Metotreksat Cipla (Methotrexate)

Methotrexate is used in several disease categories where it modulates abnormal cell proliferation and immune activity.

• Rheumatoid arthritis: reduces joint inflammation and slows disease progression.
• Psoriasis: decreases skin cell turnover, improving plaque severity.
• Acute lymphoblastic leukemia: interferes with malignant cell replication as part of chemotherapy protocols.
• Non‑Hodgkin lymphoma: contributes to tumor control in combination regimens.
• Ectopic pregnancy: terminates trophoblastic tissue when surgical options are not chosen.

• Methotrexate inhibits the enzyme dihydrofolate reductase, preventing the reduction of dihydrofolate to tetrahydrofolate. This blockade disrupts folate‑dependent synthesis of purine nucleotides and thymidylate, leading to impaired DNA, RNA and protein synthesis. The resulting antiproliferative effect targets rapidly dividing cells, including activated immune cells and malignant lymphocytes, thereby providing immunosuppressive and antineoplastic activity.

Methotrexate may cause a range of adverse reactions, varying from mild to severe.

Common Side Effects

• Nausea and vomiting: gastrointestinal upset often occurring early in therapy.
• Fatigue: persistent tiredness reported by many patients.
• Oral mucositis: soreness or ulceration of the mouth lining.
• Elevated liver enzymes: mild hepatic irritation detectable in blood tests.
• Cytopenias: reduced white blood cells, red cells or platelets.
• Alopecia: temporary hair thinning or loss.

Serious or Rare Side Effects

• Severe hepatotoxicity: potential liver failure with prolonged use.
• Pulmonary fibrosis: progressive scarring of lung tissue causing breathlessness.
• Life‑threatening infection: due to profound immunosuppression.
• Bone marrow aplasia: marked pancytopenia requiring urgent care.
• Renal toxicity: impaired kidney function from drug accumulation.
• Stevens‑Johnson syndrome: rare severe skin reaction.

When prescribing methotrexate, clinicians should observe several safety measures to minimize risks.

• Monitor blood counts: perform regular complete blood count tests.
• Assess liver function: schedule periodic liver enzyme evaluations.
• Evaluate renal function: adjust dosing if creatinine clearance is reduced.
• Avoid use in pregnancy: contraindicated due to teratogenic potential.
• Counsel on infection risk: advise patients to report fevers or signs of infection promptly.
• Store at ambient temperature: keep in the original container, protect from moisture and light.

Methotrexate interacts with several medicines that can alter its efficacy or increase toxicity.

Major Interactions (Avoid)

• Non‑steroidal anti‑inflammatory drugs (NSAIDs): increase methotrexate plasma levels and risk of toxicity.
• Trimethoprim‑sulfamethoxazole: potentiates bone marrow suppression.
• Live vaccines: heightened risk of infection due to immunosuppression.
• Azathioprine: additive myelosuppressive effect.
• High‑dose aspirin: may reduce renal clearance of methotrexate.

Moderate Interactions (Monitor Closely)

• Penicillins and other antibiotics: may affect renal excretion.
• Oral contraceptives: reduced effectiveness, consider alternative contraception.
• Alcohol: can exacerbate liver toxicity.
• Proton pump inhibitors: may increase methotrexate exposure.
• Diuretics: may enhance nephrotoxic risk.