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Methotrexate toxicity — SCE Rheumatology MCQ

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HardInflammatory ArthritisMethotrexate toxicitySCE Rheumatology

An older patient taking weekly methotrexate is prescribed trimethoprim and develops mucositis, diarrhoea, neutropenia, thrombocytopenia and acute kidney injury. Both medicines are stopped. Which rescue treatment should be discussed urgently with haematology and toxicology?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Give folinic acid rescue with toxicity-directed supportive care

Explanation lettering: E = shown as B · B = shown as C · C = shown as D · D = shown as E

B is correct. Severe antifolate toxicity with mucositis and pancytopenia requires urgent specialist management and folinic-acid rescue alongside infection, transfusion and organ-support decisions. A is prophylactic dosing rather than rescue. C may support selected neutropenia but is not the antidote. D is unrelated to the toxicity. E makes a selective toxicology intervention routine without pharmacokinetic context.

Reference: NHS Specialist Pharmacy Service: managing interactions with methotrexate: https://www.sps.nhs.uk/articles/managing-interactions-with-methotrexate/