Metotreksat: interakcje

An increased risk of hepatitis has been reported to result from combined use of methotrexate and etretinate. (etykieta leku Acytretyna, Przeciwwskazania)

Most patients who developed these infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids. (etykieta leku Adalimumab, Ostrzeżenie w ramce)

Most patients with rheumatoid arthritis who developed these infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids. (etykieta leku Baricytynib, Ostrzeżenie w ramce)

Unexpectedly severe and fatal gastrointestinal toxicity can occur with concomitant administration of XATMEP (primarily at high dosage) and nonsteroidal anti-inflammatory drugs (NSAIDs) [see Drug Interactions ( 7.1 )] . (etykieta leku Metotreksat, Ostrzeżenia i środki ostrożności)

Unexpectedly severe and fatal gastrointestinal toxicity can occur with concomitant administration of XATMEP (primarily at high dosage) and nonsteroidal anti-inflammatory drugs (NSAIDs) [see Drug Interactions ( 7.1 )] . (etykieta leku Metotreksat, Ostrzeżenia i środki ostrożności)

Unexpectedly severe and fatal gastrointestinal toxicity can occur with concomitant administration of XATMEP (primarily at high dosage) and nonsteroidal anti-inflammatory drugs (NSAIDs) [see Drug Interactions ( 7.1 )] . (etykieta leku Metotreksat, Ostrzeżenia i środki ostrożności)

In kidney, liver, and heart transplant patients Neoral may be administered with other immunosuppressive agents. (etykieta leku Cyklosporyna, Ostrzeżenie w ramce)

Immunosuppressant/neoplastic: everolimus Co-administration of everolimus and PREZISTA/ritonavir is not recommended. irinotecan Discontinue PREZISTA/ritonavir at least 1 week prior to starting irinotecan therapy. (etykieta leku Darunawir, Interakcje z innymi lekami)

Unexpectedly severe and fatal gastrointestinal toxicity can occur with concomitant administration of XATMEP (primarily at high dosage) and nonsteroidal anti-inflammatory drugs (NSAIDs) [see Drug Interactions ( 7.1 )] . (etykieta leku Metotreksat, Ostrzeżenia i środki ostrożności)

Unexpectedly severe and fatal gastrointestinal toxicity can occur with concomitant administration of XATMEP (primarily at high dosage) and nonsteroidal anti-inflammatory drugs (NSAIDs) [see Drug Interactions ( 7.1 )] . (etykieta leku Metotreksat, Ostrzeżenia i środki ostrożności)

Unexpectedly severe and fatal gastrointestinal toxicity can occur with concomitant administration of XATMEP (primarily at high dosage) and nonsteroidal anti-inflammatory drugs (NSAIDs) [see Drug Interactions ( 7.1 )] . (etykieta leku Metotreksat, Ostrzeżenia i środki ostrożności)

Use of KEVEYIS with drugs that are sensitive to OAT1 inhibition (e.g., methotrexate, famotidine, oseltamivir) is not recommended [see Clinical Pharmacology (12.3) ]. (etykieta leku Diklofenamid, Interakcje z innymi lekami)

Most patients who developed these infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids. (etykieta leku Etanercept, Ostrzeżenie w ramce)

Unexpectedly severe and fatal gastrointestinal toxicity can occur with concomitant administration of XATMEP (primarily at high dosage) and nonsteroidal anti-inflammatory drugs (NSAIDs) [see Drug Interactions ( 7.1 )] . (etykieta leku Metotreksat, Ostrzeżenia i środki ostrożności)

Unexpectedly severe and fatal gastrointestinal toxicity can occur with concomitant administration of XATMEP (primarily at high dosage) and nonsteroidal anti-inflammatory drugs (NSAIDs) [see Drug Interactions ( 7.1 )] . (etykieta leku Metotreksat, Ostrzeżenia i środki ostrożności)

…Prevention or Management: Phenytoin and antacids should not be taken at the same time of day Antineoplastic agents (usually in combination) Bleomycin, carboplatin, cisplatin, doxorubicin, methotrexate Antiviral agents Fosamprenavir, nelfinavir, ritonavir Antiepileptic drugs Carbamazepine, vigabatrin Other Chronic alcohol abuse, diazepam, diazoxide, folic acid, reserpine,… (etykieta leku Fenytoina, Interakcje z innymi lekami)

Chicken pox and measles, for example, can have a more serious or even fatal course in children on immunosuppressant corticosteroids. (etykieta leku Fludrokortyzon, Ostrzeżenia)

Persons who are on immunosuppressant doses of corticosteroids should be warned to avoid exposure to chickenpox or measles. (etykieta leku Flunizolid, Środki ostrożności)

Unexpectedly severe and fatal gastrointestinal toxicity can occur with concomitant administration of XATMEP (primarily at high dosage) and nonsteroidal anti-inflammatory drugs (NSAIDs) [see Drug Interactions ( 7.1 )] . (etykieta leku Metotreksat, Ostrzeżenia i środki ostrożności)

Because of foscarnet's tendency to cause renal impairment, the use of FOSCAVIR should be avoided in combination with potentially nephrotoxic drugs such as aminoglycosides, amphotericin B, cyclosporine, acyclovir, methotrexate, tacrolimus and intravenous pentamidine (see above) unless the potential benefits outweigh the risks to the patient. (etykieta leku Foskarnet, Interakcje z innymi lekami)

Unexpectedly severe and fatal gastrointestinal toxicity can occur with concomitant administration of XATMEP (primarily at high dosage) and nonsteroidal anti-inflammatory drugs (NSAIDs) [see Drug Interactions ( 7.1 )] . (etykieta leku Metotreksat, Ostrzeżenia i środki ostrożności)

Unexpectedly severe and fatal gastrointestinal toxicity can occur with concomitant administration of XATMEP (primarily at high dosage) and nonsteroidal anti-inflammatory drugs (NSAIDs) [see Drug Interactions ( 7.1 )] . (etykieta leku Metotreksat, Ostrzeżenia i środki ostrożności)

