ArticleCureus2025
Fatal Flaw in the Folate Pathway: Methotrexate-Bactrim Interaction, Misleading Levels, and a Cautionary Case.
Article in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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1 author.
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Abstract
Methotrexate (MTX) is one of the most commonly prescribed medications for rheumatoid arthritis and other autoimmune disorders. While therapeutic drug monitoring (TDM) protocols are well-established for high-dose MTX (HD-MTX) in oncology, no such validated protocols exist for low-dose MTX (LD-MTX) therapy - the pharmacokinetics are highly variable, and serum concentrations correlate poorly with clinical toxicity. Among the most dangerous drug interactions is the combination of MTX with trimethoprim-sulfamethoxazole (TMP-SMX), which creates synergistic toxicity. This case details a rapid, fatal MTX toxicity event in a patient on stable LD therapy who received a short course of TMP-SMX for cellulitis. Severe pancytopenia and hemorrhagic oral mucositis developed despite a serum MTX concentration of 0.07 μmol/L - well below the commonly accepted toxic threshold. This case underscores that clinicians must prioritize prompt recognition of clinical symptoms over laboratory quantification when risk factors for drug interaction are present.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.