Methotrexate, Liver toxicity

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Viewer Question

Please could you tell me the percentage of methotrexate users who develop liver damage.  I currently take 7.5 mg per week and have done so for 6 years and my consultant wishes to do a liver biopsy (as I am a long term user of Methotrexate) which I am very reluctant to undergo. Can you suggest other medication which may help my Sarcoidosis condition which does not affect the liver?  I do not know who else to contact to ask these questions so would be grateful if you could please help.
Signed, AM

Doctor's Answer

Liver damage from methotrexate is not common.  It occurs in two forms, acute and chronic.

Acute liver toxicity is manifest by elevation of liver function blood tests, called transaminases.  Elevation of liver function tests occurs in approximately 15% of patients.  It is generally considered harmless when it is low-level and temporary.  Persistent elevation of liver function tests can precede the appearance of cirrhosis or chronic liver toxicity.  Cirrhosis can be fatal.  Cirrhosis generally occurs after a total dose of at least 1.5 grams of methotrexate have been taken.

The risks of cirrhosis is increased with alcoholism, diabetes, obesity, and age.

Alternatives to methotrexate for sarcoidosis include colchicine and Plaquenil (hydroxychloroquine).

Thank you for your question.

Last Editorial Review: 1/20/2003

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