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Methotrexate: Managing Side Effects, Hepatotoxicity, Mucositis, and the Role of Folic Acid in Antirheumatic Therapy

Medical consultation with a middle-aged Hispanic doctor explaining the use of methotrexate, an antirheumatic drug, to a Hispanic patient. The doctor holds a bottle of methotrexate, and there is a brochure about folic acid on the desk. The setting is professional and conveys trust, highlighting the importance of monitoring for hepatotoxicity and mucositis.

The methotrexate is a widely used antirheumatic drug in the treatment of conditions such as rheumatoid arthritis and various types of cancer. Despite its efficacy, its use is associated with a range of side effects that can limit tolerability and adherence. Among the most common adverse effects are hepatotoxicity, mucositis, and bone marrow suppression. To mitigate these effects, the concomitant use of folates, such as folinic acid, has been proposed as a rescue agent.

Managing Side Effects of Methotrexate

Methotrexate, being a folic acid antagonist, can cause significant toxicity, especially at high doses. Renal toxicity is one of the most serious complications, resulting from the crystallization of the drug in the renal tubules, which can lead to acute kidney injury. Additionally, mucositis and hematological toxicity are common side effects that require immediate medical attention.

The use of folinic acid is crucial for preventing and treating these adverse effects. This rescue agent is effective in reducing the incidence of gastrointestinal and hepatic toxicity, and it has been shown to decrease the need to interrupt methotrexate treatment. The administration of folinic acid should be carefully adjusted according to plasma concentrations of methotrexate and the clinical status of the patient.

Conclusions

Proper management of the side effects of methotrexate is essential to maximize its therapeutic efficacy and minimize risks to the patient. Supplementation with folates has proven to be an effective strategy to reduce methotrexate-associated toxicity, allowing for better treatment tolerance. It is crucial for physicians to stay informed about current guidelines and adjust folinic acid dosages according to the individual needs of each patient to optimize clinical outcomes.

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Created 6/1/2025