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Reduced Methotrexate Efficacy: Folic acid supplements, caffeine/theophylline, and some antibiotics affecting gut flora may reduce absorption or effects Other Important Interactions: Live vaccines: contraindicated (risk of severe infection) Ciclosporin: excessive immunosuppression and toxicity Mercaptopurine: increased plasma levels (dose adjustment required) Phenytoin and sodium valproate: reduced efficacy reported, monitoring of phenytoin levels recommended Theophylline: decreased clearance, monitoring of theophylline levels recommended References Methotrexate | Drugs | BNF | NICE Accessed 5/2/26 Methotrexate 10 mg Tablets Summary of Product Characteristics (SmPC) (emc) | 11723 Accessed 5/2/26 Methotrexate | Macmillan Cancer Support Accessed 5/2/26 Methotrexate Sodium (Cancer Treatment) NCI Accessed 5/2/26 Managing interactions with methotrexate NHS SPS Specialist Pharmacy Service The first stop for professional medicines advice Accessed 7/2/26 Using folic acid with methotrexate in rheumatoid arthritis NHS SPS Specialist Pharmacy Service The first stop for professional medicines advice Accessed 7/2/26 Methotrexate once-weekly for autoimmune diseases: new measures to reduce risk of fatal overdose due to inadvertent daily instead of weekly dosing GOV.UK Accessed 7/2/26

Ltd., Sumitomo Dainippon Pharma Co., Eli Lilly, Mitsubishi Tanabe Pharma Co., MSD, Novo Nordisk Pharma, Sanofi, Takeda Pharmaceutical Co., Ltd., Kowa Pharmaceutical Co., Ltd., Ono Pharmaceutical Co., Ltd., and Taisho Toyama Pharmaceutical Co., Ltd

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