A 2018 Approach to Combating Methotrexate Toxicity: Folic Acid and Beyond

Methotrexate (MTX) was a key treatment for various rheumatic diseases, but its effectiveness depended on managing its toxicity, which could include gastrointestinal upset, liver enzyme elevation, stomatitis, hair loss, and central nervous system toxicity. Common strategies to mitigate these side effects included supplementation with folic acid and folinic acid, and switching from oral to subcutaneous MTX. Additional strategies explored included vitamin A supplementation and dextromethorphan. The review provided insights from both rheumatologic and oncologic literature, along with expert opinions, to improve patient adherence and manage MTX toxicity.