Pharmacology. Drug Interaction
Methotrexate-Aspirin-Prednisone drug interactions:
GENERALLY AVOID: Salicylates may interfere with the renal elimination of methotrexate and may displace it from binding sites. The pharmacologic effect and toxicity of methotrexate may be increased. Patients receiving high-dose methotrexate are at a greater risk of developing toxicity.
MANAGEMENT: If these agents must be used concomitantly, caution should be exercised and the patient should be monitored closely for signs and symptoms of bone marrow suppression and nephrotoxicity. Patients should be advised to report possible symptoms of toxicity including nausea, vomiting, diarrhea, stomatitis, sore throat, chills, fever, rash, unusual bruising or bleeding, jaundice, dark urine, swelling of the extremities, or shortness of breath to their physician. Patients should also be counseled to avoid any other over-the-counter salicylate products.
References
- Dixon RL, Henderson ES, Rall DP “Plasma protein binding of methotrexate and its displacement by various drugs.” Fed Proc 24 (1965): 454
- Taylor JR, Halprin KM “Effect of sodium salicylate and indomethacin on methotrexate-serum albumin binding.” Arch Dermatol 113 (1977): 588-91
- Singh RR, Malaviya AN, Pandey JN, Guleria JS “Fatal interaction between methotrexate and naproxen.” Lancet 1 (1986): 1390
