Drug interactions
Cholestyramine + Methotrexate
Severity: Moderate
Cholestyramine and Methotrexate: moderate interaction.
Last updated
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
Cholestyramine binds methotrexate in the gut and interrupts its enterohepatic recirculation, lowering systemic exposure. This reduces oral methotrexate absorption and can reduce efficacy, though the same effect is used deliberately to speed methotrexate elimination in overdose.
What this interaction means in plain words
Cholestyramine and Methotrexate can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Cholestyramine belongs to Cardiovascular; Methotrexate belongs to Oncology.
Why it happens
Bile acid sequestrant binds methotrexate in the intestine, reducing absorption and enterohepatic reabsorption.
What to do
Give oral methotrexate at least 1 hour before or 4 to 6 hours after cholestyramine. Monitor clinical response.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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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
Other interactions of Cholestyramine
Frequently asked questions
Can I take Cholestyramine with Methotrexate?
MediHelp rates the interaction as moderate. Cholestyramine and Methotrexate can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Cholestyramine binds methotrexate in the gut and interrupts its enterohepatic recirculation, lowering systemic exposure. This reduces oral methotrexate absorption and can reduce efficacy, though the same effect is used deliberately to speed methotrexate elimination in overdose.
How serious is the interaction between Cholestyramine and Methotrexate?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Give oral methotrexate at least 1 hour before or 4 to 6 hours after cholestyramine. Monitor clinical response.
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.
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