Methotrexate and trimethoprim–sulphamethoxazole—a potentially hazardous combination

A 74‐year‐old woman had been treated with methotrex‐ate over 2 years for rheumatoid arthritis. She was admitted to the hospital because of non‐healing leg ulcers. After being treated with trimethoprim‐sulphamethoxazole for a urinary‐tract infection, she developed severe pancytopenia, followed by pneumonia and septic‐shock. The patient died shortly after. Concomitant treatment with methotrexate and sulphonamides should be strongly discouraged.

[1]  B. J. Liddle,et al.  Drug interactions with methotrexate , 1989, The British journal of dermatology.

[2]  J. Kremer,et al.  Methotrexate for Rheumatoid Arthritis , 1994 .

[3]  H. Maibach,et al.  Methotrexate in psoriasis: revised guidelines. , 1988, Journal of the American Academy of Dermatology.

[4]  J. Shupack,et al.  Pancytopenia following low-dose oral methotrexate therapy for psoriasis. , 1988, JAMA.

[5]  E. Farber,et al.  Pancytopenia following low-dose methotrexate therapy. , 1988, JAMA.

[6]  J. Dover,et al.  Pancytopenia induced by the interaction between methotrexate and trimethoprim-sulfamethoxazole. , 1987, Journal of the American Academy of Dermatology.

[7]  P. Tugwell,et al.  Methotrexate in Rheumatoid Arthritis: Indications, Contraindications, Efficacy, and Safety , 1987 .

[8]  J. Frain.  Methotrexate toxicity in a patient receiving trimethoprim-sulfamethoxazole. , 1987, The Journal of rheumatology.

[9]  M. Maricic,et al.  Megaloblastic pancytopenia in a patient receiving concurrent methotrexate and trimethoprim-sulfamethoxazole treatment. , 1986, Arthritis and rheumatism.

[10]  G. Starkebaum,et al.  Pancytopenia associated with low dose pulse methotrexate in the treatment of rheumatoid arthritis. , 1985, Seminars in arthritis and rheumatism.

[11]  R. Snyderman,et al.  Pneumonitis complicating low-dose methotrexate therapy in rheumatoid arthritis. , 1985, Archives of internal medicine.

[12]  J. A. Engelbrecht,et al.  Methotrexate pneumonitis after low-dose therapy for rheumatoid arthritis. , 1983, Arthritis and rheumatism.