Drug interactions
Methotrexate + Sulphasalazine
Severity: Moderate
Methotrexate and Sulphasalazine: 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
Both drugs can cause hepatotoxicity and bone marrow suppression, and sulfasalazine may modestly affect methotrexate handling and folate status. The combination is used deliberately in rheumatoid arthritis at low doses, but toxicity is more likely with higher methotrexate doses.
What this interaction means in plain words
Methotrexate and Sulphasalazine 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; Sulphasalazine belongs to Gastrointestinal Tract.
Why it happens
Additive hematologic and hepatic toxicity, with possible folate antagonism and altered methotrexate elimination.
What to do
Monitor complete blood count and liver and renal function regularly. Use particular care with high-dose methotrexate and consider folic acid supplementation.
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 Sulphasalazine
- Deferiprone + Sulphasalazine Major
- Pexidartinib + Sulphasalazine Major
- Sepiapterin + Sulphasalazine Major
- Acalabrutinib + Sulphasalazine Moderate
- Aceclofenac + Sulphasalazine Moderate
- Asciminib + Sulphasalazine Moderate
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 Sulphasalazine?
MediHelp rates the interaction as moderate. Methotrexate and Sulphasalazine 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. Both drugs can cause hepatotoxicity and bone marrow suppression, and sulfasalazine may modestly affect methotrexate handling and folate status. The combination is used deliberately in rheumatoid arthritis at low doses, but toxicity is more likely with higher methotrexate doses.
How serious is the interaction between Methotrexate and Sulphasalazine?
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 complete blood count and liver and renal function regularly. Use particular care with high-dose methotrexate and consider folic acid supplementation.
What other medicines interact with Sulphasalazine?
MediHelp also lists interactions of Sulphasalazine with, for example, Deferiprone, Pexidartinib, Sepiapterin. The full list is on the Sulphasalazine page.
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