Drug interactions
Methotrexate + Tolmetin
Severity: Major
Methotrexate and Tolmetin: 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
Tolmetin, like other NSAIDs, can increase and prolong methotrexate levels, particularly with high-dose methotrexate or reduced kidney function. Severe myelosuppression, mucosal injury and renal toxicity have been reported with this class.
What this interaction means in plain words
Methotrexate and Tolmetin 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; Tolmetin belongs to Musculoskeletal.
Why it happens
NSAIDs reduce renal perfusion through prostaglandin inhibition and compete for tubular secretion, lowering methotrexate clearance.
What to do
Avoid with high-dose methotrexate; with low-dose regimens monitor blood counts and renal function, or use 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 Tolmetin
- Ketorolac intranasal + Tolmetin Contraindicated
- Ketorolac + Tolmetin Contraindicated
- Aceclofenac + Tolmetin Major
- Acemetacin + Tolmetin Major
- Alteplase + Tolmetin Major
- Amlodipine-hydrochlorothiazide-valsartan + Tolmetin Major
Frequently asked questions
Can I take Methotrexate with Tolmetin?
MediHelp rates the interaction as major. Methotrexate and Tolmetin 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. Tolmetin, like other NSAIDs, can increase and prolong methotrexate levels, particularly with high-dose methotrexate or reduced kidney function. Severe myelosuppression, mucosal injury and renal toxicity have been reported with this class.
How serious is the interaction between Methotrexate and Tolmetin?
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 regimens monitor blood counts and renal function, or use 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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