It is recommended to fully evaluate concomitant medications and use the following medications with caution
(1) Drugs that affect MTX pharmacokinetics, including drugs that compete for plasma protein binding (such as aspirin, phenytoin) and drugs that affect MTX clearance (such as nonsteroidal anti-inflammatory drugs, penicillins, proton pump inhibitors, sulfonamides, Ciprofloxacin and vitamin C and other drugs that affect the pH of urine), etc
(2) Drugs that affect the pharmacodynamics of MTX, including drugs that cause hematotoxicity, nephrotoxicity, hepatotoxicity, as well as warfarin, cyclosporine, hydrochlorothiazide or other drugs that have adverse interactions with MTX. When the above drugs must be used in combination, CMTX and adverse events need to be closely monitored (strong recommendation, moderate-quality evidence).