M. E. Jeurissen, MD; A.M. Boerbooms, MD, PhD; L.B. van de Putte, MD, PhD
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To the Editor: Kozarek and colleagues (1) found a dramatic clinical improvement in patients treated with methotrexate who had refractory Crohn colitis and an incomplete remission of chronic ulcerative colitis. Of 21 patients, 14 were also receiving either sulfasalazine or metronidazole (exact number of patients not mentioned).
The risk of bone marrow suppression is increased when other antifolate drugs (derivatives of sulfonamides, trimethoprim) are used simultaneously with methotrexate. Besides additive folate antagonism, other pharmacologic mechanisms, such as competition with tubular secretion and displacement from albumin binding sites, play an important role in interactions of sulfonamides and methotrexate. Moreover, it was
Jeurissen ME, Boerbooms A, van de Putte L. Pancytopenia and Methotrexate with Trimethoprim- Sulfamethoxazole. Ann Intern Med. 1989;111:261. doi: https://doi.org/10.7326/0003-4819-111-3-261_1
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Published: Ann Intern Med. 1989;111(3):261.
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