Methotrexate

  Hello
  Hi I was just wondering what kind of Liver damage can occur by using
  a drug called Methotrexate.?
  Any infor would be great
  Thanks
  Don
_Dear Don,
Methotrexate is a drug that inhibits the vitamin folic acid. It is used in low doses for patients with rheumatoid arthritis or psoriasis and in high doses as chemotherapy for cancer patients. It has also been tried as a treatment for other diseases with variable success.
It has been established that chronic therapy with methotrexate causes fibrosis (scarring) and cirrhosis of the liver. In patients who received a  total cumulative dose of 1.5 grams or greater  the incidence of cirrhosis increases. Other risk factors include: diabetes, pre-existing liver abnormalities, alcohol use, obesity, pulmonary fibrosis (lung scarring), advanced age and kidney abnormalities. In the majority of patients who develop liver toxicity from methotrexate the disease is subclinical and nonprogressive (if the drug is discontinued). Acute liver failure is reported in only a handful of cases. Hepatocellular carcinoma (liver cancer) has been rarely reported as a result of methotrexate.
For the most part, liver function tests are insufficiently sensitive to be able to monitor patients. Evolution to fibrosis has occurred despite normal test results. Therefore,  it has been recommended for patients to undergo a liver biopsy (a test where a piece of liver tissue is analyzed in the laboratory by a pathologist) prior to initiating treatment and periodically during treatment. This practice has not been universally accepted because of the risks of liver biopsy. The current approach is to recommend pretreatment biopsies in patients who consume significant amounts of alcohol or have preexisting liver disease. Further biopsies are indicated by persistent liver function test abnormalities. The presence of significant liver disease at initial evaluation or its subsequent development is considered a relative contraindication to the further use of methotrexate.
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.
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