For MTX intolerance, which administration change is commonly used?

• A. Switch from oral to subcutaneous
• B. Increase oral dose
• C. Switch to Sulfasalazine
• D. Add NSAID

Answer: (A)

MTX intolerance is often driven by gastrointestinal side effects and inconsistent oral absorption. Switching to subcutaneous methotrexate delivers the drug more reliably and with less GI irritation, improving tolerability and allowing patients to continue effective dosing. The subcutaneous route bypasses much of the GI tract, leading to higher and steadier bioavailability and fewer mucosal side effects, which is why it’s a common adjustment.

Increasing the oral dose would likely worsen GI toxicity and intolerance. Switching to Sulfasalazine changes the medication class and doesn’t specifically address MTX intolerance. Adding NSAIDs can raise MTX toxicity risk and is not a standard fix for intolerance.