Medical Health Encyclopedia

Drug and Alcohol Interactions. Alcohol and many drugs interact with methotrexate, and in some cases the combinations can be toxic. Patients should discuss with their doctor any other medications they are taking. The following are just a few examples:

• Many of the common nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil), or naproxen, cause serious toxic interactions. Some NSAIDs, namely ketoprofen, fluorobiprofen, and piroxicam, appear to be safe when given with methotrexate and may be used in patients with psoriatic arthritis. (Rheumatoid arthritis patients who take methotrexate often take NSAIDs as well, but methotrexate doses in psoriasis patients are usually much higher than those in RA.)
• Specific antibiotics interact with methotrexate. Of note, the antibiotic trimethoprim-sulfamethoxazole increases the toxicity of methotrexate.

People Who Should Avoid Methotrexate. Pregnant and nursing mothers should never take methotrexate because it increases the risk for severe, even fatal, birth defects and miscarriage. The drug should be discontinued several months before planning a pregnancy. It may also cause temporary impairment of fertility in men. Other people who should avoid methotrexate are alcoholics, those who also have kidney or liver abnormalities (such as hepatitis), who have active infections, and patients with impaired immune systems. Patients at risk for liver complications include diabetes and people who are obese. Anyone with a previous history of hepatitis should have a biopsy before treatment. Others who might avoid methotrexate are people with peptic ulcers, rheumatoid arthritis, anemia, or other blood abnormalities.

Oral Retinoids

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Oral retinoids are derivatives of vitamin A. Those used for psoriasis include acitretin (Soriatane) and isotretinoin (Accutane). Acitretin is the retinoid of choice and may be dramatically effective for severe psoriasis, particularly pustular or erythrodermic variants. When used alone, it is much less effective against more common forms, such plaque or guttate psoriasis. However, combinations with PUVA phototherapy can markedly improve the response even in these patients.