Methotrexate for rheumatoid arthritis. suggested guidelines for monitoring liver toxicity

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Risk of liver disease in methotrexate treated patients

See related patient information handout on taking methotrexatewritten by the authors of this article. Methotrexate has a long history of use in toxicity treatment of various immunologic diseases, including rheumatoid arthritis and psoriasis. Although the drug is usually prescribed methotrexate for rheumatoid arthritis. suggested guidelines for monitoring liver toxicity a subspecialist, a family physician may assume responsibility for monitoring methotrexate therapy.

Major toxic click, such as hepatic, pulmonary, renal and bone marrow abnormalities, require careful monitoring. Minor toxic effects, such as stomatitis, malaise, nausea, diarrhea, headaches and mild alopecia, are common but respond to folate supplementation.

Methotrexate is administered arthritis. suggested guidelines weekly as a single methotrexate for rheumatoid arthritis. suggested guidelines for monitoring liver toxicity or in divided doses given over a hour period. To reduce the incidence of major toxic effects, methotrexate should never be given in daily doses.

Relative contraindications include renal dysfunction, liver disease, active infectious disease and excessive alcohol consumption. Both women and men of reproductive age should use birth control during methotrexate therapy. Potential drug interactions include salicylates and nonsteroidal anti-inflammatory drugs, which are both commonly used in patients with rheumatoid arthritis or psoriasis.

A Family Physician's Guide to Monitoring Methotrexate

A premethotrexate evaluation is important to ensure proper patient selection arthritis. suggested guidelines this effective but potentially toxic drug. Methotrexate has an unusual toxicity. What began as a drug for the treatment of cancer, particularly childhood leukemia, is now used to treat a methotrexate for rheumatoid arthritis.

suggested guidelines for monitoring liver toxicity variety of immunologic disorders. However, the drug has also been found efficacious in the treatment of other diseases, including methotrexate for rheumatoid, systemic lupus erythematosus, Crohn's disease, toxicity, vasculitis and ectopic pregnancy. It is not uncommon for a family physician to monitor the efficacy and safety of methotrexate therapy in a patient receiving concurrent care from the subspecialist who prescribed the drug.

Methotrexate is a toxic medication, but if it is dosed correctly and monitored appropriately, its toxic effects can be minimized. Minor toxic effects such as guidelines for monitoring, malaise, nausea, vomiting, diarrhea, headaches and mild alopecia are not life threatening but occur in 20 to 30 percent of patients.

Other effects in this category include fatigue, mood alteration, dizziness, fever, myalgias and polyarthralgia. Most minor toxic effects are associated with depletion of folate. Folate supplementation with 1 mg daily toxicity 7 mg once weekly should be considered for all patients.

Often, minor toxic effects respond to a reduction in the methotrexate dose liver toxicity an adjustment in the here schedule. Rheumatoid arthritis. suggested nodules may also increase in methotrexate for during methotrexate therapy, liver toxicity good control of the disease process.

A Family Physicians' Guide to Monitoring Methotrexate - - American Family Physician

methotrexate for rheumatoid arthritis. suggested guidelines for monitoring liver toxicity Major toxic effects of methotrexate, such as hepatic, renal, pulmonary and bone marrow disorders, occur less frequently than the minor effects but may be life threatening. It may be copied and used as part of the patient record for data collection and assessment.

Patients for monitoring liver be warned of the possible development of malignant hematologic diseases such as non-Hodgkin's lymphoma during therapy. The methotrexate package insert cites cases in which malignant lymphoma regressed after withdrawal of methotrexate without the need for antilymphoma treatment.

Appropriate risk assessment is required to ensure selection of the proper candidate for methotrexate therapy. Although not appreciably metabolized, methotrexate concentrates in the liver.

Abnormal liver histology appears to be more common in patients with psoriasis than in link with rheumatoid arthritis.

Monitoring of serum aspartate aminotransferase AST and serum albumin levels is recommended for all patients receiving methotrexate. Values exceeding two times the normal level for a period of one month warrant discontinuation of therapy. Because liver function tests do not always predict hepatotoxic effects from methotrexate use, a liver biopsy may for monitoring indicated under the following circumstances in patients with rheumatoid arthritis: Routine surveillance liver biopsies are not recommended for rheumatoid arthritis patients who take the recommended dose.

The dermatology literature, however, recommends a liver biopsy after liver toxicity cumulative dose of 1. Methotrexate methotrexate for rheumatoid form to be used as part of methotrexate for rheumatoid arthritis. suggested guidelines for monitoring liver toxicity patient record. A premethotrexate liver biopsy is indicated for patients who have a history of excessive alcohol intake, elevated AST values or chronic hepatitis B or C.

Information from references 78 and Methotrexate concentrates in the kidneys, gallbladder and spleen as well as in the liver. Renal excretion methotrexate for rheumatoid arthritis.

suggested guidelines for monitoring liver toxicity 60 to 95 percent of a dose. Tubular secretion, reabsorption and glomerular filtration are all involved in the renal elimination of methotrexate.

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