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PPI and methotrexate — GPhC CRA MCQ

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HardDrug InteractionsPPI and methotrexateGPhC CRA

A patient on high-dose methotrexate for cancer is prescribed omeprazole by a locum. The oncology plan mentions renal monitoring. What is the most important interaction to flag?

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

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Correct answer: E — Possible reduced methotrexate clearance and toxicity risk

PPIs can reduce methotrexate clearance, especially at high doses. Oncology or prescriber confirmation is needed. In this scenario, the correct option is possible reduced methotrexate clearance and toxicity risk. The other options are plausible but do not address the key clinical, legal or safety issue as directly. This aligns with UK pharmacy practice guidance cited in the reference field.

Reference: BNF; Stockley's Drug Interactions