Can I take Warfarin and Methotrexate together?

Tomar warfarina y metotrexato together should be done with caution as taking them together can significantly increase your risk of bleeding.

You must speak to your doctor before taking these together. If you are prescribed both, you will need much more frequent blood tests (INR) to monitor how quickly your blood clots.

Por qué sucede esto

Methotrexate can displace warfarin from the proteins in your blood that normally carry it, leaving more 'active' warfarin to thin your blood.

Additionally, methotrexate can sometimes affect how the liver processes warfarin and may cause damage to the lining of the stomach or gut, which increases the risk of a bleed starting.

You may be experiencing an interaction between warfarin and methotrexate if:

• You notice unusual bruising or bleeding, such as nosebleeds or bleeding gums.

• You have blood in your pee (urine) or poo (stools), or have black, tarry poo.

• You feel unusually tired, weak, or dizzy.

• You develop mouth ulcers or a sore throat.

• You have signs of infection, such as fever or chills.

• Your blood tests show a raised INR or changes in blood counts.

Si tienes alguno de los síntomas mencionados, deberías:

• Contacte a su médico de cabecera o a la clínica de anticoagulación para obtener asesoramiento lo antes posible.

• Seek urgent medical help if you have heavy bleeding or bleeding that will not stop.

• Do not stop taking warfarin or methotrexate suddenly unless advised by a healthcare professional.

• Attend any blood tests arranged to check your INR or blood counts.

Tell your healthcare professional about all medicines, supplements, and herbal remedies you are taking.

Riesgo de sangrado

Warfarin increases your risk of serious bleeding. You must seek immediate medical attention if you have a fall, a head injury, or notice signs of internal bleeding such as dark/tarry stools or coughing up blood.

Drug interactions (NSAIDs)

Do not take anti-inflammatory painkillers like ibuprofen or aspirin unless specifically prescribed. These can dangerously increase the levels of methotrexate in your blood or significantly increase your risk of a major bleed while on warfarin.

Pregnancy and conception

Methotrexate causes severe birth defects and miscarriage. Both men and women must use effective contraception during treatment and for at least 6 months after stopping. If you think you are pregnant, seek medical advice immediately.

La warfarina puede causar daños graves a un bebé no nacido. Debe usar anticonceptivos efectivos mientras la toma y informar a su médico de inmediato si piensa que está embarazada.

Infection and blood disorders

Methotrexate can suppress your immune system and bone marrow. You must report a sore throat, fever, or unexplained bruising/bleeding immediately, as these can be signs of life-threatening blood toxicity or infection.

Lung and Liver Toxicity - methotrexate

Contact your doctor immediately if you develop a persistent dry cough or shortness of breath, as this can indicate serious lung inflammation. Avoid alcohol as it increases the risk of liver damage.

Horario de dosificación

Methotrexate for inflammatory conditions must only be taken ONCE A WEEK on the same day. Taking it daily can be fatal.

Alcohol

It is best to avoid or strictly limit alcohol while taking warfarin. Alcohol can affect how your liver processes the medicine, which may increase your risk of bleeding or cause your INR levels to become unstable. If you do drink, keep it to a minimum and do not binge drink.

It is best to avoid or strictly limit alcohol when taking methotrexate. Both methotrexate and alcohol can cause damage to the liver; combining them significantly increases the risk of serious liver toxicity.

Alimentos ricos en vitamina K (por ejemplo, espinacas, col rizada, brócoli, coles de Bruselas, espárragos)

La vitamina K ayuda a que la sangre coagule, lo cual contrarresta el efecto de la warfarina. No es necesario evitar completamente estos alimentos, pero debes mantener la cantidad que consumes de manera constante. Un aumento o disminución repentina en la ingesta de vitamina K puede alterar la efectividad de tu warfarina.

Caffeine (Coffee, Tea, Cola)

Large amounts of caffeine may reduce the effectiveness of methotrexate for certain conditions like rheumatoid arthritis. Monitor your symptoms if you consume high levels of caffeine.

Cranberry juice and Goji berries

Cranberry juice and goji berry products can significantly increase the blood-thinning effect of warfarin, leading to a higher risk of bruising or bleeding. It is best to avoid these while taking warfarin.

Jugo de toronja

El jugo de pomelo puede aumentar los niveles de warfarina en su sangre, lo que puede incrementar su riesgo de sangrado. Es mejor evitar el jugo de pomelo.

Jugo de granada

Algunas evidencias sugieren que el jugo de granada puede interactuar con la warfarina y aumentar el riesgo de sangrado. Es mejor evitarlo.

Folic Acid (Vitamin B9) and Fortified Foods

While your doctor will likely prescribe a folic acid supplement to reduce side effects, you should avoid taking additional over-the-counter multivitamins containing folic acid or eating excessive amounts of foods highly fortified with folic acid without consulting your specialist, as it can interfere with how the medicine works.

Taking multiple medicines? Our Verificador de Interacciones de Medicamentos helps you check whether your prescriptions, over-the-counter medicines, and supplements are safe to take together. Simply search for your medicines to see potential interactions and what to do about them.

Descargo de responsabilidad

Esta información es solo para fines educativos generales y no debe considerarse como un sustituto del consejo médico profesional. Siempre consulte a su médico de cabecera, farmacéutico u otro profesional de la salud calificado antes de tomar decisiones sobre sus medicamentos. Las circunstancias individuales pueden variar, y solo un profesional de la salud que conozca su historial médico puede proporcionar orientación personalizada.