Pancytopenia from Using Trimethoprim and Methotrexate

Letters15 November 1992Pancytopenia from Using Trimethoprim and MethotrexateJoseph A. Govert, MD, Suzanne Patton, MD, PhD, Robert L. Fine, MDJoseph A. Govert, MDSearch for more papers by this author, Suzanne Patton, MD, PhDSearch for more papers by this author, Robert L. Fine, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-117-10-877_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the Editors: Methotrexate is currently used for the treatment of psoriasis, asthma, rheumatoid arthritis, and cancer. Hazardous interactions may occur when combined with other drugs whose mechanism of action involves the same biochemical pathway. One such rarely described interaction is between low-dose, oral methotrexate and the antibiotic trimethoprim-sulfamethoxazole (TMP-SMX) resulting in marrow hypoplasia (1-3).A 58-year-old, white man with a long history of rheumatoid arthritis presented with symptoms and signs of prostatitis. His arthritis had been successfully managed with oral methotrexate, 7.5 mg weekly since 1988. A complete blood count showed a hemoglobin of 133 g/L, a hematocrit of...References1. MaricicDavisGall MME. Megaloblastic pancytopenia in a patient receiving concurrent methotrexate and trimethoprim-sulfamethoxazole treatment. Arthritis Rheum. 1986;29:133-5. CrossrefMedlineGoogle Scholar2. ThomasGutterman ML. Methotrexate toxicity in a patient receiving trimethoprim-sulfamethoxazole. J Rheum. 1986;13:440-1. MedlineGoogle Scholar3. GroenendalRampen HF. Methotrexate and trimethoprim-sulfamethoxazole—a potentially hazardous combination. Clin Ex Derm. 1990;15:358-60. CrossrefMedlineGoogle Scholar4. JovietCowanCurtGlendeninnChabner JKGNB. The pharmacology and clinical use of methotrexate. N Engl J Med. 1983;309:1094-104. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Duke University Medical Center Durham Veterans Affairs Medical Center Durham, NC 27705 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByClinical Pharmacokinetic and Pharmacodynamic Considerations in the Treatment of Inflammatory Bowel DiseaseMethotrexatePneumocystis Jirovecii Pneumonia in Rheumatoid Arthritis Patients: Risks and Prophylaxis RecommendationsCytostatic and cytotoxic drugsMethotrexate and trimethoprim-sulphamethoxazole: extremely serious and life-threatening combinationDrug interactions in childhood cancerMethotrexate Drug Interactions in the Treatment of Rheumatoid Arthritis: A Systematic ReviewCanadian Recommendations for Use of Methotrexate in Patients with Rheumatoid ArthritisAn evidence-based assessment of the clinical significance of drug-drug interactions between disease-modifying antirheumatic drugs and non-antirheumatic drugs according to rheumatologists and pharmacistsOral Antibiotic Drug Interactions of Clinical Significance to DermatologistsClinically Significant Drug–Drug Interactions Between Oral Anticancer Agents and Nonanticancer Agents: Profiling and Comparison of Two Drug CompendiaPrevalence and predictors of potential drug–drug interactions in Regione Emilia-Romagna, ItalyVasculitis in the Geriatric PopulationMethotrexate-induced pancytopenia associated with co-prescription of penicillin and trimethoprimClinical drug interactions in outpatients of a university hospital in ThailandVasculitis in the Geriatric PopulationAn analysis of the utilisation of chemoprophylaxis against Pneumocystis jirovecii pneumonia in patients with malignancy receiving corticosteroid therapy at a cancer hospitalPharmacoepidemiologic study of potential drug interactions in outpatients of a university hospital in ThailandMethotrexate as an alternative to classic immunosuppressive therapiesPharmacokinetic Considerations in the Treatment of Inflammatory Bowel DiseaseMETHOTREXATE USE IN SYSTEMIC VASCULITISMethotrexateINFECTIOUS COMPLICATIONS OF IMMUNOSUPPRESSIVE THERAPY IN PATIENTS WITH RHEUMATIC DISEASESPancytopenia secondary to methotrexate therapy in rheumatoid arthritis: Comment on the article by Gutierrez-Ureña et alIncidence of pancytopenia with methotrexate treatment of rheumatoid arthritis in germany: Comment on the article by Gutierrez-Ureña et al9 Effects of folate deficiency on embryonic developmentAn analysis of forty-two wegener's granulomatosis patients treated with methotrexate and prednisoneMajor adverse effects from systemic drugs: Defining the risksLow-dose methotrexate in rheumatic diseases—Efficacy, side effects, and risk factors for side effectsMethotrexateReplyMethotrexate interactionDrug Interactions and Adverse Reactions 15 November 1992Volume 117, Issue 10Page: 877-878KeywordsCancer treatmentDrug interactionsDrugsHematocritHemoglobinMethotrexateProstatitisPsoriasisRheumatoid arthritisSigns and symptoms Issue Published: 15 November 1992 PDF DownloadLoading ...