Brand name: methotrexate
Generic name: Emthexate, Rheumatrex, amethopterin, Methoblastin, MTX

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Methotrexate has been reported to cause fetal death and/or congenital anomalies. May aid in identifying patients with delayed methotrexate clearance; toxicity appears to be related at least as much to the length of time that methotrexate concentrations are elevated as to the peak concentrations achieved. Methotrexate, especially at higher doses or with prolonged treatment, has been associated with hepatotoxicity including acute hepatitis, chronic fibrosis, necrosis, cirrhosis, and liver enzyme elevations. Taking methotrexate and alcohol together may increase the risk of liver injury. However, elderly patients are more likely to have age-related renal function impairment, which may require adjustment of dosage in patients receiving leucovorin as a rescue from the effects of high-dose methotrexate. Necrotizing fasciitis resulting in death has been reported in a 54-year-old man with rheumatoid arthritis receiving infliximab every 8 weeks along with intramuscular methotrexate weekly dosage. It is recommended that duration of leucovorin administration in these patients be based on determination of plasma methotrexate concentrations. In patients receiving concomitant methotrexate, the incidence was 6% compared to 26% with Humira monotherapy.

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