Unexpectedly severe and fatal gastrointestinal toxicity can occur with concomitant administration of XATMEP (primarily at high dosage) and nonsteroidal anti-inflammatory drugs (NSAIDs) [see Drug Interactions ( 7.1 )] . (etykieta leku Metotreksat, Ostrzeżenia i środki ostrożności)

Unexpectedly severe and fatal gastrointestinal toxicity can occur with concomitant administration of XATMEP (primarily at high dosage) and nonsteroidal anti-inflammatory drugs (NSAIDs) [see Drug Interactions ( 7.1 )] . (etykieta leku Metotreksat, Ostrzeżenia i środki ostrożności)

Most patients who developed these infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids. (etykieta leku Infliksymab, Ostrzeżenie w ramce)

Immunosuppressants Everolimus Sirolimus Temsirolimus (IV) Not recommended during and 2 weeks after TOLSURA treatment. (etykieta leku Itrakonazol, Interakcje z innymi lekami)

About 13 percent of the cases of neutropenia have ended fatally, but almost all fatalities were in patients with serious illness, having collagen vascular disease, renal failure, heart failure or immunosuppressant therapy, or a combination of these complicating factors. (etykieta leku Kaptopryl, Ostrzeżenia)

Unexpectedly severe and fatal gastrointestinal toxicity can occur with concomitant administration of XATMEP (primarily at high dosage) and nonsteroidal anti-inflammatory drugs (NSAIDs) [see Drug Interactions ( 7.1 )] . (etykieta leku Metotreksat, Ostrzeżenia i środki ostrożności)

Unexpectedly severe and fatal gastrointestinal toxicity can occur with concomitant administration of XATMEP (primarily at high dosage) and nonsteroidal anti-inflammatory drugs (NSAIDs) [see Drug Interactions ( 7.1 )] . (etykieta leku Metotreksat, Ostrzeżenia i środki ostrożności)

Prevention or Management Concomitant use with myelosuppressive or other immunosuppressive drugs is not recommended. (etykieta leku Kladrybina, Interakcje z innymi lekami)

Unexpectedly severe and fatal gastrointestinal toxicity can occur with concomitant administration of XATMEP (primarily at high dosage) and nonsteroidal anti-inflammatory drugs (NSAIDs) [see Drug Interactions ( 7.1 )] . (etykieta leku Metotreksat, Ostrzeżenia i środki ostrożności)

Unexpectedly severe and fatal gastrointestinal toxicity can occur with concomitant administration of XATMEP (primarily at high dosage) and nonsteroidal anti-inflammatory drugs (NSAIDs) [see Drug Interactions ( 7.1 )] . (etykieta leku Metotreksat, Ostrzeżenia i środki ostrożności)

Unexpectedly severe and fatal gastrointestinal toxicity can occur with concomitant administration of XATMEP (primarily at high dosage) and nonsteroidal anti-inflammatory drugs (NSAIDs) [see Drug Interactions ( 7.1 )] . (etykieta leku Metotreksat, Ostrzeżenia i środki ostrożności)

Unexpectedly severe and fatal gastrointestinal toxicity can occur with concomitant administration of XATMEP (primarily at high dosage) and nonsteroidal anti-inflammatory drugs (NSAIDs) [see Drug Interactions ( 7.1 )] . (etykieta leku Metotreksat, Ostrzeżenia i środki ostrożności)

Unexpectedly severe and fatal gastrointestinal toxicity can occur with concomitant administration of XATMEP (primarily at high dosage) and nonsteroidal anti-inflammatory drugs (NSAIDs) [see Drug Interactions ( 7.1 )] . (etykieta leku Metotreksat, Ostrzeżenia i środki ostrożności)

Unexpectedly severe and fatal gastrointestinal toxicity can occur with concomitant administration of XATMEP (primarily at high dosage) and nonsteroidal anti-inflammatory drugs (NSAIDs) [see Drug Interactions ( 7.1 )] . (etykieta leku Metotreksat, Ostrzeżenia i środki ostrożności)

Unexpectedly severe and fatal gastrointestinal toxicity can occur with concomitant administration of XATMEP (primarily at high dosage) and nonsteroidal anti-inflammatory drugs (NSAIDs) [see Drug Interactions ( 7.1 )] . (etykieta leku Metotreksat, Ostrzeżenia i środki ostrożności)

…methylergonovine • HMG-CoA reductase inhibitors: lovastatin, simvastatin (these drugs can be temporarily discontinued to allow PAXLOVID use [see Table 2 , Drug Interactions (7.3) ] ) • Immunosuppressants: voclosporin • Microsomal triglyceride transfer protein inhibitor: lomitapide • Migraine medications: eletriptan, ubrogepant • Mineralocorticoid receptor antagonists:… (etykieta leku Nirmatrelwir + rytonawir, Przeciwwskazania)

Unexpectedly severe and fatal gastrointestinal toxicity can occur with concomitant administration of XATMEP (primarily at high dosage) and nonsteroidal anti-inflammatory drugs (NSAIDs) [see Drug Interactions ( 7.1 )] . (etykieta leku Metotreksat, Ostrzeżenia i środki ostrożności)

Unexpectedly severe and fatal gastrointestinal toxicity can occur with concomitant administration of XATMEP (primarily at high dosage) and nonsteroidal anti-inflammatory drugs (NSAIDs) [see Drug Interactions ( 7.1 )] . (etykieta leku Metotreksat, Ostrzeżenia i środki ostrożności)

Unexpectedly severe and fatal gastrointestinal toxicity can occur with concomitant administration of XATMEP (primarily at high dosage) and nonsteroidal anti-inflammatory drugs (NSAIDs) [see Drug Interactions ( 7.1 )] . (etykieta leku Metotreksat, Ostrzeżenia i środki ostrożności)

Unexpectedly severe and fatal gastrointestinal toxicity can occur with concomitant administration of XATMEP (primarily at high dosage) and nonsteroidal anti-inflammatory drugs (NSAIDs) [see Drug Interactions ( 7.1 )] . (etykieta leku Metotreksat, Ostrzeżenia i środki ostrożności)

