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In patients receiving concomitant methotrexate, the incidence was 6% compared to 26% with Humira monotherapy. Alkalinization of urine (with bicarbonate and/or acetazolamide) and intravenous hydration (1000 mL per square meter of body surface area over six hours prior to beginning the methotrexate infusion and 3000 mL per square meter of body surface area per day during the methotrexate infusion and for two days after the infusion is completed) are also important to prevent renal toxicity caused by methotrexate and/or its metabolites. Methotrexate elimination is reduced in patients with impaired renal function, ascites, or pleural effusions. MANAGEMENT: The use of methotrexate in combination with other potentially hepatotoxic agents (e. Patients treated with methotrexate should be advised to seek medical attention if they experience potential signs and symptoms of hepatotoxicity such as fever, rash, anorexia, nausea, vomiting, fatigue, right upper quadrant pain, dark urine, and jaundice. Leucovorin may limit methotrexate action on normal cells by competing with methotrexate for the same transport processes into the cell. Methotrexate has been reported to cause fetal death and/or congenital anomalies. No interference occurs, however, if methotrexate is measured by a radioimmunoassay (RIA). Antibodies developed in 12% of patients on adalimumab monotherapy and in 1% of patients on concurrent methotrexate.
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