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Methotrexate should be used with great care in patients with hepatic or renal impairment. It should also be used cautiously in alcoholics or those with ulcerative disorders of the gastro-intestinal tract. With high-dose regimens, plasma concentrations of Methotrexate and urinary excretion should be monitored. Regular monitoring of complete blood count with the different platelet counts as well as liver function is advisable.
Precipitation of Methotrexate or its metabolites in the renal tubules may be prevented by alkalinisation of the urine.
Using sodium bicarbonate and maintaining an adequate urine flow. Pleural or ascetic effusions may act as a depot for Methotrexate and produce enhanced toxicity.
Use in Pregnancy: Methotrexate is teratogenic, and should not ordinarily be administered during pregnancy.
Use in Lactation: Methotrexate should not be administered to mothers who are breast-feeding.
