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PPI and methotrexate — GPhC CRA MCQ

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HardDrug InteractionsPPI and methotrexateGPhC CRA

A patient taking methotrexate 25 mg once weekly for psoriasis is prescribed omeprazole for dyspepsia. His renal function is reduced and he has had mouth ulcers previously. What is the most important interaction to flag?

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Correct answer: B — Omeprazole may increase methotrexate toxicity risk in susceptible patients

Proton pump inhibitors may reduce methotrexate clearance, with greater concern at higher doses or reduced renal function. The patient's previous mouth ulcers increase concern about toxicity. The prescriber should consider whether a PPI is necessary and whether monitoring or an alternative is appropriate.

Reference: SPS; BNF