Drug interactions
Methotrexate + Salicylates
Severity: Major
Methotrexate and Salicylates: 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
Salicylates can raise methotrexate levels and displace it from plasma proteins, increasing the risk of myelosuppression, mucositis and renal toxicity. The risk is greatest with high-dose methotrexate and impaired renal function.
What this interaction means in plain words
Methotrexate and Salicylates 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 protein binding.
What to do
Avoid with high-dose methotrexate. With low-dose methotrexate, monitor blood counts and renal function and use an alternative analgesic if possible.
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?
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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 Methotrexate with Salicylates?
MediHelp rates the interaction as major. Methotrexate and Salicylates 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. Salicylates can raise methotrexate levels and displace it from plasma proteins, increasing the risk of myelosuppression, mucositis and renal toxicity. The risk is greatest with high-dose methotrexate and impaired renal function.
How serious is the interaction between Methotrexate and Salicylates?
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 use an alternative analgesic if possible.
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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