Use of methotrexate in older patients. A risk-benefit assessment

Drugs & Aging
S E Tett, E J Triggs

Abstract

Methotrexate is eliminated almost entirely by the kidneys. The risk of methotrexate toxicity is therefore increased in patients with poor renal function, most likely as a result of drug accumulation. Declining renal function with age may thus be an important predictor of toxicity to methotrexate. Up to 60% of all patients who receive methotrexate for rheumatoid arthritis (RA) discontinue taking it because of adverse effects, most of which occur during the first year of therapy. Gastrointestinal complications are the most common adverse effects of methotrexate, but hepatotoxicity, haematological toxicity, pulmonary toxicity, lymphoproliferative disorders and exacerbation of rheumatic nodules have all been reported. Decreased renal function as a result of disease and/or aging appears to be an important determinant of hepatic, lymphoproli ferative and haematological toxicity. Concomitant use of low doses of folic acid has been recommended as an approach to limiting toxicity. Interactions between methotrexate and several nonsteroidal anti-inflammatory drugs have been reported, but they may not be clinically significant. However, caution is advised in the use of such combinations in patients with reduced renal function. More serious...Continue Reading

Citations

Jun 21, 2005·Zeitschrift für Rheumatologie·P Harten
Nov 21, 2000·Postgraduate Medical Journal·B HirshbergA Rubinow
Jul 3, 2002·Drugs & Aging·Darrell S PardiMichael Camilleri
Jun 18, 2004·European Journal of Gastroenterology & Hepatology·Denis HeresbachUNKNOWN ABERMAD
Feb 11, 2014·Disease-a-month : DM·James T O'DonnellJames J O'Donnell
Oct 9, 2001·Seminars in Arthritis and Rheumatism·A RozinA M Nahir
Jul 6, 2019·British Journal of Clinical Pharmacology·Catherine J LucasJennifer H Martin
Jun 28, 2002·The Annals of Pharmacotherapy·Ali MofredjAbdelatif Charoud
Oct 27, 2020·Frontline Gastroenterology·Jonathan P SegalBu'Hussain Hayee

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