Unexpectedly severe and fatal gastrointestinal toxicity can occur with concomitant administration of XATMEP (primarily at high dosage) and nonsteroidal anti-inflammatory drugs (NSAIDs) [see Drug Interactions ( 7.1 )] . (etykieta leku Metotreksat, Ostrzeżenia i środki ostrożności)

Dihydrofolate Reductase (DHFR) Inhibitors : Avoid concomitant use (e.g., trimethoprim, methotrexate, trimetrexate, pemetrexed, pralatrexate, raltitrexed, or piritrexim). (etykieta leku Sepiapteryna, Interakcje z innymi lekami)

Coadministration of VOSEVI with BCRP substrates (e.g., methotrexate, mitoxantrone, imatinib, irinotecan, lapatinib, rosuvastatin, sulfasalazine, topotecan) is not recommended [see Clinical Pharmacology (12.3) ]. (etykieta leku Sofosbuwir + welpataswir, Interakcje z innymi lekami)

Unexpectedly severe and fatal gastrointestinal toxicity can occur with concomitant administration of XATMEP (primarily at high dosage) and nonsteroidal anti-inflammatory drugs (NSAIDs) [see Drug Interactions ( 7.1 )] . (etykieta leku Metotreksat, Ostrzeżenia i środki ostrożności)

Unexpectedly severe and fatal gastrointestinal toxicity can occur with concomitant administration of XATMEP (primarily at high dosage) and nonsteroidal anti-inflammatory drugs (NSAIDs) [see Drug Interactions ( 7.1 )] . (etykieta leku Metotreksat, Ostrzeżenia i środki ostrożności)

…IN TRANSPLANT PATIENTS; AND INCREASED MORTALITY IN FEMALE LIVER TRANSPLANT PATIENTS • Increased risk for developing serious infections and malignancies with ASTAGRAF XL ® or other immunosuppressants that may lead to hospitalization or death. [see Warnings and Precautions ( 5.1 , 5.2 )] • Increased mortality in female liver transplant patients with ASTAGRAF XL. (etykieta leku Takrolimus, Ostrzeżenie w ramce)

Most patients who developed these infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids. (etykieta leku Tocilizumab, Ostrzeżenie w ramce)

Most patients who developed these infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids. (etykieta leku Tofacytynib, Ostrzeżenie w ramce)

Unexpectedly severe and fatal gastrointestinal toxicity can occur with concomitant administration of XATMEP (primarily at high dosage) and nonsteroidal anti-inflammatory drugs (NSAIDs) [see Drug Interactions ( 7.1 )] . (etykieta leku Metotreksat, Ostrzeżenia i środki ostrożności)

Most patients who developed these infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids. (etykieta leku Upadacytynib, Ostrzeżenie w ramce)

Monitor patients receiving XATMEP with other potential hepatotoxins (e.g., azathioprine, retinoids, and sulfasalazine) for possible signs of hepatotoxicity. (etykieta leku Metotreksat, Interakcje z innymi lekami)

Effect of XATMEP on Other Drugs Theophylline Methotrexate may decrease the clearance of theophylline. (etykieta leku Metotreksat, Interakcje z innymi lekami)

Effect of XATMEP on Other Drugs Theophylline Methotrexate may decrease the clearance of theophylline. (etykieta leku Metotreksat, Interakcje z innymi lekami)

Immunosuppressants Amlodipine may increase the systemic exposure of cyclosporine or tacrolimus when co-administered. (etykieta leku Amlodypina, Interakcje z innymi lekami)

Impact of Amlodipine on Other Drugs Immunosuppressants Amlodipine may increase the systemic exposure of cyclosporine or tacrolimus when co-administered. (etykieta leku Amlodypina + atorwastatyna, Interakcje z innymi lekami)

Immunosuppressants: Amlodipine may increase the systemic exposure of cyclosporine or tacrolimus when co-administered. (etykieta leku Amlodypina + olmesartan, Interakcje z innymi lekami)

Immunosuppressants Amlodipine may increase the systemic exposure of cyclosporine or tacrolimus when coadministered. (etykieta leku Amlodypina + walsartan, Interakcje z innymi lekami)

Effect of Other Drugs on XATMEP Oral Antibiotics Penicillins may reduce the renal clearance of methotrexate; increased serum concentrations of methotrexate with concomitant hematologic and gastrointestinal toxicity have been observed with methotrexate. (etykieta leku Metotreksat, Interakcje z innymi lekami)

Effect of Other Drugs on XATMEP Oral Antibiotics Penicillins may reduce the renal clearance of methotrexate; increased serum concentrations of methotrexate with concomitant hematologic and gastrointestinal toxicity have been observed with methotrexate. (etykieta leku Metotreksat, Interakcje z innymi lekami)

Effect of Other Drugs on XATMEP Oral Antibiotics Penicillins may reduce the renal clearance of methotrexate; increased serum concentrations of methotrexate with concomitant hematologic and gastrointestinal toxicity have been observed with methotrexate. (etykieta leku Metotreksat, Interakcje z innymi lekami)

Effect of Other Drugs on XATMEP Oral Antibiotics Penicillins may reduce the renal clearance of methotrexate; increased serum concentrations of methotrexate with concomitant hematologic and gastrointestinal toxicity have been observed with methotrexate. (etykieta leku Metotreksat, Interakcje z innymi lekami)

Immunosuppressants: cyclosporine, sirolimus, tacrolimus ↑ immunosuppressants Therapeutic concentration monitoring is recommended for these immunosuppressants when coadministered with REYATAZ. (etykieta leku Atazanawir, Interakcje z innymi lekami)

Monitor patients receiving XATMEP with other potential hepatotoxins (e.g., azathioprine, retinoids, and sulfasalazine) for possible signs of hepatotoxicity. (etykieta leku Metotreksat, Interakcje z innymi lekami)

NSAIDs, Aspirin, and Steroids: May elevate and prolong serum methotrexate levels and increase gastrointestinal toxicity. (etykieta leku Metotreksat, Interakcje z innymi lekami)

Caution should be used when NSAIDs and salicylates are administered concomitantly with lower doses of methotrexate, including XATMEP. (etykieta leku Metotreksat, Interakcje z innymi lekami)

