Compatibility «Methotrexate-Ebewe» and «Bactrim»

• Interactions Methotrexate-Ebewe with Bactrim

  • Dangerous interactions
    • ⓘ Methotrexate partially binds to serum albumin and can be displaced from this connection when used simultaneously with drugs that strongly bind to plasma proteins, such as sulfonylureas, aminobenzoic acid, salicylates, phenylbutazone, phenytoin, sulfonamides, some antibiotics (penicillins, tetracycline, pristinamycin, chloramphenicol), probenecid, which can lead to an increase in toxicity of methotrexate.
    • ⓘ It has been reported that co-trimoxazole in rare cases increases the inhibition of bone marrow function in patients receiving methotrexate, probably due to a decrease in tubular secretion and/or an additive antifolate effect.
    • ⓘ The possibility of increased hepatotoxicity when prescribing methotrexate with other hepatotoxic drugs has not been evaluated.
    • ⓘ Therefore, patients receiving methotrexate and other potentially hepatotoxic drugs together (for example, leflunomide, azathioprine, sulfasalazine, retinoids) should be closely monitored due to a possible increased risk of hepatotoxicity.
    • ⓘ The frequency and severity of myelotoxic and nephrotoxic adverse events may increase with the simultaneous use of trimethoprim-sulfamethoxazole and other drugs with myelosuppressive effects or capable of causing impaired renal function (nucleoside analogues, tacrolimus, azathioprine or mercaptopurine).
    • ⓘ Trimethoprim has a low affinity for human dehydrofolate reductase, however, it can increase the toxicity of methotrexate, especially in the presence of risk factors such as senility, hypoalbuminemia, impaired renal function, bone marrow depression, as well as in patients receiving high doses of methotrexate.
    • ⓘ Sulfonamides (D06BA) and co-trimoxazole (J01EE01) + Indirect anticoagulants, oral antidiabetic agents, methotrexate => Increased effects and toxic effects of these drugs.
    • ⓘ Sulfonamides (D06BA) + Anthuran, butadione, indomethacin. methotrexate, salicylates, phenyline => Increased side effects of sulfonamides (leukopenia, neuritis, kidney damage).
  • Negative interactions
    • ⓘ The increased and prolonged effect of methotrexate, leading to intoxication, is facilitated by the simultaneous use of NSAIDs, barbiturates, sulfonamides, corticosteroids, tetracyclines, trimethoprim, chloramphenicol, paraaminobenzoic and paraaminohippuric acids, probenecid.
    • ⓘ Penicillins and sulfonamides can reduce the renal clearance of methotrexate, hematological and gastrointestinal toxicity has been observed in combination with methotrexate.
    • ⓘ To prevent myelosuppression, such patients should be prescribed folic acid or calcium folinate.
  • No interactions
    • ⓘ However, when determining methotrexate by the radioimmune method, there is no effect.
  • Unclear interactions
    • ⓘ Laboratory studies show that various compounds, including sulfonamides, salicylates, tetracyclines, chloramphenicol and phenytoin, can displace methotrexate from binding to plasma albumin.
    • ⓘ Penicillins and sulfonamides.
    • ⓘ Hepatotoxic drugs.
    • ⓘ Sulfonamides, including sulfamethoxazole, can compete for protein binding and renal transport of methotrexate, thus increasing concentrations of free methotrexate and its systemic effect.
    • ⓘ Cases of pancytopenia have been described in patients taking trimethoprim and methotrexate.
    • ⓘ Trimethoprim-sulfamethoxazole and, in particular, trimethoprim, which is part of it, may affect the results of determining the concentration of methotrexate in serum, carried out by the method of competitive binding to proteins using bacterial dihydrofolate reductase as a ligand.

Decoding the colors of interactions and contraindications

Dangerous	—	a pronounced negative interaction or contraindication.
Negative	—	negative interaction or side effect that may reduce effectiveness.
Positive	—	the interaction can SOMETIMES be used as a positive (often a dose adjustment is needed), or it is an indication.
No	—	the drugs do NOT interact, which is separately indicated in the instructions.
Unclear	—	the system failed to pre-assess the danger.

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Additional information

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• The use of information about interactions is only possible as an introduction. This information should not be used to adjust therapy without consulting a specialist.
• The article is written: artificial intelligence Kiberis
• Sources: official instructions for medicines and their active substances, as well as inter-group interactions described in medical studies and textbooks.
• Total analyzed: 170,027,037 possible combinations of drugs and their components were found 412,563 interacting combinations.
• Medicine section: Standard evidence-based medicine
• The date of the last update of the interaction database: 2026-01-01

Category - medicine