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After about six months on the plaquenil, with out much relief, he switched me to 6 tabs once a week of methotrexate and increased my anti-inflammatory to diclofenac.

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pregnancy should be avoided if either partner is receiving methotrexate; during and for a minimum of three months after therapy for male patients, and during and for at least one ovulatory cycle after therapy for female patients.

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indomethacin may increase the amount of methotrexate in your body to toxic levels.

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5 mg but are fully reversible; symptoms especially dry cough may necessitate interruption of treatment and investigation methotrexate clearance rates vary widely and are generally decreased at higher doses glucarpidase is indicated for treatment of toxic methotrexate concentrations in patients with delayed methotrexate clearance due to impaired renal function refer to the glucarpidase prescribing information ; if glucarpidase used, do not administer leucovorin within two hours before or after dose of glucarpidase because leucovorin is a substrate for glucarpidase; there are published case reports of intravenous and intrathecal glucarpidase treatment to hasten clearance of methotrexate in cases of overdose gi toxicity diarrhea or ulcerative stomatitis warrants discontinuance of therapy risk of hemorrhagic enteritis or intestinal perforation bone marrow suppression may cause anemia, aplastic anemia, pancytopenia, leukopenia, neutropenia, and or thrombocytopenia; use caution in patients with preexisting hematopoietic impairment and with concomitant use of nsaids; a significant drop in blood counts warrants discontinuation of therapy may impair fertility, cause oligospermia, and menstrual dysfunction; exclude pregnancy before initiating treatment neurotoxicity may cause neurotoxicity, including stroke-like encephalopathy, seizures, leukoencephalopathy, and myelopathy nephrotoxicity risk of acute renal failure especially at high doses caution should be used while driving or operating machinery due to risk of dizziness and fatigue.

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this interaction is mediated through accumulation of methotrexate resulting from impairment of renal excretion in the presence of the nsaid.

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