Interaction Checker
Potential Interaction
Tenofovir-DF (TDF)
Methotrexate (Amethopterin)
Quality of Evidence: Very Low
Summary:
Coadministration has not been studied. Methotrexate is predominantly eliminated via the kidneys, including active tubular secretion (OAT1, OAT3 mediate methotrexate transport in the kidney whereas MRP4 and BCRP mediate methotrexate efflux in the urine). In theory, there is potential for competition for active renal transport mechanisms if tenofovir-DF and methotrexate are coadministered. However, the results of a clinical study evaluating the co-administration of high-dose of intravenous methotrexate with different NRTI, including tenofovir, showed that methotrexate half-life was not prolonged. However, since methotrexate and tenofovir may both cause tubular toxicity, the use of tenofovir-DF should be avoided with concurrent or recent use of a nephrotoxic medicinal product. If coadministration is unavoidable, renal function should be monitored closely. Note, some methotrexate product labels contraindicate its use or advise caution in immunodeficiency and some contraindicate its use in HIV infection.
Description:
Tenofovir disoproxil fumarate has not been evaluated in patients receiving nephrotoxic medicinal products (e.g. aminoglycosides, amphotericin B, foscarnet, ganciclovir, pentamidine, vancomycin, cidofovir or interleukin-2). Use of tenofovir disoproxil fumarate should be avoided with concurrent or recent use of a nephrotoxic medicinal product. If concomitant use of tenofovir disoproxil fumarate and nephrotoxic agents is unavoidable, renal function should be monitored weekly.
Viread Summary of Product Characteristics, Gilead Sciences Ltd, September 2016.
Tenofovir-DF should be avoided with concurrent or recent use of a nephrotoxic agent. Since tenofovir-DF is primarily eliminated by the kidneys, coadministration of tenofovir-DF with drugs that reduce renal function or compete for active tubular secretion may increase serum concentrations of tenofovir and/or increase the concentrations of other renally eliminated drugs. Some examples include, but are not limited to, cidofovir, acyclovir, valacyclovir, ganciclovir, valganciclovir, aminoglycosides (e.g., gentamicin), and high-dose or multiple NSAIDs.
Viread Prescribing Information, Gilead Sciences International Inc, February 2016.
Methotrexate concentrations were determined in 43 HIV+ patients treated with ARVs and chemotherapy containing high dose methotrexate (3g/m2). Methotrexate elimination half-life was not affected by use of NNRTIs, integrase inhibitors or NRTIs (tenofovir /emtricitabine or abacavir/lamivudine).
The pharmacokinetics of high‑dose methotrexate in people living with HIV on antiretroviral therapy. Dalla Pria A, Bendle M, Ramaswami R, et al. Cancer Chemother Pharmacol, 2016, 77:653-657.
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