Compatibility «Acetylsalicylic acid» and «Methotrexate»

• Interactions Acetylsalicylic acid with Methotrexate

  • Dangerous interactions
    • ⓘ Increased hematological toxicity of methotrexate (decrease in renal clearance of methotrexate and its displacement from plasma proteins by salicylates) (see 'Contraindications').
    • ⓘ NSAIDs should not be prescribed before or simultaneously with high doses of methotrexate.
    • ⓘ It has been reported that the simultaneous use of certain NSAIDs with high doses of methotrexate increases and prolongs the concentration of methotrexate in serum, which can lead to death from severe hematological (including suppression of bone marrow function and aplastic anemia) and gastrointestinal toxicity.
    • ⓘ Animal studies have shown that NSAIDs reduce the tubular secretion of methotrexate and can increase its toxicity by increasing the concentration of methotrexate in the blood.
    • ⓘ In the treatment of rheumatoid arthritis using methotrexate, the possibility of increased toxicity with the simultaneous use of NSAIDs, including salicylates, has not been fully studied.
    • ⓘ 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.
    • ⓘ 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.
  • Negative interactions
    • ⓘ Increases the toxicity of methotrexate, reducing its renal clearance, the effects of narcotic analgesics (codeine), oral antidiabetic drugs, heparin, indirect anticoagulants, thrombolytics and inhibitors of platelet aggregation, reduces the effect of uricosuric drugs (benzbromarone, sulfinpyrazone), hypotensive agents, diuretics (spironolactone, furosemide).
    • ⓘ Myelotoxic drugs enhance the manifestations of hematotoxicity of acetylsalicylic acid.
    • ⓘ 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.
    • ⓘ Caution should be exercised when using NSAIDs and salicylates simultaneously with lower doses of methotrexate in the form of injections.
  • No interactions
    • ⓘ Despite the possibility of interaction, studies of methotrexate in patients with rheumatoid arthritis, usually with simultaneous administration of NSAIDs in fixed doses, have not revealed any obvious problems.
  • Unclear interactions
    • ⓘ Methotrexate, used in doses of 15 mg per week or more.
    • ⓘ Methotrexate, used in doses of less than 15 mg per week.
    • ⓘ Laboratory studies show that various compounds, including sulfonamides, salicylates, tetracyclines, chloramphenicol and phenytoin, can displace methotrexate from binding to plasma albumin.
    • ⓘ НПВС.
    • ⓘ Hepatotoxic drugs.

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 of the drug.
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: 169,994,378 possible combinations of drugs and their components were found 412,530 interacting combinations.
• Medicine section: Standard evidence-based medicine
• The date of the last update of the interaction database: 2024-12-19

Category - medicine