NSAIDs, Aspirin, and Steroids: May elevate and prolong serum methotrexate levels and increase gastrointestinal toxicity. (etykieta leku Metotreksat, Interakcje z innymi lekami)

Monitor patients receiving XATMEP with other potential hepatotoxins (e.g., azathioprine, retinoids, and sulfasalazine) for possible signs of hepatotoxicity. (etykieta leku Metotreksat, Interakcje z innymi lekami)

Antineoplastic agents (e.g., cyclophosphamide, methotrexate) : Concomitant use of thiazide diuretics may reduce renal excretion of cytotoxic agents and enhance their myelosuppressive effects. (etykieta leku Benazepryl + hydrochlorotiazyd, Interakcje z innymi lekami)

Consider discontinuation or reduction of any concomitant chemotherapy or immunosuppressive therapy in patients who develop PML. (etykieta leku Bendamustyna, Ostrzeżenia i środki ostrożności)

Effect of Other Drugs on XATMEP Oral Antibiotics Penicillins may reduce the renal clearance of methotrexate; increased serum concentrations of methotrexate with concomitant hematologic and gastrointestinal toxicity have been observed with methotrexate. (etykieta leku Metotreksat, Interakcje z innymi lekami)

NSAIDs, Aspirin, and Steroids: May elevate and prolong serum methotrexate levels and increase gastrointestinal toxicity. (etykieta leku Metotreksat, Interakcje z innymi lekami)

NSAIDs, Aspirin, and Steroids: May elevate and prolong serum methotrexate levels and increase gastrointestinal toxicity. (etykieta leku Metotreksat, Interakcje z innymi lekami)

NSAIDs, Aspirin, and Steroids: May elevate and prolong serum methotrexate levels and increase gastrointestinal toxicity. (etykieta leku Metotreksat, Interakcje z innymi lekami)

Effect of XATMEP on Other Drugs Theophylline Methotrexate may decrease the clearance of theophylline. (etykieta leku Metotreksat, Interakcje z innymi lekami)

Effect of XATMEP on Other Drugs Theophylline Methotrexate may decrease the clearance of theophylline. (etykieta leku Metotreksat, Interakcje z innymi lekami)

NSAIDs, Aspirin, and Steroids: May elevate and prolong serum methotrexate levels and increase gastrointestinal toxicity. (etykieta leku Metotreksat, Interakcje z innymi lekami)

Methotrexate Use with caution Inhibition of methotrexate renal tubular transport potentially leading to increased methotrexate plasma levels Potential increase in the risk of methotrexate associated toxic reactions. (etykieta leku Cyprofloksacyna, Interakcje z innymi lekami)

Therapeutic drug monitoring is recommended with concomitant use Immunosuppressant /neoplastic: everolimus ↑ immunosuppressants Co-administration of everolimus and PREZCOBIX or PREZCOBIX PED is not recommended. irinotecan Discontinue PREZCOBIX or PREZCOBIX PED at least 1 week prior to starting irinotecan therapy. (etykieta leku Darunawir + kobicystat, Interakcje z innymi lekami)

Hepatotoxic medications, such as high-dose methotrexate, may impair liver function and increase the risk of toxicity. (etykieta leku Daunorubicyna, Interakcje z innymi lekami)

NSAIDs, Aspirin, and Steroids: May elevate and prolong serum methotrexate levels and increase gastrointestinal toxicity. (etykieta leku Metotreksat, Interakcje z innymi lekami)

NSAIDs, Aspirin, and Steroids: May elevate and prolong serum methotrexate levels and increase gastrointestinal toxicity. (etykieta leku Metotreksat, Interakcje z innymi lekami)

Interaction with Methotrexate : Concomitant use with PPIs may elevate and/or prolong serum concentrations of methotrexate and/or its metabolite, possibly leading to toxicity. (etykieta leku Dekslanzoprazol, Ostrzeżenia i środki ostrożności)

Other risk factors for the development of ONJ include immunosuppressive therapy, treatment with angiogenesis inhibitors, systemic corticosteroids, diabetes, and gingival infections. (etykieta leku Denosumab, Ostrzeżenia i środki ostrożności)

NSAIDs, Aspirin, and Steroids: May elevate and prolong serum methotrexate levels and increase gastrointestinal toxicity. (etykieta leku Metotreksat, Interakcje z innymi lekami)

Effect of Other Drugs on XATMEP Oral Antibiotics Penicillins may reduce the renal clearance of methotrexate; increased serum concentrations of methotrexate with concomitant hematologic and gastrointestinal toxicity have been observed with methotrexate. (etykieta leku Metotreksat, Interakcje z innymi lekami)

Aspirin, carbapenem antibiotics, estrogen-containing hormonal contraceptives, methotrexate: Monitoring of valproate concentrations is recommended ( 7.1 ) (etykieta leku Diwalproeks (walproinian), Interakcje z innymi lekami)

Immunosuppressants: Cyclosporine, tacrolimus, sirolimus and others metabolized by CYP3A ↓ immunosuppressant Dose adjustments of the immunosuppressant may be required. (etykieta leku Efawirenz, Interakcje z innymi lekami)

Immunosuppressants: Cyclosporine, tacrolimus, sirolimus, and others metabolized by CYP3A ↓ immunosuppressant Dose adjustments of the immunosuppressant may be required. (etykieta leku Efawirenz + lamiwudyna + tenofowir, Interakcje z innymi lekami)

…(e.g., atorvastatin, bosentan, ezetimibe, fluvastatin, glyburide, olmesartan, pitavastatin, pravastatin, rosuvastatin, repaglinide, rifampin, simvastatin acid, SN-38 [active metabolite of irinotecan], valsartan) or breast cancer resistance protein (BCRP) (e.g., imatinib, irinotecan, lapatinib, methotrexate, mitoxantrone, rosuvastatin, sulfasalazine, topotecan). (etykieta leku Eltrombopag, Interakcje z innymi lekami)

