Drug interactions
Esomeprazole + Methotrexate
Severity: Moderate
Esomeprazole 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
Proton pump inhibitors may delay methotrexate elimination, leading to higher and more prolonged levels. This is mainly relevant with high-dose methotrexate, where it can increase toxicity such as myelosuppression and renal injury.
What this interaction means in plain words
Esomeprazole 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.
Esomeprazole belongs to Gastrointestinal Tract; Methotrexate belongs to Oncology.
Why it happens
PPIs may inhibit renal tubular secretion of methotrexate and its metabolite, possibly via transporter inhibition.
What to do
With high-dose methotrexate, consider temporarily withholding the PPI or switching to an H2 blocker. Monitor methotrexate levels and renal function.
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 Esomeprazole
- Esomeprazole + Mavacamten Contraindicated
- Esomeprazole + Rilpivirine Contraindicated
- Acalabrutinib + Esomeprazole Major
- Atazanavir + Esomeprazole Major
- Citalopram + Esomeprazole Major
- Clopidogrel + Esomeprazole Major
Frequently asked questions
Can I take Esomeprazole with Methotrexate?
MediHelp rates the interaction as moderate. Esomeprazole 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. Proton pump inhibitors may delay methotrexate elimination, leading to higher and more prolonged levels. This is mainly relevant with high-dose methotrexate, where it can increase toxicity such as myelosuppression and renal injury.
How serious is the interaction between Esomeprazole 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: With high-dose methotrexate, consider temporarily withholding the PPI or switching to an H2 blocker. Monitor methotrexate levels and renal function.
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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