title: [Is methotrexate nephrotoxic? Dose-dependency, comorbidities and comedication].
abstract: Methotrexate (MTX) in low-doses is an important component of anti-inflammatory therapy of rheumatoid arthritis and other inflammatory joint diseases. In contrast to high-dose administration of MTX in oncology, which can lead to direct tubulus toxicity and subsequent renal failure, renal side-effects are a rare exception for low-dose MTX. The biggest problem under low-dose MTX is that an already limited renal function due to comorbidities or an increasing, sometimes clinically insufficiently monitored renal insufficiency due to comedications, such as non-steroidal antirheumatics (NSAR) and antibiotics, leads to a reduced excretion of MTX and therefore to an accumulation in serum. This is primarily accompanied by gastrointestinal mucositis and bone marrow depression. For this reason low-dose MTX should never be administered once the glomerular filtration rate (GFR) is less than <30 ml/min and only 50% of the original dosage should be administered if the GFR is between 30 and 60 ml/min.
authors: Division of Nephrology, University of Virginia Health System, Charlottesville, VA 22908, USA. ue2u@virginia.edu
authors: U
authors: U
authors: Erdbrügger
authors: K
authors: K
authors: de Groot
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000633:toxicity; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000633:toxicity; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000633:toxicity*; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000188:drug therapy*; D015897:Comorbidity; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D008657:Metabolic Clearance Rate / Q000187:drug effects; D008727:Methotrexate / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000633:toxicity*; D051437:Renal Insufficiency / Q000097:blood / Q000139:chemically induced*; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D018501:Antirheumatic Agents; D008727:Methotrexate