Methotrexate and proton pump inhibitors (PPIs)
Methotrexate toxicity
- proton pump inhibitors (for example, lansoprazole, omeprazole or pantoprazole) reduce the clearance of methotrexate via the kidneys and therefore increase the risk of methotrexate toxicity
- evidence to support a clinically significant interaction is limited (1)
- risks of this interaction are greater at high doses of methotrexate and in those with renal impairment (1)
Suggested management options (1):
- no additional action is required
- routine monitoring of methotrexate should detect any signs of methotrexate toxicity
- counsel the person to report signs of methotrexate toxicity, for example sore throat, mouth ulcers, unexplained bruising or bleeding
- consider use of H2-receptor antagonists as an alternative if required
Reference:
Related pages
Create an account to add page annotations
Annotations allow you to add information to this page that would be handy to have on hand during a consultation. E.g. a website or number. This information will always show when you visit this page.