Drug interactions
Methotrexate + Sulindac
Severity: Major
Methotrexate and Sulindac: 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
NSAIDs such as sulindac can raise and prolong methotrexate exposure, especially with high-dose methotrexate or impaired renal function. This has led to serious bone marrow suppression, gastrointestinal toxicity and acute kidney injury.
What this interaction means in plain words
Methotrexate and Sulindac 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.
Methotrexate belongs to Oncology; Sulindac belongs to Musculoskeletal.
Why it happens
NSAIDs reduce renal blood flow via prostaglandin inhibition and compete for tubular secretion, decreasing methotrexate clearance.
What to do
Avoid NSAIDs with high-dose methotrexate; with low-dose weekly methotrexate, monitor blood counts, renal function and signs of toxicity, or choose an alternative analgesic.
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
Other interactions of Sulindac
- Ketorolac intranasal + Sulindac Contraindicated
- Ketorolac + Sulindac Contraindicated
- Aceclofenac + Sulindac Major
- Acetylsalicylic acid + Sulindac Major
- Alteplase + Sulindac Major
- Amiloride + Sulindac Major
Frequently asked questions
Can I take Methotrexate with Sulindac?
MediHelp rates the interaction as major. Methotrexate and Sulindac 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. NSAIDs such as sulindac can raise and prolong methotrexate exposure, especially with high-dose methotrexate or impaired renal function. This has led to serious bone marrow suppression, gastrointestinal toxicity and acute kidney injury.
How serious is the interaction between Methotrexate and Sulindac?
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 NSAIDs with high-dose methotrexate; with low-dose weekly methotrexate, monitor blood counts, renal function and signs of toxicity, or choose an alternative analgesic.
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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