pancytopenia, megaloblastic anemia)Clinical Management If possible, avoid concurrent administration.
Diclofenac Preps.Clinical Management: In general, do not administer Diclofenac Preps within 10 days of high-dose methotrexate (ie, doses used in cancer therapy). If concomitant administration is necessary, monitor closely for toxicity
Doxycycline Adverse Effect an increased risk of methotrexate toxicity (leukopenia, thrombocytopenia, anemia, nephrotoxicity, mucosal ulcerations
Erythromycin Adverse Effect an increased risk of methotrexate toxicity (myelotoxicity, pancytopenia, megaloblastic anemia)Clinical Management If possible, avoid concurrent administration.
Flurbiprofen Adverse Effect methotrexate toxicity (leukopenia, thrombocytopenia, anemia, nephrotoxicity, mucosal ulcerations)Clinical Management In general, do not administer NSAIDS within 10 days of high-dose methotrexate (ie, doses used in cancer therapy).
Ibuprofen Adverse Effect methotrexate toxicity (leukopenia, thrombocytopenia, anemia, nephrotoxicity, mucosal ulcerations)Clinical Management In general, do not administer NSAIDS within 10 days of high-dose methotrexate (ie, doses used in cancer therapy).
Indomethacin Adverse Effect methotrexate toxicity (leukopenia, thrombocytopenia, anemia, nephrotoxicity, mucosal ulcerations)Clinical Management In general, do not administer NSAIDS within 10 days of high-dose methotrexate (ie, doses used in cancer therapy).
Ketoprofen Adverse Effect methotrexate toxicity (leukopenia, thrombocytopenia, anemia, nephrotoxicity, mucosal ulcerations)Clinical Management In general, do not administer NSAIDS within 10 days of high-dose methotrexate (ie, doses used in cancer therapy).
Ketorolac Adverse Effect methotrexate toxicity (leukopenia, thrombocytopenia, anemia, nephrotoxicity, mucosal ulcerations)Clinical Management In general, do not administer NSAIDS within 10 days of high-dose methotrexate (ie, doses used in cancer therapy).
L - asparaginase Adverse Effect decreased methotrexate antineoplastic activityClinical Management Administer asparaginase nine to ten days before methotrexate therapy or shortly after methotrexate therapy.
LeucoverinAdverse Effect decreased efficacy of concurrently administered methotrexateClinical Management Methotrexate and leucovorin should not be administered concurrently. If leucovorin is being utilized as a folic acid rescue, therapy must be started after the administration of methotrexate.
Mefenamic Acid Adverse Effect methotrexate toxicity (leukopenia, thrombocytopenia, anemia, nephrotoxicity, mucosal ulcerations)Clinical Management In general, do not administer NSAIDS within 10 days of high-dose methotrexate (ie, doses used in cancer therapy).
MeloxicamAdverse Effect methotrexate toxicity (leukopenia, thrombocytopenia, anemia, nephrotoxicity, mucosal ulcerations)Clinical Management In general, do not administer NSAIDS within 10 days of high-dose methotrexate (ie, doses used in cancer therapy).
Mercaptopurine Adverse Effect mercaptopurine toxicity (nausea, vomiting, delayed leukopenia)Clinical Management Monitor patients for increased mercaptopurine toxicity (nausea, vomiting, delayed leukopenia).
NabumetoneAdverse Effect methotrexate toxicity (leukopenia, thrombocytopenia, anemia, nephrotoxicity, mucosal ulcerations)Clinical Management In general, do not administer NSAIDS within 10 days of high-dose methotrexate (ie, doses used in cancer therapy).
Naproxen Adverse Effect methotrexate toxicity (leukopenia, thrombocytopenia, anemia, nephrotoxicity, mucosal ulcerations)Clinical Management In general, do not administer NSAIDS within 10 days of high-dose methotrexate (ie, doses used in cancer therapy).
Neomycin
Adverse Effect Decreased methotrexate effectivenesClinical Management If clinically possible, avoid giving oral neomycin and oral methotrexate together. Expect a decreased response if given concomitantly. A supplemental dose of oral methotrexate may be necessary if these drugs are given together.
Nimesulide Adverse Effect methotrexate toxicity (leukopenia, thrombocytopenia, anemia, nephrotoxicity, mucosal ulcerations)Clinical Management In general, do not administer NSAIDS within 10 days of high-dose methotrexate (ie, doses used in cancer therapy).
OmeprazoleAdverse Effect an increased risk of methotrexate toxicityClinical Management Closely monitor patients receiving omeprazole and methotrexate concurrently. Omeprazole may have to be temporarily discontinued.
OxyphenbutazoneAdverse Effect methotrexate toxicity (leukopenia, thrombocytopenia, anemia, nephrotoxicity, mucosal ulcerations)Clinical Management In general, do not administer NSAIDS within 10 days of high-dose methotrexate (ie, doses used in cancer therapy).
Penicillin V ( Phenoxymethyl ) Adverse Effect an increased risk of methotrexate toxicityClinical Management Avoid the concurrent use of methotrexate and penicillin if possible. If concomitant therapy is unavoidable, consider decreasing the methotrexate dose.
PhenacetinAdverse Effect methotrexate toxicity (leukopenia, thrombocytopenia, anemia, nephrotoxicity, mucosal ulcerations)Clinical Management In general, do not administer NSAIDS within 10 days of high-dose methotrexate (ie, doses used in cancer therapy).
PhenylbutazoneAdverse Effect methotrexate toxicity (leukopenia, thrombocytopenia, anemia, nephrotoxicity, mucosal ulcerations)Clinical Management In general, do not administer NSAIDS within 10 days of high-dose methotrexate (ie, doses used in cancer therapy).
Phenytoin Adverse Effect Decreased phenytoin effectivenessClinical Management In patients maintained on phenytoin, phenytoin level should be obtained after or during combination chemotherapy to assure adequate anticonvulsant coverage.
Piperacillin Adverse Effect an increased risk of methotrexate toxicityClinical Management Avoid the concurrent use of methotrexate and penicillin if possible. If concomitant therapy is unavoidable, consider decreasing the methotrexate dose.
Piroxicam Adverse Effect methotrexate toxicity (leukopenia, thrombocytopenia, anemia, nephrotoxicity, mucosal ulcerations)Clinical Management In general, do not administer NSAIDS within 10 days of high-dose methotrexate (ie, doses used in cancer therapy).
Procaine Penicillin Adverse Effect an increased risk of methotrexate toxicityClinical Management Avoid the concurrent use of methotrexate and penicillin if possible. If concomitant therapy is unavoidable, consider decreasing the methotrexate dose.
Rofecoxib Adverse Effect Elevation of plasma Methotrexate levels and a reduction in renal Methotrexate clearanceClinical Management: Monitor Methotrexate- related toxicity when both the drugs are administered together.
TamoxifenAdverse Effect an increased risk of thromboembolismClinical Management In patients undergoing therapy with tamoxifen for breast cancer, the risks of adding methotrexate should be weighed against the potential benefits.
TenoxicamAdverse Effect methotrexate toxicity (leukopenia, thrombocytopenia, anemia, nephrotoxicity, mucosal ulcerations)Clinical Management In general, do not administer NSAIDS within 10 days of high-dose methotrexate (ie, doses used in cancer therapy).
Theophylline Adverse Effect Theophylline toxicityClinical Management Theophylline serum concentrations should be closely monitored when methotrexate is added, discontinued, or when dosing changes occur. Dosing adjustments of theophylline may be necessary.
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