Immuno-suppressants: e.g., cyclosporine (CsA) sirolimus tacrolimus ↑ immuno-suppressants ↑ elvitegravir (with CsA) ↑ cobicistat (with CsA) Therapeutic monitoring of the immunosuppressive agents is recommended upon coadministration with GENVOYA. (etykieta leku Elwitegrawir + kobicystat + emtrycytabina + tenofowir, Interakcje z innymi lekami)

Effect of XATMEP on Other Drugs Theophylline Methotrexate may decrease the clearance of theophylline. (etykieta leku Metotreksat, Interakcje z innymi lekami)

Immunosuppressants : cyclosporine sirolimus tacrolimus ↓ immunosuppressant Etravirine and systemic immunosuppressants should be co-administered with caution because plasma concentrations of cyclosporine, sirolimus, or tacrolimus may be affected. (etykieta leku Etrawiryna, Interakcje z innymi lekami)

• Interaction with Methotrexate : Concomitant use with PPIs may elevate and/or prolong serum concentrations of methotrexate and/or its metabolite, possibly leading to toxicity. (etykieta leku Ezomeprazol, Ostrzeżenia i środki ostrożności)

Effect of XATMEP on Other Drugs Theophylline Methotrexate may decrease the clearance of theophylline. (etykieta leku Metotreksat, Interakcje z innymi lekami)

Immunosuppressants Clinical Impact: Immunosuppressants such as cyclosporine and tacrolimus can produce nephrotoxicity with decreases in creatinine clearance and rises in serum creatinine, and because renal excretion is the primary elimination route of fibrate drugs including fenofibrate, there is a risk that an interaction will lead to deterioration of renal… (etykieta leku Fenofibrat, Interakcje z innymi lekami)

Effect of Other Drugs on XATMEP Oral Antibiotics Penicillins may reduce the renal clearance of methotrexate; increased serum concentrations of methotrexate with concomitant hematologic and gastrointestinal toxicity have been observed with methotrexate. (etykieta leku Metotreksat, Interakcje z innymi lekami)

NSAIDs, Aspirin, and Steroids: May elevate and prolong serum methotrexate levels and increase gastrointestinal toxicity. (etykieta leku Metotreksat, Interakcje z innymi lekami)

NSAIDs, Aspirin, and Steroids: May elevate and prolong serum methotrexate levels and increase gastrointestinal toxicity. (etykieta leku Metotreksat, Interakcje z innymi lekami)

NSAIDs, Aspirin, and Steroids: May elevate and prolong serum methotrexate levels and increase gastrointestinal toxicity. (etykieta leku Metotreksat, Interakcje z innymi lekami)

Immunosuppressants: Cyclosporine, tacrolimus, sirolimus ↑ Immunosuppressants Therapeutic concentration monitoring is recommended for immunosuppressant agents. (etykieta leku Fosamprenawir, Interakcje z innymi lekami)

…ticlopidine, tolbutamide, trazodone, warfarin Drugs that may decrease phenytoin serum levels Antineoplastic agents usually in combination Bleomycin, carboplatin, cisplatin, doxorubicin, methotrexate Antiviral agents Fosamprenavir, nelfinavir, ritonavir Antiepileptic drugs Carbamazepine, vigabatrin Other Chronic alcohol abuse, diazepam, diazoxide, folic acid, reserpine,… (etykieta leku Fosfenytoina, Interakcje z innymi lekami)

Methotrexate and other drugs undergoing renal tubular secretion Furosemide may decrease renal elimination of other drugs that undergo tubular secretion. (etykieta leku Furosemid, Interakcje z innymi lekami)

NSAIDs, Aspirin, and Steroids: May elevate and prolong serum methotrexate levels and increase gastrointestinal toxicity. (etykieta leku Metotreksat, Interakcje z innymi lekami)

NSAIDs, Aspirin, and Steroids: May elevate and prolong serum methotrexate levels and increase gastrointestinal toxicity. (etykieta leku Metotreksat, Interakcje z innymi lekami)

Methotrexate Concomitant use of PLAQUENIL and methotrexate may increase the incidence of adverse reactions. (etykieta leku Hydroksychlorochina, Interakcje z innymi lekami)

Gleevec may delay the clearance of methotrexate when methotrexate is used at high doses (> 500 mg/m 2 ). (etykieta leku Imatynib, Interakcje z innymi lekami)

Monitor patients receiving XATMEP with other potential hepatotoxins (e.g., azathioprine, retinoids, and sulfasalazine) for possible signs of hepatotoxicity. (etykieta leku Metotreksat, Interakcje z innymi lekami)

Cytotoxic products – Thiazides may reduce the renal excretion of cytotoxic medicinal products (e.g. cyclophosphamide, methotrexate) and potentiate their myelosuppressive effects. (etykieta leku Kandesartan + hydrochlorotiazyd, Interakcje z innymi lekami)

Closely monitor for signs of renal toxicity when XELODA is used concomitantly with nephrotoxic drugs (e.g. platinum salts, irinotecan, methotrexate, intravenous bisphosphonates). (etykieta leku Kapecytabina, Interakcje z innymi lekami)

Immunosuppressants everolimus, rapamycin (also known as sirolimus), temsirolimus budesonide, ciclesonide, cyclosporine, dexamethasone, fluticasone, methylprednisolone, tacrolimus Rapamycin (sirolimus): Ketoconazole tablets 200 mg daily for 10 days increased the C max and AUC of a single 5 mg dose of sirolimus by 4.3 fold and 10.9 fold, respectively in 23 healthy… (etykieta leku Ketokonazol, Interakcje z innymi lekami)

NSAIDs, Aspirin, and Steroids: May elevate and prolong serum methotrexate levels and increase gastrointestinal toxicity. (etykieta leku Metotreksat, Interakcje z innymi lekami)

Frequent PT/INR determinations are advisable until it has been definitely determined that the PT/INR has stabilized Immunosuppressants Clinical Impact: Immunosuppressants such as cyclosporine and tacrolimus can produce nephrotoxicity with decreases in creatinine clearance and rises in serum creatinine, and because renal excretion is the primary elimination route… (etykieta leku Kwas fenofibrowy, Interakcje z innymi lekami)

