Brand name: methotrexate
Generic name: Methoblastin, Emthexate, Rheumatrex, MTX, amethopterin

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It works like folic acid in the body, which helps to reduce the action and toxic effects of folic acid antagonists (eg, methotrexate). Alkalinization of urine (with bicarbonate and/or acetazolamide) and intravenous hydration (1000 mL per square meter of body surface area over six hours prior to beginning the methotrexate infusion and 3000 mL per square meter of body surface area per day during the methotrexate infusion and for two days after the infusion is completed) are also important to prevent renal toxicity caused by methotrexate and/or its metabolites. His only other medications were amlodipine (5 mg per day) and methotrexate (15 mg per week). He was treated for RA with infliximab (3 mg/kg) for 3 years, as well as methotrexate (20 mg/week), and corticosteroids. However, elderly patients are more likely to have age-related renal function impairment, which may require adjustment of dosage in patients receiving leucovorin as a rescue from the effects of high-dose methotrexate. Patients treated with concomitant methotrexate had a lower rate of antibody development than patients on Humira monotherapy (1% versus 12%). In patients receiving concomitant methotrexate, the incidence was 6% compared to 26% with Humira monotherapy. She had been successfully treated with infliximab 3 mg/kg every 6 to 8 weeks together with methotrexate, without side effects. Methotrexate, especially at higher doses or with prolonged treatment, has been associated with hepatotoxicity including acute hepatitis, chronic fibrosis, necrosis, cirrhosis, and liver enzyme elevations. Patients treated with methotrexate should be advised to seek medical attention if they experience potential signs and symptoms of hepatotoxicity such as fever, rash, anorexia, nausea, vomiting, fatigue, right upper quadrant pain, dark urine, and jaundice. Leucovorin given at the appropriate time rescues bone marrow and gastrointestinal cells from methotrexate but has no apparent effect on pre-existing methotrexate nephrotoxicity.

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