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Methotrexate hepatic monitoring — GPhC CRA MCQ

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HardMusculoskeletal TherapeuticsMethotrexate hepatic monitoringGPhC CRA

A 55-year-old man on methotrexate and folic acid asks for co-codamol for back pain. He also buys ibuprofen regularly and his latest ALT is 88 IU/L with alcohol intake of 28 units weekly. What monitoring is required?

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Correct answer: D — LFT review and prescriber assessment before further hepatotoxic risk

Methotrexate can cause hepatotoxicity, and raised ALT with high alcohol intake increases concern. Further medicines or behaviours that worsen hepatic risk should prompt review rather than simple OTC escalation. The pharmacist should advise avoiding excess alcohol and liaise with the rheumatology or GP team.

Reference: BNF; NICE CKS