Drug interactions
Aspirin / citric acid / sodium bicarbonate + Methotrexate
Severity: Major
Aspirin / citric acid / sodium bicarbonate and Methotrexate: major interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
The aspirin in this effervescent combination can raise methotrexate exposure and increase the risk of myelosuppression, mucositis and renal toxicity. The risk is highest with high-dose methotrexate and in renal impairment.
What this interaction means in plain words
Aspirin / citric acid / sodium bicarbonate and Methotrexate can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Why it happens
Salicylates reduce renal tubular secretion of methotrexate and displace it from plasma proteins.
What to do
Avoid with high-dose methotrexate. With low-dose methotrexate, monitor blood counts and renal function and consider an alternative analgesic such as paracetamol.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
Pro+ members
Unlock the full page
Create an account and start a Pro+ trial to unlock the full management advice for Aspirin / citric acid / sodium bicarbonate and Methotrexate, the additional notes, the evidence detail and the whole-prescription interaction checker.
- Full clinical management advice
- Additional notes
- Evidence detail
- Interaction checker for a whole prescription
Try Pro+ free for 7 days on the web. No card needed.
References
Other interactions of Methotrexate
- Acitretin + Methotrexate Contraindicated
- Adenovirus types 4 and 7 live + Methotrexate Contraindicated
- Influenza virus vaccine quadrivalent intranasal + Methotrexate Contraindicated
- Ketorolac + Methotrexate Contraindicated
- Measles mumps and rubella vaccine live + Methotrexate Contraindicated
- Measles mumps and rubella vaccine + Methotrexate Contraindicated
Frequently asked questions
Can I take Aspirin / citric acid / sodium bicarbonate with Methotrexate?
MediHelp rates the interaction as major. Aspirin / citric acid / sodium bicarbonate and Methotrexate can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. The aspirin in this effervescent combination can raise methotrexate exposure and increase the risk of myelosuppression, mucositis and renal toxicity. The risk is highest with high-dose methotrexate and in renal impairment.
How serious is the interaction between Aspirin / citric acid / sodium bicarbonate and Methotrexate?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid with high-dose methotrexate. With low-dose methotrexate, monitor blood counts and renal function and consider an alternative analgesic such as paracetamol.
What other medicines interact with Methotrexate?
MediHelp also lists interactions of Methotrexate with, for example, Acitretin, Adenovirus types 4 and 7 live, Influenza virus vaccine quadrivalent intranasal. The full list is on the Methotrexate page.
Full monographs, dosing and an interaction checker in the MediHelp app
Open the complete reference, check multi-drug interactions and use dosing tools in the MediHelp app.
