Interactions between Epivir-HBV and Methotrexate

The lamiVUDine in Epivir-HBV has a major potential interaction with Alcoholism.

Hepatotoxicity including lactic acidosis, severe hepatomegaly with steatosis, fulminant hepatitis, and hepatic failure has been associated with the use of some nucleoside reverse transcriptase inhibitors (NRTIs) alone or in combination with other antiretroviral agents. Therapy with NRTIs should be administered cautiously in patients with preexisting liver disease, a history of alcohol abuse, or hepatitis. Therapy should be suspended if clinical or laboratory findings suggestive of lactic acidosis or pronounced hepatotoxicity occur. The use of abacavir is contraindicated in patients with moderate to severe liver dysfunction as its safety and efficacy have not been established in these patients.

The lamiVUDine in Epivir-HBV has a major potential interaction with Alcoholism.

The nucleoside reverse transcriptase inhibitors, didanosine, stavudine, and lamivudine, may cause pancreatitis. The incidence is generally low but is up to 7% with didanosine, and up to 18% in pediatric patients given lamivudine. Patients with a history of or known risk factors for pancreatitis (such as alcohol abuse or hypertriglyceridemia) should be monitored closely during therapy with these agents. Therapy should be discontinued at the first signs/symptoms suggestive of pancreatitis (e.g., nausea, vomiting, abdominal pain, hyperamylasemia with dysglycemia, rising triglycerides, decreasing serum calcium), and preferably permanently discontinued if clinical pancreatitis develops.

Methotrexate has a major potential interaction with Alcoholism.

The use of methotrexate is contraindicated as treatment for psoriasis or rheumatoid arthritis in patients with alcoholism, alcoholic liver disease or other chronic liver diseases. Methotrexate causes hepatotoxicity, fibrosis and cirrhosis, usually after long-term therapy. Fibrosis and cirrhosis may not be preceded by symptoms or abnormal liver function tests. If methotrexate is used, patients should be instructed to immediately report any signs or symptoms suggestive of hepatic dysfunction such as jaundice, dark urine, right upper quadrant pain, or anorexia. Persistent liver function test abnormalities and/or depression of serum albumin may require evaluation, including a liver biopsy.

Methotrexate has a major potential interaction with Anemia.

Methotrexate can induce myelosuppression causing leukopenia, thrombocytopenia, neutropenia, pancytopenia and anemia. Therapy with methotrexate is contraindicated as treatment of psoriasis in patients with bone marrow suppression or preexisting blood dyscrasias. Methotrexate should be discontinued immediately in patients with psoriasis or rheumatoid arthritis if there is a significant fall in blood cell counts. If need outweighs risk, therapy with methotrexate should be administered cautiously in patients with malignancy and hematopoietic impairment. Additionally, methotrexate should be used with extreme caution in patients with active infection, and it is usually contraindicated in patients with overt or laboratory evidence of immunodeficiency syndromes. Patients should be instructed to immediately report any signs or symptoms suggesting bone marrow suppression or infection such as fever, sore throat, or bleeding. Clinical monitoring of hematopoietic function is recommended.

Methotrexate has a major potential interaction with Bone Marrow Depression/Low Blood Counts.

Methotrexate can induce myelosuppression causing leukopenia, thrombocytopenia, neutropenia, pancytopenia and anemia. Therapy with methotrexate is contraindicated as treatment of psoriasis in patients with bone marrow suppression or preexisting blood dyscrasias. Methotrexate should be discontinued immediately in patients with psoriasis or rheumatoid arthritis if there is a significant fall in blood cell counts. If need outweighs risk, therapy with methotrexate should be administered cautiously in patients with malignancy and hematopoietic impairment. Additionally, methotrexate should be used with extreme caution in patients with active infection, and it is usually contraindicated in patients with overt or laboratory evidence of immunodeficiency syndromes. Patients should be instructed to immediately report any signs or symptoms suggesting bone marrow suppression or infection such as fever, sore throat, or bleeding. Clinical monitoring of hematopoietic function is recommended.

Methotrexate has a major potential interaction with Diarrhea.

