title: Interactions among Low Dose of Methotrexate and Drugs Used in the Treatment of Rheumatoid Arthritis.
abstract: Methotrexate (MTX) is a nonbiological disease-modifying antirheumatic drug that has shown both a good control of clinical disease and a good safety. Usually drug-drug interactions (DDIs) represent the most limiting factor during the clinical management of any disease, in particular when several drugs are coadministered to treat the same disease. In this paper, we report the interactions among MTX and the other drugs commonly used in the management of rheumatoid arthritis. Using Medline, PubMed, Embase, Cochrane libraries, and Reference lists, we searched for the articles published until June 30, 2012, and we reported the most common DDIs between MTX and antirheumatic drugs. In particular, clinically relevant DDIs have been described during the treatment with MTX and NSAIDs, for example, diclofenac, indomethacin, or COX-2 inhibitors, and between MTX and prednisone or immunosuppressant drugs (e.g., leflunomide and cyclosporine). Finally, an increase in the risk of infections has been recorded during the combination treatment with MTX plus antitumor necrosis factor- α agents. In conclusion, during the treatment with MTX, DDIs play an important role in both the development of ADRs and therapeutic failure.
authors.affiliation: Department of Health Science, School of Medicine, University of Catanzaro, Viale Europa, 88100 Catanzaro, Italy ; Pharmacovigilance's Center Regione Calabria, University Hospital Mater Domini, 88100 Catanzaro, Italy.
authors.forename: Marinella
authors.initials: M
authors.lastname: Patanè
authors.forename: Miriam
authors.initials: M
authors.lastname: Ciriaco
authors.forename: Serafina
authors.initials: S
authors.lastname: Chimirri
authors.forename: Francesco
authors.initials: F
authors.lastname: Ursini
authors.forename: Saverio
authors.initials: S
authors.lastname: Naty
authors.forename: Rosa Daniela
authors.initials: RD
authors.lastname: Grembiale
authors.forename: Luca
authors.initials: L
authors.lastname: Gallelli
authors.forename: Giovambattista
authors.initials: G
authors.lastname: De Sarro
authors.forename: Emilio
authors.initials: E
authors.lastname: Russo