Drug interactions
Methotrexate + Omeprazole
Severity: Moderate
Methotrexate and Omeprazole: 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 can slow methotrexate clearance and increase its blood levels. This matters mainly with high-dose methotrexate, where toxicity such as myelosuppression and renal injury can occur.
What this interaction means in plain words
Methotrexate and Omeprazole 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.
Methotrexate belongs to Oncology; Omeprazole belongs to Gastrointestinal Tract.
Why it happens
Inhibition of renal tubular secretion of methotrexate and its metabolite, possibly via transporters such as BCRP.
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 Omeprazole
- Mavacamten + Omeprazole Contraindicated
- Omeprazole + Rilpivirine Contraindicated
- Acalabrutinib + Omeprazole Major
- Atazanavir + Omeprazole Major
- Citalopram + Omeprazole Major
- Clopidogrel + Omeprazole Major
Frequently asked questions
Can I take Methotrexate with Omeprazole?
MediHelp rates the interaction as moderate. Methotrexate and Omeprazole 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 can slow methotrexate clearance and increase its blood levels. This matters mainly with high-dose methotrexate, where toxicity such as myelosuppression and renal injury can occur.
How serious is the interaction between Methotrexate and Omeprazole?
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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