Methotrexate (Rheumatrex®) is used dermatologically for the treatment of severe recalcitrant psoriasis; less commonly for the treatment of immune mediated bullous disorders and other conditions.
- Blood dyscrasia, cytopenia
- Liver disease
- Active infectious disease
- Methotrexate therapy carries a very real risk of significant hepatic toxicity. Its use should be judged in relationship to the clinical problem, and to the risks and benefits of alternative therapy.
- Toxicity can be enhanced by the use of concomitant medications such as aspirin, nonsteroidal anti-inflammatory agents, many antibiotics, and dilantin. Please consult your compendium.
- GI discomfort, nausea
- Elevation of liver enzymes
- Many others. Please consult your compendium.
- Psoriasis therapy is usually 2.5 mg every 12 hrs x 3, once each week for typical course of 6 weeks.
- A liver biopsy is recommended prior to starting therapy.
- Duration of therapy should be kept to a minimum.
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