Methotrexate
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied Health
• Folic acid and vitamin B12 supplementation may be beneficial.1
• Magnesium depletion is possible. Monitor electrolyte levels.2
• Zinc, copper, vitamin E and pyridoxine may also be beneficial in rheumatoid arthritis patients on long term methotrexate therapy.3
• Drink adequate fluids to increase urine output.4
• Methotrexate could interfere with glutamine absorption.5
• Avoid alcohol with Methotrexate.6
• Herbs with salicylate properties such as: meadowsweet, european poplar, willow, sweet birch, and wintergreen may potentially increase the side effects or the effects of methotrexate.7
References1 Alarcon GS, Morgan SL. Guidelines for folate supplementation in rheumatoid arthritis patients treated with methotrexate: comment on the guidelines for monitoring drug therapy. Arthritis Rheum. 1997 Feb;40(2):391; discussion 391-2.
1 Leeb BF, Witzmann G, Ogris E, Studnicka-Benke A, Andel I, Schweitzer H, Smolen JS. Folic acid and cyanocobalamin levels in serum and erythrocytes during low-dose methotrexate therapy of rheumatoid arthritis and psoriatic arthritis patients. Clin Exp Rheumatol. 1995 Jul-Aug;13(4):459-63.
1 Morgan SL, Baggott JE, Vaughn WH, Austin JS, Veitch TA, Lee JY, Koopman WJ, Krumdieck CL, Alarcon GS. Supplementation with folic acid during methotrexate therapy for rheumatoid arthritis. A double-blind, placebo-controlled trial. Ann Intern Med. 1994 Dec 1;121(11):833-41.
1 Morgan SL, Baggott JE, Vaughn WH, Young PK, Austin JV, Krumdieck CL, Alarcon GS. The effect of folic acid supplementation on the toxicity of low-dose methotrexate in patients with rheumatoid arthritis. Arthritis Rheum. 1990 Jan;33(1):9-18.
2 Koch Nogueira PC, Hadj-Aissa A, Schell M, Dubourg L, Brunat-Mentigny M, Cochat P. Long-term nephrotoxicity of cisplatin, ifosfamide, and methotrexate in osteosarcoma. Pediatr Nephrol. 1998 Sep;12(7):572-5.
2 Morgan SL, Hine RJ, Vaughn WH, Brown A. Dietary intake and circulating vitamin levels of rheumatoid arthritis patients treated with methotrexate. Arthritis Care Res. 1993 Mar;6(1):4-10.
3 Morgan SL, Hine RJ, Vaughn WH, Brown A. Dietary intake and circulating vitamin levels of rheumatoid arthritis patients treated with methotrexate. Arthritis Care Res. 1993 Mar;6(1):4-10.
3 Kremer JM, Bigaouette J. Nutrient intake of patients with rheumatoid arthritis is deficient in pyridoxine, zinc, copper, and magnesium. J Rheumatol. 1996 Jun;23(6):990-4.
4 Pronsky, Z Food Medication Interactions, 11th edition, 1999
5 Anderson PM, et al. "Effect of low-dose oral glutamine on painful stomatitis during bone marrow transplantation." Bone Marrow Transplant, 1998; 22(4):339-44.
6 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer Company, 2000
6 Pronsky, Z Food Medication Interactions, 11th edition, 1999
7 Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A Guide for Health-care Professionals. London: The Pharmaceutical Press, 1996.
7 Facts and Comparisons, Review of Natural Products, Clinisphere 2.0, Wolters Kluwer Company, 2000
7 PDR for Herbal Medicines, 2nd edition, Medical Economics Company, 2000
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Disclaimers
The information in Drug Watch is provided as a courtesy to NewsTarget readers by Applied Health Solutions in cooperation with Healthway Solutions. Although the information is presented with scientific references, we do not wish to imply that this represents a comprehensive list of considerations about any specific drug, herb or nutrient. Nor should this information be considered a substitute for the advice of your doctor, pharmacist, or other healthcare practitioner. Please read the disclaimer about the intentions and limitations of the information provided on these pages. It is important to tell your doctor and pharmacist about all other drugs and nutritional supplements that you are taking if they are recommending a new medication. Copyright © 2007 by Applied Health Solutions, Inc. All rights reserved.
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