Methotrexate Oral Effects — MFDS Part 1 MCQ
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Correct answer: A — Oral ulceration and increased susceptibility to infection
The correct answer is A. Methotrexate is a folate antagonist that can damage rapidly dividing oral epithelium, causing mucositis, stomatitis and oral ulceration. It can also suppress haematopoiesis and immune function, increasing susceptibility to infection. New or severe oral ulceration may therefore indicate clinically important toxicity and warrants medical review, particularly if accompanied by fever, sore throat, bruising or bleeding. Gingival enlargement is more characteristically associated with medicines such as ciclosporin, calcium-channel blockers and phenytoin. Oral lichenoid lesions, salivary gland enlargement and intrinsic tooth discolouration are not characteristic methotrexate effects. Xerostomia may have many causes in a patient with rheumatoid arthritis, but enamel erosion is not a direct recognised methotrexate complication.
Reference: Sandoz Limited. Methotrexate 2.5 mg Tablets BP, Summary of Product Characteristics, sections 4.4 and 4.8, updated 2024. https://www.medicines.org.uk/emc/product/4608/smpc