NSAIDs should be avoided with which disease-modifying agent due to interaction?

• A. No interaction with methotrexate
• B. Avoid use with methotrexate
• C. Increase methotrexate clearance
• D. Methotrexate toxicity is reduced

Answer: (B)

NSAIDs and methotrexate can interact in a way that raises methotrexate levels and increases toxicity. Methotrexate is eliminated by the kidneys, and NSAIDs can impair renal function and the renal clearance of MTX. They can reduce renal blood flow and glomerular filtration, and they may interfere with tubular secretion pathways that MTX uses to be excreted. This combination can lead to higher circulating and free MTX, raising the risk of serious adverse effects such as bone marrow suppression, mucositis, liver toxicity, and kidney injury. Because of that, the safer approach is to avoid using NSAIDs with methotrexate whenever possible.

If analgesia is still needed, consider alternative strategies (like acetaminophen) and monitor closely if NSAIDs must be used, potentially adjusting MTX dosing or timing. The other options imply no interaction, increased clearance, or reduced toxicity, none of which are correct for this combination.