Nitrous Oxide The use of nitrous oxide anesthesia potentiates the effect of methotrexate on folate-dependent metabolic pathways, resulting in the potential for increase toxicity. (etykieta leku Metotreksat, Interakcje z innymi lekami)

Interaction with Methotrexate : Concomitant use with PPIs may elevate and/or prolong serum concentrations of methotrexate and/or its metabolite, possibly leading to toxicity. (etykieta leku Lanzoprazol, Ostrzeżenia i środki ostrożności)

HBV reactivation has also been reported in patients receiving certain immunosuppressants or chemotherapeutic agents; the risk of HBV reactivation associated with treatment with HCV direct-acting antivirals may be increased in these patients. (etykieta leku Ledipaswir + sofosbuwir, Ostrzeżenia i środki ostrożności)

If ARAVA and methotrexate are given concomitantly, follow the American College of Rheumatology (ACR) guidelines for monitoring methotrexate liver toxicity with ALT, AST, and serum albumin testing. (etykieta leku Leflunomid, Ostrzeżenia i środki ostrożności)

Caution should be exercised when JUXTAPID is used with other medications known to have potential for hepatotoxicity, such as isotretinoin, amiodarone, acetaminophen (>4 g/day for ≥3 days/week), methotrexate, tetracyclines, and tamoxifen. (etykieta leku Lomitapid, Ostrzeżenia i środki ostrożności)

Immunosuppressants: e.g. cyclosporine, tacrolimus, sirolimus ↑ immunosuppressants Therapeutic concentration monitoring is recommended for immunosuppressant agents when co-administered with KALETRA. (etykieta leku Lopinawir + rytonawir, Interakcje z innymi lekami)

Caution should be used when NSAIDs and salicylates are administered concomitantly with lower doses of methotrexate, including XATMEP. (etykieta leku Metotreksat, Interakcje z innymi lekami)

A treatment regimen containing multiple immunosuppressants (including thiopurines) should therefore be used with caution as this could lead to lymphoproliferative disorders, some with reported fatalities. (etykieta leku Merkaptopuryna, Ostrzeżenia i środki ostrożności)

Caution should be used when NSAIDs and salicylates are administered concomitantly with lower doses of methotrexate, including XATMEP. (etykieta leku Metotreksat, Interakcje z innymi lekami)

NSAIDs, Aspirin, and Steroids: May elevate and prolong serum methotrexate levels and increase gastrointestinal toxicity. (etykieta leku Metotreksat, Interakcje z innymi lekami)

NSAIDs, Aspirin, and Steroids: May elevate and prolong serum methotrexate levels and increase gastrointestinal toxicity. (etykieta leku Metotreksat, Interakcje z innymi lekami)

Lymphoma and Other Malignancies Patients receiving immunosuppressants, including mycophenolate mofetil, are at increased risk of developing lymphomas and other malignancies, particularly of the skin [see Adverse Reactions ( 6.1 )]. (etykieta leku Mykofenolan, Ostrzeżenia i środki ostrożności)

Effect of Other Drugs on XATMEP Oral Antibiotics Penicillins may reduce the renal clearance of methotrexate; increased serum concentrations of methotrexate with concomitant hematologic and gastrointestinal toxicity have been observed with methotrexate. (etykieta leku Metotreksat, Interakcje z innymi lekami)

…infections, Crohn’s disease patients receiving natalizumab products should not be treated with concomitant immunosuppressants (e.g., 6‑ mercaptopurine, azathioprine, cyclosporine, or methotrexate) or inhibitors of TNF-α, and corticosteroids should be tapered in those patients with Crohn’s disease who are on chronic corticosteroids when they start TYRUKO therapy… (etykieta leku Natalizumab, Interakcje z innymi lekami)

Immunosuppressive Agents There have been reports of increased blood concentrations of cyclosporine and tacrolimus into toxic ranges when patients received these drugs concomitantly with nefazodone. (etykieta leku Nefazodon, Interakcje z innymi lekami)

Immunosuppressants: Cyclosporine, tacrolimus, sirolimus Plasma concentrations may be decreased. (etykieta leku Newirapina, Interakcje z innymi lekami)

OAT1/OAT3 Substrates (e.g., adefovir, ganciclovir, methotrexate) Clinical Impact Increased exposure of the interacting drug. [see Clinical Pharmacology ( 12.3 )] Prevention or Management Monitor for potential adverse reactions related to the co-administered drug. (etykieta leku Nityzynon, Interakcje z innymi lekami)

Effect of Other Drugs on XATMEP Oral Antibiotics Penicillins may reduce the renal clearance of methotrexate; increased serum concentrations of methotrexate with concomitant hematologic and gastrointestinal toxicity have been observed with methotrexate. (etykieta leku Metotreksat, Interakcje z innymi lekami)

Immunosuppressants: Amlodipine may increase the systemic exposure of cyclosporine or tacrolimus when co-administered. (etykieta leku Olmesartan + amlodypina + hydrochlorotiazyd, Interakcje z innymi lekami)

NSAIDs, Aspirin, and Steroids: May elevate and prolong serum methotrexate levels and increase gastrointestinal toxicity. (etykieta leku Metotreksat, Interakcje z innymi lekami)

• Interaction with Methotrexate : Concomitant use with PPIs may elevate and/or prolong serum concentrations of methotrexate and/or its metabolite, possibly leading to toxicity. (etykieta leku Omeprazol, Ostrzeżenia i środki ostrożności)

Interaction with Methotrexate : Concomitant use with PPIs may elevate and/or prolong serum concentrations of methotrexate and/or its metabolite, possibly leading to toxicity. (etykieta leku Omeprazol + wodorowęglan sodu, Ostrzeżenia i środki ostrożności)

In a crossover trial in 76 pediatric patients, intravenous ondansetron did not increase blood levels of high-dose methotrexate. (etykieta leku Ondansetron, Interakcje z innymi lekami)

Concomitant Use of PROTONIX I.V. with Methotrexate Literature suggests that concomitant use of PPIs with methotrexate (primarily at high dose; see methotrexate prescribing information) may elevate and prolong serum levels of methotrexate and/or its metabolite, possibly leading to methotrexate toxicities. (etykieta leku Pantoprazol, Ostrzeżenia i środki ostrożności)