Methotrexate induces stomatitis within the oral mucosa and gastrointestinal tract. Therapy with methotrexate should be administered with extreme caution in patients with peptic ulcer disease or ulcerative colitis. If vomiting, diarrhea or ulcerative stomatitis occur, treatment should be discontinued until recovery to avoid the risk of hemorraghic enteritis or intestinal perforation which could be fatal.

The lamiVUDine in Epivir-HBV has a major potential interaction with High Cholesterol.

The nucleoside reverse transcriptase inhibitors, didanosine, stavudine, and lamivudine, may cause pancreatitis. The incidence is generally low but is up to 7% with didanosine, and up to 18% in pediatric patients given lamivudine. Patients with a history of or known risk factors for pancreatitis (such as alcohol abuse or hypertriglyceridemia) should be monitored closely during therapy with these agents. Therapy should be discontinued at the first signs/symptoms suggestive of pancreatitis (e.g., nausea, vomiting, abdominal pain, hyperamylasemia with dysglycemia, rising triglycerides, decreasing serum calcium), and preferably permanently discontinued if clinical pancreatitis develops.

Methotrexate has a major potential interaction with Infection.

Because of their cytotoxic effects on rapidly proliferating tissues, antineoplastic agents frequently can, to varying extent, induce myelosuppression. The use of these drugs may be contraindicated in patients with known infectious diseases. All patients should be instructed to immediately report any signs or symptoms suggesting infection such as fever, sore throat, or local infection during antineoplastic therapy. Close clinical monitoring of hematopoietic function is recommended.

Methotrexate has a major potential interaction with Infection.

Methotrexate can induce myelosuppression causing leukopenia, thrombocytopenia, neutropenia, pancytopenia and anemia. Therapy with methotrexate is contraindicated as treatment of psoriasis in patients with bone marrow suppression or preexisting blood dyscrasias. Methotrexate should be discontinued immediately in patients with psoriasis or rheumatoid arthritis if there is a significant fall in blood cell counts. If need outweighs risk, therapy with methotrexate should be administered cautiously in patients with malignancy and hematopoietic impairment. Additionally, methotrexate should be used with extreme caution in patients with active infection, and it is usually contraindicated in patients with overt or laboratory evidence of immunodeficiency syndromes. Patients should be instructed to immediately report any signs or symptoms suggesting bone marrow suppression or infection such as fever, sore throat, or bleeding. Clinical monitoring of hematopoietic function is recommended.

The lamiVUDine in Epivir-HBV has a major potential interaction with Infectious Hepatitis.

Severe acute exacerbations of HBV have been reported in HIV-1/HBV-coinfected patients who have discontinued products containing emtricitabine, lamivudine, and/or tenofovir disoproxil fumarate (DF) and may occur with discontinuation of tenofovir alafenamide-containing products. It is recommended that all patients with HIV-1 infection be tested for the presence of HBV before or when initiating products containing emtricitabine, lamivudine, tenofovir DF, or tenofovir alafenamide. Hepatic function should be monitored closely with both clinical and laboratory follow-up for at least several months in HIV-1/HBV-coinfected patients who discontinue products (including fixed-dose combination products) that contain emtricitabine, lamivudine, tenofovir DF, or tenofovir alafenamide. If appropriate, initiation or resumption of antihepatitis B therapy may be warranted, especially in patients with advanced liver disease or cirrhosis since posttreatment exacerbation of hepatitis may lead to hepatic decompensation and liver failure.

Methotrexate has a major potential interaction with Inflammatory Bowel Disease.

Methotrexate induces stomatitis within the oral mucosa and gastrointestinal tract. Therapy with methotrexate should be administered with extreme caution in patients with peptic ulcer disease or ulcerative colitis. If vomiting, diarrhea or ulcerative stomatitis occur, treatment should be discontinued until recovery to avoid the risk of hemorraghic enteritis or intestinal perforation which could be fatal.

The lamiVUDine in Epivir-HBV has a major potential interaction with Liver Disease.

