Описание
NSAIDs reduce methotrexate renal elimination, raising its plasma levels and significantly increasing the risk of methotrexate toxicity (myelosuppression, mucositis, nephrotoxicity).
Механизм
NSAIDs reduce renal blood flow via prostaglandin inhibition and compete with methotrexate for renal tubular secretion, reducing its clearance and prolonging exposure.
Клиническое значение
Methotrexate AUC can increase 2–4-fold; severe and fatal toxicity (pancytopenia, acute renal failure) has been reported, especially at higher methotrexate doses used for oncology.
Тактика ведения
Avoid high-dose methotrexate + NSAIDs; low-dose rheumatology regimens require caution—monitor CBC, renal function, and methotrexate levels. Withhold NSAID for 24–48 h around weekly methotrexate dose if possible.
Медицинский отказ от ответственности
This content is for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before making medication decisions.