Methotrexate Pharmacology

Real Life Pharmacology - Pharmacology Education for Health Care Professionals

Eric Christianson, PharmD; Pharmacology Expert and Clinical Pharmacist

Education, Health & Fitness, Medicine

5 • 716 Ratings

🗓️ 3 January 2019

⏱️ 12 minutes

🔗️ Recording | iTunes | RSS

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Summary

On this episode of the Real Life Pharmacology Podcast, I cover the pharmacology of methotrexate.

Methotrexate has a few different indications. It can be used for treatment of cancer. These doses are typically going to be much higher than standard low doses for other conditions.

Lower dose methotrexate is often used for autoimmune type conditions like rheumatoid arthritis and psoriasis.

Folic acid should be supplemented with use of methotrexate to help reduce the risk of adverse effects.

Liver toxicity and immune system suppression are two important factors to monitor in a patient taking chronic methotrexate.

I also talk about important cumulative drug interactions with methotrexate such as immunosuppressives and other agents that may impact liver function.

Be sure to listen to the end as I talk about the potential impact of methotrexate on some vaccines!

Transcript

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0:00.0	Welcome back. You're listening to the real-life pharmacology podcast with pharmacist Eric Christensen.
0:07.2	Thanks so much for listening today. Today I'm going to cover methotrexate pharmacology.
0:15.1	So methotrexate is a generic name. A couple of common brand names I've heard, rheumatrex or trexol. But again,
0:24.7	most often I think clinicians will call it methylorexate or occasionally I'll see or hear
0:32.3	the abbreviation mtX. I always discourage using abbreviations because it certainly could be interpreted as
0:41.1	potentially something else if somebody doesn't know. So yeah, just a little side note there anyway.
0:48.2	So methotrexate is kind of a unique drug in that it can be used for oncology cancer type purposes, which I'm not
0:58.5	going to talk about a ton today on the podcast. I'm going to try to give you the basics anyway.
1:04.8	More commonly, I would say what I see it used in is rheumatoid arthritis as well as psoriasis occasionally.
1:14.9	But by far I would say rheumatoid arthritis is where I see this medication used more often.
1:22.7	Now, its classification, Methatraxate, is considered a disease-modifying antiromatic drug.
1:31.5	That's kind of its classification.
1:33.7	Again, also could be classified as an oncology, anti-cancer type agent as well.
1:41.2	Now, the mechanism in psoriasis as well as methotrex, or excuse me, as well as rheumatoid arthritis,
1:51.0	is not quite as well understood as is in oncology. In the oncology setting, it blocks the
2:00.5	activity of dihydropholate reductase, which ultimately leads
2:05.6	to preventing the formation of what are called purines, which are part of DNA, and ultimately
2:14.1	stopping, slowing down appropriate DNA production production and inhibiting kind of that cell growth and proliferation, which can happen in cancer.
2:25.8	So that's kind of how it works in the cancer setting.
2:30.5	Anti-inflammatory, anti-rumatic side of things. Again, not quite as well understood, but definitely
2:39.5	thought to suppress the immune system in some way, shape, or form there. So let's talk about
2:49.3	warnings a little bit because there are some significant boxed warnings with this medication.
	...

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