Treatment has consisted of high doses of corticosteroids alone or, in some cases, concomitantly with an immunosuppressant. (etykieta leku Penicylamina, Ostrzeżenia)

Effect of XATMEP on Other Drugs Theophylline Methotrexate may decrease the clearance of theophylline. (etykieta leku Metotreksat, Interakcje z innymi lekami)

Effect of Other Drugs on XATMEP Oral Antibiotics Penicillins may reduce the renal clearance of methotrexate; increased serum concentrations of methotrexate with concomitant hematologic and gastrointestinal toxicity have been observed with methotrexate. (etykieta leku Metotreksat, Interakcje z innymi lekami)

However, the concomitant use of other antifolic drugs or agents associated with myelosuppression including sulfonamides or trimethoprim- sulfamethoxazole combinations, proguanil, zidovudine, or cytostatic agents (e.g., methotrexate), while the patient is receiving pyrimethamine, may increase the risk of bone marrow suppression. (etykieta leku Pirymetamina, Interakcje z innymi lekami)

NSAIDs, Aspirin, and Steroids: May elevate and prolong serum methotrexate levels and increase gastrointestinal toxicity. (etykieta leku Metotreksat, Interakcje z innymi lekami)

NSAIDs, Aspirin, and Steroids: May elevate and prolong serum methotrexate levels and increase gastrointestinal toxicity. (etykieta leku Metotreksat, Interakcje z innymi lekami)

Probenecid Probenecid may reduce renal elimination of methotrexate. (etykieta leku Metotreksat, Interakcje z innymi lekami)

Probenecid Probenecid may reduce renal elimination of methotrexate. (etykieta leku Metotreksat, Interakcje z innymi lekami)

Interaction with Methotrexate : Concomitant use with PPIs may elevate and/or prolong serum concentrations of methotrexate and/or its metabolite, possibly leading to toxicity. (etykieta leku Rabeprazol, Ostrzeżenia i środki ostrożności)

BCRP Substrates with a Narrow Therapeutic Index (e.g., methotrexate, topotecan, or irinotecan) Clinical Impact: Increased plasma concentrations of BCRP substrates (e.g., methotrexate, topotecan, or irinotecan) may result in potential adverse reactions [see Clinical Pharmacology (12.3) ]. (etykieta leku Rolapitant, Interakcje z innymi lekami)

Glipizide Decrease exposure Immunosuppressive Agents Cyclosporine Decrease exposure Tacrolimus Prevention or Management: Monitoring of whole blood concentrations and appropriate dosage adjustments of tacrolimus are recommended when rifampin and tacrolimus are used concomitantly. (etykieta leku Ryfampicyna, Interakcje z innymi lekami)

…Digoxin Corticosteroids Prednisone Fibrates Clofibrate Oral Hypoglycemics Sulfonylureas (e.g., glyburide, glipizide) Hormonal Contraceptives/Progestins Ethinyl estradiol, levonorgestrel Immunosuppressants Cyclosporine, tacrolimus Methylxanthines Theophylline Narcotic analgesics Methadone Phosphodiesterase-5 (PDE-5) Inhibitors Sildenafil Thyroid preparations Levothyroxine… (etykieta leku Ryfapentyna, Interakcje z innymi lekami)

Immunosuppressants: cyclosporine, tacrolimus, sirolimus (rapamycin) ↑ immunosuppressants Therapeutic concentration monitoring is recommended for immunosuppressant agents when co-administered with ritonavir. (etykieta leku Rytonawir, Interakcje z innymi lekami)

Inhibitors of Folate Synthesis (e.g., methotrexate, valproic acid, phenobarbital, trimethoprim) Clinical Impact In vitro and in vivo nonclinical data suggest that drugs that inhibit folate synthesis may decrease the bioavailability of endogenous BH4 by inhibiting the enzyme dihydrofolate reductase, which is involved in the recycling (regeneration) of BH4. (etykieta leku Sapropteryna, Interakcje z innymi lekami)

Drug Interactions Administration of a sulfonamide may increase the effect of oral anticoagulants and methotrexate, probably by displacement of these drugs from binding sites on plasma albumin. (etykieta leku Sulfadiazyna, Interakcje z innymi lekami)

Trimethoprim/sulfamethoxazole has been reported to increase bone marrow suppression in patients receiving methotrexate. (etykieta leku Metotreksat, Interakcje z innymi lekami)

Monitor patients receiving XATMEP with other potential hepatotoxins (e.g., azathioprine, retinoids, and sulfasalazine) for possible signs of hepatotoxicity. (etykieta leku Metotreksat, Interakcje z innymi lekami)

Immunosuppressants: Amlodipine may increase the systemic exposure of cyclosporine or tacrolimus when co-administered. (etykieta leku Telmisartan + amlodypina, Interakcje z innymi lekami)

Prophylaxis of PJP should be considered when concomitant use of corticosteroids or other immunosuppressive agents are required. (etykieta leku Temsyrolimus, Ostrzeżenia i środki ostrożności)

Effect of XATMEP on Other Drugs Theophylline Methotrexate may decrease the clearance of theophylline. (etykieta leku Metotreksat, Interakcje z innymi lekami)

In patients taking AUBAGIO, exposure of drugs which are OAT3 substrates (e.g., cefaclor, cimetidine, ciprofloxacin, penicillin G, ketoprofen, furosemide, methotrexate, zidovudine) may be increased. (etykieta leku Teryflunomid, Interakcje z innymi lekami)

Monitor patients receiving XATMEP with other potential hepatotoxins (e.g., azathioprine, retinoids, and sulfasalazine) for possible signs of hepatotoxicity. (etykieta leku Metotreksat, Interakcje z innymi lekami)

NSAIDs, Aspirin, and Steroids: May elevate and prolong serum methotrexate levels and increase gastrointestinal toxicity. (etykieta leku Metotreksat, Interakcje z innymi lekami)

Trimethoprim/sulfamethoxazole has been reported to increase bone marrow suppression in patients receiving methotrexate. (etykieta leku Metotreksat, Interakcje z innymi lekami)

