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

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In patients receiving concomitant methotrexate, the incidence was 6% compared to 26% with Humira monotherapy. In patients with psoriatic arthritis, the rate of antibody development in patients receiving Humira monotherapy was comparable to patients with rheumatoid arthritis; however, in patients receiving concomitant methotrexate the rate was 7% compared to 1% in rheumatoid arthritis. His only other medications were amlodipine (5 mg per day) and methotrexate (15 mg per week). It works like folic acid in the body, which helps to reduce the action and toxic effects of folic acid antagonists (eg, methotrexate). This indicates that NSAIDs may enhance the toxicity of methotrexate. Patients treated with methotrexate should be advised to seek medical attention if they experience potential signs and symptoms of hepatotoxicity such as fever, rash, anorexia, nausea, vomiting, fatigue, right upper quadrant pain, dark urine, and jaundice. 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. Alkalinization of urine (with bicarbonate and/or acetazolamide) and intravenous hydration (1000 mL per square meter of body surface area over six hours prior to beginning the methotrexate infusion and 3000 mL per square meter of body surface area per day during the methotrexate infusion and for two days after the infusion is completed) are also important to prevent renal toxicity caused by methotrexate and/or its metabolites. Antibodies developed in 12% of patients on adalimumab monotherapy and in 1% of patients on concurrent methotrexate. Methotrexate elimination is reduced in patients with impaired renal function, ascites, or pleural effusions. Patients treated with concomitant methotrexate had a lower rate of antibody development than patients on Humira monotherapy (1% versus 12%). Her RA had been treated with methotrexate (10 mg per week) and bucillamine (200 mg per day) for 6 years.

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