MTX

Question 1

Monitoring

Answer 1

Full blood count, renal function, liver function - local protocols for frequency of monitoring may vary

Question 2

Warning signs

Answer 2

• Gastro-intestinal toxicity e.g. stomatitis
• Liver toxicity e.g. jaundice, nausea, vomiting, abdominal discomfort, dark urine
• Blood disorders – bone marrow suppression e.g. sore throat, bruising, mouth ulcers, fever,
rash
• Pulmonary toxicity - pneumonitis e.g. dyspnoea, cough
• Pregnancy and breast feeding

Question 3

Actions required

Answer 3

• Advise patient to report immediately to a doctor if any warning signs occur
• Ensure the patient is aware that methotrexate tablets are to be taken once a week, on the
same day each week, to take folic acid as prescribed

and the patient is given a

methotrexate treatment booklet
• Counsel the patient on the importance of effective contraception during treatment
• Advise the patient to avoid OTC preparations containing NSAIDs/aspirin
• Recommend to the patient to obtain an annual flu vaccine but live vaccines should be avoided

Question 4

interactions

Answer 4

• Increased plasma concentration and risk of hepatotoxicity with acitretin (avoid)
• Excretion reduced by NSAIDs and penicillins therefore increased risk of toxicity. Also increased
risk of toxicity when given with ciprofoxacin, doxycycline, tetracycline, sufonamides,
clicosporin, proton pump inhibitors, lefunomide
• Increased risk of haematological toxicity when given with sulfamethoxazole (co-trimoxazole)
or trimethoprim