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Nonsteroidal anti-inflammatory drugs (standard or coxibs) - prescribing issues - Management
What should I do for a person who requires methotrexate and an NSAID?
- Concurrent use of methotrexate and a nonsteroidal anti-inflammatory drug (NSAID) may reduce the excretion of methotrexate and increase the risk of methotrexate toxicity.
- Where possible, avoid using an NSAID (especially azapropazone, and over-the-counter aspirin and ibuprofen).
- If an NSAID is needed, perform a full blood count and kidney and liver function tests every 2 months.
- So that methotrexate toxicity can be detected early, tell people to report immediately the onset of:
- Signs and symptoms suggestive of infection (e.g. sore throat, mouth ulcers).
- Liver toxicity (e.g. nausea, vomiting, abdominal discomfort, and dark urine).
- Respiratory effects (e.g. cough, shortness of breath).
Basis for recommendation
- These recommendations are based on information in an authoritative reference manual on drug interactions and the British National Formulary [Baxter, 2006; BNF 55, 2008]:
- The risk of methotrexate toxicity increases with the dose of methotrexate [Baxter, 2006].
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