Rheumatrex Dose Pack and Vancomycin Hydrochloride

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Using methotrexate together with vancomycin may increase the effects of methotrexate. Contact your doctor if you experience pale skin, easy bruising or bleeding, unusual weakness, mouth sores, nausea, vomiting, black or bloody stools, coughing up blood or vomit that looks like coffee grounds, and urinating less than usual or not at all. If your doctor does prescribe these medications together, you may need a dose adjustment or special test to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

MONITOR: Concurrent or recent exposure to systemic vancomycin may significantly prolong the clearance of methotrexate (MTX) and increase the risk of toxicity. The mechanism is impaired renal excretion of MTX due to vancomycin-induced nephrotoxicity. In two patients with osteosarcoma receiving chemotherapy containing high-dose MTX (12 g/m2), the time for serum MTX levels to fall below 0.2 mcM/L increased from within 48-96 hours to 170-231 hours following therapy with vancomycin in the preceding 10 days, and this delay was associated with development of MTX toxicity. Both patients were found to have subclinical renal impairment as indicated by impaired glomerular filtration rates (GFRs). In subsequent cycles using an unmodified schedule, MTX cleared within 72 hours in both patients, and marked improvements in their GFR were noted.

MANAGEMENT: Methotrexate, particularly in high dosages, should be administered cautiously in patients who have recently received or are receiving treatment with intravenous vancomycin, even in the absence of overt renal impairment (e.g., abnormal BUN or serum creatinine). The author of the case report recommends assessing GFR in these patients to allow for dose modification of MTX if necessary. Patients should be monitored closely for development of MTX toxicity such as myelosuppression and mucositis.

Rheumatrex Dose Pack

Generic Name: methotrexate

Brand name: Rheumatrex Dose Pack, Trexall, Xatmep, Otrexup, Rasuvo, Methotrexate Sodium, Preservative Free

Synonyms: Rheumatrex

What is Rheumatrex Dose Pack?

Vancomycin Hydrochloride

Generic Name: vancomycin

Brand name: FIRST-Vancomycin, Vancocin HCl Pulvules, First-Vancomycin 25, First-Vancomycin 50, Firvanq, Vancocin, First-Vancomycin 25, First-Vancomycin 50

Synonyms: Vancomycin

What is Vancomycin Hydrochloride?