Drug interactions
Methotrexate + Tofacitinib
Severity: Moderate
Methotrexate and Tofacitinib: 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
Tofacitinib is routinely used with methotrexate in rheumatoid arthritis and does not meaningfully change methotrexate exposure. The combination does, however, increase overall immunosuppression and the risk of serious infection and cytopenias.
What this interaction means in plain words
Methotrexate and Tofacitinib 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; Tofacitinib belongs to Musculoskeletal.
Why it happens
Additive immunosuppression from JAK inhibition and antimetabolite activity; no important pharmacokinetic interaction.
What to do
Monitor for infections and check blood counts and liver enzymes periodically. Hold therapy during serious infection.
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 Tofacitinib
- Baricitinib + Tofacitinib Contraindicated
- Cladribine + Tofacitinib Contraindicated
- Tofacitinib + Upadacitinib Contraindicated
- Abatacept + Tofacitinib Major
- Anti-thymocyte + Tofacitinib Major
- Antithymocyte globulin equine + Tofacitinib Major
Frequently asked questions
Can I take Methotrexate with Tofacitinib?
MediHelp rates the interaction as moderate. Methotrexate and Tofacitinib 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. Tofacitinib is routinely used with methotrexate in rheumatoid arthritis and does not meaningfully change methotrexate exposure. The combination does, however, increase overall immunosuppression and the risk of serious infection and cytopenias.
How serious is the interaction between Methotrexate and Tofacitinib?
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 for infections and check blood counts and liver enzymes periodically. Hold therapy during serious infection.
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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