Hepatotoxicity including lactic acidosis, severe hepatomegaly with steatosis, fulminant hepatitis, and hepatic failure has been associated with the use of some nucleoside reverse transcriptase inhibitors (NRTIs) alone or in combination with other antiretroviral agents. Therapy with NRTIs should be administered cautiously in patients with preexisting liver disease, a history of alcohol abuse, or hepatitis. Therapy should be suspended if clinical or laboratory findings suggestive of lactic acidosis or pronounced hepatotoxicity occur. The use of abacavir is contraindicated in patients with moderate to severe liver dysfunction as its safety and efficacy have not been established in these patients.

Methotrexate has a major potential interaction with Liver Disease.

The use of methotrexate is contraindicated as treatment for psoriasis or rheumatoid arthritis in patients with alcoholism, alcoholic liver disease or other chronic liver diseases. Methotrexate causes hepatotoxicity, fibrosis and cirrhosis, usually after long-term therapy. Fibrosis and cirrhosis may not be preceded by symptoms or abnormal liver function tests. If methotrexate is used, patients should be instructed to immediately report any signs or symptoms suggestive of hepatic dysfunction such as jaundice, dark urine, right upper quadrant pain, or anorexia. Persistent liver function test abnormalities and/or depression of serum albumin may require evaluation, including a liver biopsy.

The lamiVUDine in Epivir-HBV has a major potential interaction with Pancreatitis.

The nucleoside reverse transcriptase inhibitors, didanosine, stavudine, and lamivudine, may cause pancreatitis. The incidence is generally low but is up to 7% with didanosine, and up to 18% in pediatric patients given lamivudine. Patients with a history of or known risk factors for pancreatitis (such as alcohol abuse or hypertriglyceridemia) should be monitored closely during therapy with these agents. Therapy should be discontinued at the first signs/symptoms suggestive of pancreatitis (e.g., nausea, vomiting, abdominal pain, hyperamylasemia with dysglycemia, rising triglycerides, decreasing serum calcium), and preferably permanently discontinued if clinical pancreatitis develops.

Methotrexate has a major potential interaction with Peptic Ulcer.

Methotrexate induces stomatitis within the oral mucosa and gastrointestinal tract. Therapy with methotrexate should be administered with extreme caution in patients with peptic ulcer disease or ulcerative colitis. If vomiting, diarrhea or ulcerative stomatitis occur, treatment should be discontinued until recovery to avoid the risk of hemorraghic enteritis or intestinal perforation which could be fatal.

Methotrexate has a major potential interaction with Pleural Effusion.

Methotrexate is primarily eliminated by the kidney via glomerular filtration and active secretion. Clearance rates for methotrexate vary and at higher doses are generally decreased due to saturation of renal tubular reabsorption. Renal impairment or third space effusion (ascites, pleural effusions), decrease elimination and increase methotrexate serum concentrations. Therapy with methotrexate should be administered cautiously and at reduced dosages in patients with compromised renal function. Administration of leucovorin reduces toxicity from high dose methotrexate regimens or delayed elimination. Clinical monitoring of renal function is recommended.

Methotrexate has a major potential interaction with Renal Dysfunction.

Methotrexate is primarily eliminated by the kidney via glomerular filtration and active secretion. Clearance rates for methotrexate vary and at higher doses are generally decreased due to saturation of renal tubular reabsorption. Renal impairment or third space effusion (ascites, pleural effusions), decrease elimination and increase methotrexate serum concentrations. Therapy with methotrexate should be administered cautiously and at reduced dosages in patients with compromised renal function. Administration of leucovorin reduces toxicity from high dose methotrexate regimens or delayed elimination. Clinical monitoring of renal function is recommended.

The lamiVUDine in Epivir-HBV has a moderate potential interaction with Renal Dysfunction.

The apparent oral clearance of nucleoside reverse transcriptase inhibitors is decreased in patients with renal dysfunction. Dosage adjustments are recommended for lamivudine and stavudine in patients with CrCl less than 50 mL/min; zidovudine dosage should be reduced in patients with CrCl less than 15 mL/min. Fixed-dose combination products containing lamivudine are not recommended for patients with CrCl less than 30 or 50 mL/min; the manufacturer product information should be consulted.