methotrexate - oral, Rheumatrex (cont.)
DRUG INTERACTIONS: See also Warning section.The effects of some drugs can change if you take other drugs or herbal products at the same time. This can increase your risk for serious side effects or may cause your medications not to work correctly. These drug interactions are possible, but do not always occur. Your doctor or pharmacist can often prevent or manage interactions by changing how you use your medications or by close monitoring.To help your doctor and pharmacist give you the best care, be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products) before starting treatment with this product. While using this product, do not start, stop, or change the dosage of any other medicines you are using without your doctor's approval.Some products that may interact with this drug include: acitretin, asparaginase, ciprofloxacin, digoxin, leflunomide, live vaccines, natalizumab, other cancer treatments potentially toxic to the kidney (e.g., cisplatin), other drugs potentially toxic to the liver (e.g., azathioprine, sulfasalazine, retinoids such as isotretinoin), penicillins, phenytoin, probenecid, procarbazine, pyrimethamine, sulfa medications, theophylline.Certain drugs that reduce stomach acid (proton pump inhibitors-PPIs such as esomeprazole, omeprazole, pantoprazole) may increase the blood level of methotrexate. This may lead to a higher chance of side effects, especially with high-dose methotrexate treatment. Ask your doctor or pharmacist for details and ways to lessen the risk of side effects.Certain antibiotics (e.g., chloramphenicol, sulfa, tetracyclines) may interfere with methotrexate blood tests (increase methotrexate blood levels due to protein-binding displacement). Make sure laboratory personnel and your doctors know you are using any of these types of antibiotics.This document does not contain all possible drug interactions. Keep a list of all the products you use. Share this list with your doctor and pharmacist to lessen your risk for serious medication problems.
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