Low doses of methotrexate can suppress bone marrow

Low dose methotrexate is a preferred treatment in rheumatoid arthritis, as well as treatment for psoriasis. It is usually effective and well tolerated and may even prolong survival in patients with rheumatoid arthritis. However, it can be associated with life threatening bone marrow suppression, particularly when taken in combination with trimethoprim or certain other drugs, or when a dosage error is made. Sosin and Handa (p 266) present three cases of these complications, including one which resulted in death, and remind doctors to check for interactions when prescribing any other drug for patients receiving methotrexate. Regular monitoring of blood counts is helpful in picking up some cases of early toxicity but may not prevent all episodes of bone marrow suppression.

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Lesson of the week: Low dose methotrexate and bone marrow suppression

Michael Sosin and Sunil Handa
BMJ 2003 326: 266-267. [Extract] [Full Text] [PDF]