Brand name: methotrexate
Generic name: MTX, Emthexate, amethopterin, Methoblastin, Rheumatrex

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Methotrexate, especially at higher doses or with prolonged treatment, has been associated with hepatotoxicity including acute hepatitis, chronic fibrosis, necrosis, cirrhosis, and liver enzyme elevations. Methotrexate elimination is reduced in patients with impaired renal function, ascites, or pleural effusions. In patients with psoriatic arthritis, the rate of antibody development in patients receiving Humira monotherapy was comparable to patients with rheumatoid arthritis; however, in patients receiving concomitant methotrexate the rate was 7% compared to 1% in rheumatoid arthritis. Necrotizing fasciitis resulting in death has been reported in a 54-year-old man with rheumatoid arthritis receiving infliximab every 8 weeks along with intramuscular methotrexate weekly dosage. It is recommended that duration of leucovorin administration in these patients be based on determination of plasma methotrexate concentrations. Cutaneous lesions partially remitted following infliximab discontinuation and methotrexate treatment. Duration of leucovorin administration varies with the dosage of methotrexate and plasma concentrations achieved (including rate of elimination); in general, leucovorin administration is continued until methotrexate concentrations fall to less than 5 � 10 -8 Molar. Interstitial pneumonitis has been reported in a limited number of patients receiving infliximab concomitantly with a stable dosage of methotrexate. This indicates that NSAIDs may enhance the toxicity of methotrexate. In patients receiving concomitant methotrexate, the incidence was 6% compared to 26% with Humira monotherapy. It works like folic acid in the body, which helps to reduce the action and toxic effects of folic acid antagonists (eg, methotrexate).

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