Cyclosporine, tacrolimus: Monitor for toxicities of these immunosuppressive drugs ( 7.1 ) (etykieta leku Tynidazol, Interakcje z innymi lekami)

In addition, voriconazole has been associated with photosensitivity related skin reactions such as pseudoporphyria, cheilitis, and cutaneous lupus erythematosus, as well as increased risk of skin toxicity with concomitant use of methotrexate, a drug associated with ultraviolet (UV) reactivation. (etykieta leku Worykonazol, Ostrzeżenia i środki ostrożności)

Caution should be used when NSAIDs and salicylates are administered concomitantly with lower doses of methotrexate, including XATMEP. (etykieta leku Metotreksat, Interakcje z innymi lekami)

Thirty-four patients were treated with corticosteroids and one patient was treated with a non-steroidal immunosuppressant. (etykieta leku Aksytynib, Ostrzeżenia i środki ostrożności)

IMNM is characterized by proximal muscle weakness and elevated serum creatine kinase that persists despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody; muscle biopsy showing necrotizing myopathy; and improvement with immunosuppressive agents. (etykieta leku Atorwastatyna, Ostrzeżenia i środki ostrożności)

…Probenecid Probenecid is known to interact with the metabolism or renal tubular excretion of many drugs (e.g., acetaminophen, acyclovir, angiotensin-converting enzyme inhibitors, aminosalicylic acid, barbiturates, benzodiazepines, bumetanide, clofibrate, methotrexate, famotidine, furosemide, nonsteroidal anti-inflammatory agents, theophylline, and zidovudine). (etykieta leku Cydofowir, Interakcje z innymi lekami)

Administer prophylaxis for PJP when concomitant use of corticosteroids or other immunosuppressive agents are required. (etykieta leku Ewerolimus, Ostrzeżenia i środki ostrożności)

IMNM is characterized by proximal muscle weakness and elevated serum creatine kinase that persist despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody; muscle biopsy showing necrotizing myopathy without significant inflammation; and improvement with immunosuppressive agents. (etykieta leku Ezetymib + symwastatyna, Ostrzeżenia i środki ostrożności)

IMNM is characterized by proximal muscle weakness and elevated serum CK, which persist despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody, muscle biopsy showing necrotizing myopathy, and improvement with immunosuppressive agents. (etykieta leku Fluwastatyna, Ostrzeżenia i środki ostrożności)

IMNM is characterized by: proximal muscle weakness and elevated serum creatine kinase, which persist despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody; muscle biopsy showing necrotizing myopathy; and improvement with immunosuppressive agents. (etykieta leku Lowastatyna, Ostrzeżenia)

Oral neomycin inhibits the gastrointestinal absorption of penicillin V, oral vitamin B-12, methotrexate and 5-fluorouracil. (etykieta leku Neomycyna, Interakcje z innymi lekami)

Immunosuppressive Drugs Tacrolimus: Tacrolimus has been shown to be metabolized via the CYP3A system. (etykieta leku Nifedypina, Środki ostrożności)

…performed, the following concomitant drugs were used in at least 10% of patients in either or both Sjogren's efficacy studies: acetylsalicylic acid, artificial tears, calcium, conjugated estrogens, hydroxychloroquine sulfate, ibuprofen, levothyroxine sodium, medroxyprogesterone acetate, methotrexate, multivitamins, naproxen, omeprazole, paracetamol, and prednisone. (etykieta leku Pilokarpina, Interakcje z innymi lekami)

IMNM is characterized by proximal muscle weakness and elevated serum creatine kinase that persist despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody; muscle biopsy showing necrotizing myopathy; and improvement with immunosuppressive agents. (etykieta leku Pitawastatyna, Ostrzeżenia i środki ostrożności)

CYP3A Substrates Immunosuppressants that are CYP3A4 Substrates Mechanism and Clinical Effect(s) Posaconazole is a strong CYP3A4 inhibitor. (etykieta leku Pozakonazol, Interakcje z innymi lekami)

IMNM is characterized by proximal muscle weakness and elevated serum creatine kinase that persist despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody; muscle biopsy showing necrotizing myopathy; and improvement with immunosuppressive agents. (etykieta leku Prawastatyna, Ostrzeżenia i środki ostrożności)

In some cases, vasculitis resolved/improved with drug discontinuation; however, more severe cases required treatment with additional measures including corticosteroids, immunosuppressant therapy, and plasmapheresis. (etykieta leku Propylotiouracyl, Ostrzeżenia)

IMNM is characterized by proximal muscle weakness and elevated serum creatine kinase that persist despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody; muscle biopsy showing necrotizing myopathy; and improvement with immunosuppressive agents. (etykieta leku Rozuwastatyna, Ostrzeżenia i środki ostrożności)

The effect of rituximab on immune responses was assessed in a randomized, controlled study in patients with RA treated with rituximab and methotrexate (MTX) compared to patients treated with MTX alone. (etykieta leku Rytuksymab, Ostrzeżenia i środki ostrożności)

IMNM is characterized by proximal muscle weakness and elevated serum creatine kinase that persist despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody; muscle biopsy showing necrotizing myopathy without significant inflammation; and improvement with immunosuppressive agents. (etykieta leku Symwastatyna, Ostrzeżenia i środki ostrożności)

In some cases, vasculitis resolved/improved with drug discontinuation; however, more severe cases required treatment with additional measures including corticosteroids, immunosuppressant therapy, and plasmapheresis. (etykieta leku Tiamazol, Ostrzeżenia)

…Repaglinide, Rosiglitazone: [See Warnings and Precautions ( 5.4 ) and Adverse Reactions ( 6.2 )] Insulin Insulin: [See Warnings and Precautions ( 5.4 ) and Adverse Reactions ( 6.2 )] Immunosuppressants: Cyclosporine Use With Caution Cyclosporine: There have been spontaneous or published reports of CYP3A based interactions of clarithromycin with cyclosporine. (etykieta leku Klarytromycyna, Interakcje z innymi lekami)