Methotrexate and anticonvulsants
Methotrexate toxicity with anticonvulsants (antiseizure medicines)
- some antiseizure medicines including levetiracetam, phenytoin and sodium valproate reduce the clearance of methotrexate leading to increased blood levels of methotrexate
- leads to an increased risk of toxicity
- reduced antiseizure efficacy
- are case reports of decreased efficacy of phenytoin and sodium valproate when given with methotrexate
- risks of these interactions are greater at high doses of methotrexate
- liver toxicity
- co-administration of methotrexate and antiseizure medicines together can increase the risk of liver toxicity
Suggested management options (1):
- routine monitoring of methotrexate should detect any signs of methotrexate or liver toxicity
- inform the specialist looking after methotrexate therapy if antiseizure medicines are started
- monitor for any changes in seizure activity
- counsel the person to report signs of methotrexate toxicity, for example sore throat, mouth ulcers, unexplained bruising or bleeding
Reference:
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