Drug interactions
Enalapril-hydrochlorothiazide + Methotrexate
Severity: Moderate
Enalapril-hydrochlorothiazide 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
Thiazide diuretics may reduce renal elimination of methotrexate and have been reported to prolong and intensify myelosuppression. ACE inhibitors and diuretics can also reduce renal perfusion, which further impairs methotrexate clearance. This matters most with high-dose methotrexate or reduced renal function.
What this interaction means in plain words
Enalapril-hydrochlorothiazide 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.
Enalapril-hydrochlorothiazide belongs to Cardiovascular; Methotrexate belongs to Oncology.
Why it happens
Reduced renal clearance of methotrexate via decreased tubular secretion and diuretic or ACE inhibitor effects on renal hemodynamics.
What to do
Monitor blood counts and renal function closely, and consider methotrexate dose reduction or an alternative antihypertensive, especially with high-dose methotrexate.
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 Enalapril-hydrochlorothiazide
- Aliskiren + Enalapril-hydrochlorothiazide Contraindicated
- Dofetilide + Enalapril-hydrochlorothiazide Contraindicated
- Enalapril-hydrochlorothiazide + Protein a column Contraindicated
- Enalapril-hydrochlorothiazide + Sacubitril / valsartan Contraindicated
- Amifostine + Enalapril-hydrochlorothiazide Major
- Amiloride + Enalapril-hydrochlorothiazide Major
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 Enalapril-hydrochlorothiazide with Methotrexate?
MediHelp rates the interaction as moderate. Enalapril-hydrochlorothiazide 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. Thiazide diuretics may reduce renal elimination of methotrexate and have been reported to prolong and intensify myelosuppression. ACE inhibitors and diuretics can also reduce renal perfusion, which further impairs methotrexate clearance. This matters most with high-dose methotrexate or reduced renal function.
How serious is the interaction between Enalapril-hydrochlorothiazide 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: Monitor blood counts and renal function closely, and consider methotrexate dose reduction or an alternative antihypertensive, especially with high-dose methotrexate.
What other medicines interact with Enalapril-hydrochlorothiazide?
MediHelp also lists interactions of Enalapril-hydrochlorothiazide with, for example, Aliskiren, Dofetilide, Protein a column. The full list is on the Enalapril-hydrochlorothiazide page.
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