Descripción
Dexamethasone and methotrexate are commonly combined in oncology regimens; dexamethasone may modestly reduce methotrexate's antifolate toxicity but also reduce some therapeutic activity.
Mecanismo
Dexamethasone upregulates DHFR (dihydrofolate reductase), the target enzyme of methotrexate, potentially reducing cytotoxic efficacy while also partially protecting normal rapidly dividing cells; the net effect depends on the clinical context (cancer type, regimen).
Relevancia clínica
In haematological malignancies where both drugs are protocol-specified, the combination is deliberately used (e.g., HyperCVAD); interaction is a pharmacodynamic consideration rather than a contraindication.
Manejo clínico
Follow established oncology protocols; avoid adding dexamethasone to methotrexate-based regimens outside of standardised protocols without oncology guidance.