Question Title: Methotrexate and possible drug interactions

Within the past 2 years my grandfather has been receiving treatment from a HMO health care provider. During these past two years my grandfather has seemed to develop Cirrhosis of the liver. My family thinks this is due to improper health supervision.

My grandfather was prescribed methotrexate for Arthritis purposes in December of 96. His dosage was as follows: 2.5 mg three times weekly. This was a long term medication in which the doctor never took liver tests to see if the medication was affecting his liver. Before he started on the methotrexate he was also taking various medications as well, which lead me to believe there was a drug interaction of some sort that lead to my grandfather's illness. Some of the medications were: Naproxen 500mg twice daily, Daypro 600mg twice daily, ect.

I am severely worried about the health of my grandfather. It seems like something could have been prevented and i was incquiring about this because we are thinking of taking legal action. My grandfathers health is depleting fast he has lost 60 lbs going from 215lbs to 120lbs within the past year. He also suffers from severe water build-up, and stomach problems. I was wondering if this may have to due with drug interactions and/or lack of liver testing.

Thank you so much for the time you take in answering my questions.

Sincerely,
Kelly Greenlief
Nastidon@aol.com

Dear Kelly,

I’m sorry that grandfather developed cirrhosis. I recently posted an answer to Don on May 12 in which I discuss the toxicity of the liver secondary to methotrexate. Please refer to that communication for more information regarding liver toxicity secondary to methotrexate. In terms of the drugs naproxen and Daypro, those are drugs classified as non-steroidal anti-inflammatory drugs (NSAIDS). NSAIDS differ in their potential for causing liver damage. A recent study from Canada showed that the risk for developing liver toxicity from NSAIDS is 5 per 100,000 person years. Risk factors include: advanced age, kidney damage, multiple drug use, use of high doses and the use of alcohol while on NSAIDS. Naproxen carries an intermediate risk for the development of liver damage. I hope you find this information helpful. Good luck to your grandfather.

This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.

If you would like to be seen at our institution please call 1-800-653-6568, our Referring Physicians’ Office and make an appointment to see one of our expert Hepatologists (liver specialists).

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*Keywords: methotrexate, cirrhosis, non-steroidal anti-inflammatory drugs