Drug interactions
Methotrexate + Tocilizumab
Severity: Moderate
Methotrexate and Tocilizumab: 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
Tocilizumab is commonly combined with methotrexate in rheumatoid arthritis, but together they add to immunosuppression and the risk of serious infection. Both can also raise liver enzymes, so hepatotoxicity may be additive.
What this interaction means in plain words
Methotrexate and Tocilizumab 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; Tocilizumab belongs to Musculoskeletal.
Why it happens
Additive immunosuppression through IL-6 receptor blockade and antimetabolite effects, with additive hepatic effects.
What to do
Combination is an established regimen; monitor for infection, and check liver enzymes and neutrophil and platelet counts periodically. Interrupt therapy if serious infection or marked enzyme elevation develops.
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 Tocilizumab
- Bcg vaccine live + Tocilizumab Contraindicated
- Measles mumps and rubella vaccine live + Tocilizumab Contraindicated
- Measles mumps rubella and varicella vaccine live + Tocilizumab Contraindicated
- Measles vaccine + Tocilizumab Contraindicated
- Rubella vaccine + Tocilizumab Contraindicated
- Smallpox vaccine live + Tocilizumab Contraindicated
Frequently asked questions
Can I take Methotrexate with Tocilizumab?
MediHelp rates the interaction as moderate. Methotrexate and Tocilizumab 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. Tocilizumab is commonly combined with methotrexate in rheumatoid arthritis, but together they add to immunosuppression and the risk of serious infection. Both can also raise liver enzymes, so hepatotoxicity may be additive.
How serious is the interaction between Methotrexate and Tocilizumab?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Combination is an established regimen; monitor for infection, and check liver enzymes and neutrophil and platelet counts periodically. Interrupt therapy if serious infection or marked enzyme elevation develops.
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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