Methotrexate(low strength inj, oral)/Proton Pump Inhibitors
This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.
Medical warning:
Moderate. These medicines may cause some risk when taken together. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.
How the interaction occurs:
Proton pump inhibitors may decrease the ability of your kidneys to remove methotrexate from your body.
What might happen:
The amount of methotrexate in your body may increase, which may increase the risk for serious side effects.
What you should do about this interaction:
Make sure your healthcare professionals (e.g. doctor or pharmacist) know that you are taking these medicines together.Your doctor may want to monitor the amount of methotrexate in your blood, change the dose of your methotrexate, or change your acid medicine. Let your doctor know right away if you develop nausea, stomach pain, yellowing of the eyes or skin, dark urine, fever, fatigue, a persistent sore throat, easy bruising or bleeding, black stools, a change in the amount of urine you pass, skin rash, breathing problems, dry cough, diarrhea, or mouth sores while taking these medicines together.Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.
References:
1.Reid T, Yuen A, Catolico M, Carlson RW. Impact of omeprazole on the plasma clearance of methotrexate. Cancer Chemother Pharmacol 1993;33(1):82-4.
2.Suzuki K, Doki K, Homma M, Tamaki H, Hori S, Ohtani H, Sawada Y, Kohda Y. Co-administration of proton pump inhibitors delays elimination of plasma methotrexate in high-dose methotrexate therapy. Br J Clin Pharmacol 2009 Jan;67(1):44-9.
3.Breedveld P, Zelcer N, Pluim D, Sonmezer O, Tibben MM, Beijnen JH, Schinkel AH, van Tellingen O, Borst P, Schellens JH. Mechanism of the pharmacokinetic interaction between methotrexate and benzimidazoles: potential role for breast cancer resistance protein in clinical drug-drug interactions. Cancer Res 2004 Aug 15;64(16):5804-11.
4.Prilosec (omeprazole) US prescribing information. AstraZeneca Pharmaceuticals LP October, 2012.
5.Beorlegui B, Aldaz A, Ortega A, Aquerreta I, Sierrasesumega L, Giraldez J. Potential interaction between methotrexate and omeprazole. Ann Pharmacother 2000 Sep;34(9):1024-7.
6.Bauters TG, Verlooy J, Robays H, Laureys G. Interaction between methotrexate and omeprazole in an adolescent with leukemia: a case report. Pharm World Sci 2008 Aug;30(4):316-8.
7.Troger U, Stotzel B, Martens-Lobenhoffer J, Gollnick H, Meyer FP. Drug points: Severe myalgia from an interaction between treatments with pantoprazole and methotrexate. BMJ 2002 Jun 22;324(7352):1497.
8.Vakily M, Amer F, Kukulka MJ, Andhivarothai N. Coadministration of lansoprazole and naproxen does not affect the pharmacokinetic profile of methotrexate in adult patients with rheumatoid arthritis. J Clin Pharmacol 2005 Oct;45(10):1179-86.
9.Health Canada. New Safety Information: Interaction of Proton Pump Inhibitors (PPIs) with Methotrexate. URL: http://www.hc-sc.gc.ca/ahc-asc/media/advisories-avis/_2012/2012_157-eng.ph p October 19, 2012.
