Indometacin Methotrexate

The first-line agents in the treatment of rheumatoid arthritis are non-steroidal anti-inflammatory drugs such as diclofenac. Diclofenac and indometacin, another NSAID, tend to have similar activity hov/ever, indometacin has a higher incidence of side-effects and therefore diclofenac is more appropriate for initial treatment. Sodium aurothiomalate is classified as a disease-modifying antirheumatic drug and is used as a second-line treatment in rheumatoid arthritis, but has been superseded by methotrexate, administered v/eekly. Paracetamol is often indicated in the management of osteoarthritis. Local intra-articular injections of dexamethasone may be administered for the relief of soft-tissue inflammatory conditions. 

NS AIDs METHOTREXATE t methotrexate levels, with reports of toxicity, with ibuprofen, indometacin and possibly diclofenac, flurbiprofen, ketopro-fen, meloxicam and naproxen Uncertain postulated that an NSAID-induced i in renal perfusion may have an effect Consider using an alternative NSAID... 

Intravenous bolus 15 to 60 mg/m s then 15 to 60 mg/m intravenous infusion over 36 hours Dicloxacillin (not stated) (Indometacin ako given) Oesophageal cancer (1) 93% reduction in methotrexate clearance prolonged folinic acid rescue necessary 3... 

A study found that diclofenac 100 mg daily did not affect the pharmacokinetics of methotrexate however, 5 patients taking low-dose methotrexate 7.5 to 12.5 mg weekly for psoriasis or rheumatoid arthritis developed serious/fatal neutropenias. These cases probably involved other drug interactions, but diclofenac may have been an additional factor in two of them. Other cases involving diclofenac are mentioned in the sections on indometacin (k) and ketoprofen (1). 

The AUC of child taking methotrexate 7.5 mg/m weekly for 9 months was increased by 140% when indometacin and aspirin were also given. Another study found that indometaein did not affeet the pharmacokinetics of methotrexate. ... 

A study in patients with rheumatoid arthritis found that the clearance of oral methotrexate 7.5 to 15 mg was unaffected by the concurrent use of paracetamol. In a study of patients with psoriasis taking methotrexate in doses up to 25 mg weekly, no cases of toxicity occurred in 4 patients also taking paracetamol or indometacin. In one study, methotrexate clearance was reduced by NSAIDs but not by paracetamol, which was included in the study as a control. ... 

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