Methotrexate and trimethoprim–sulphamethoxazole: extremely serious and life-threatening combination
Article first published online: 22 MAR 2013
© 2013 Blackwell Publishing Ltd
Journal of Clinical Pharmacy and Therapeutics
Volume 38, Issue 3, pages 203–205, June 2013
How to Cite
Al-Quteimat, O. M. and Al-Badaineh, M. A. (2013), Methotrexate and trimethoprim–sulphamethoxazole: extremely serious and life-threatening combination. Journal of Clinical Pharmacy and Therapeutics, 38: 203–205. doi: 10.1111/jcpt.12060
- Issue published online: 21 APR 2013
- Article first published online: 22 MAR 2013
- Manuscript Accepted: 4 MAR 2013
- Manuscript Received: 1 FEB 2013
- drug interaction;
- methotrexate toxicity;
What is known and Objective
Combining methotrexate (MTX) with trimethoprim-sulfamethoxazole (TS) is associated with a potential drug interaction that increases MTX toxicity. The aim of this article is to review the current literature about the potential drug interaction resulting from combining MTX with TS, and to establish therapeutic recommendations regarding their use together.
Literature for relevant evidence was searched by Medline (through PubMed), Cochrane library and a manual search through major journals for articles referenced in those located through PubMed.
Results and Discussion
One systematic review, three studies and 17 case reports were found to be relevant to the topic. Results from the current available literature clearly indicate a major drug interaction between MTX and TS, which increases the risk of MTX toxicity, like severe pancytopenia, which was fatal in some cases. Recommendations to prevent this serious interaction should be developed and implemented in the currently available therapeutic guidelines related to MTX therapy.
What is new and Conclusion
MTX and TS is an extremely serious and life-threatening combination that should be avoided. Practical recommendations regarding MTX use can be established to prevent harm from drug interactions. Increasing awareness of physicians, pharmacist and patients is essential to assure safe and effective MTX therapy.