What is the increased risk associated with NSAID use in patients taking methotrexate?

Methotrexate is an antimetabolite drug commonly used to treat conditions such as rheumatoid arthritis and certain cancers. When considering the increased risks associated with the concurrent use of nonsteroidal anti-inflammatory drugs (NSAIDs) in patients taking methotrexate, nephrotoxicity is a significant concern.

NSAIDs can impair renal function, particularly in situations where they are used in patients with pre-existing renal issues or dehydration. Methotrexate is renally excreted, and its potential for toxicity increases when renal function is compromised. The concomitant use of NSAIDs can further reduce renal blood flow and glomerular filtration, leading to an accumulation of methotrexate in the body. This can increase the risk of methotrexate toxicity, which can manifest as nephrotoxicity among other hazardous effects.

Other options, while they can be associated with NSAID use, do not represent the specific increased risk seen with methotrexate. Gastrointestinal bleeding is a known risk with NSAIDs but is more generalized and not specifically linked to methotrexate. Cardiovascular events and hypotension can occur with NSAID use but are less directly related to the interaction with methotrexate compared to the risk of neph