Monitoring of Methotrexate
A full blood examination, including haemoglobin, white cell and platelet counts, creatinine, and liver function tests should be performed monthly for the first 6 months, then every 1 to 2 months thereafter. In patients with a low risk of toxicity, consideration may be given to increasing the intervals between blood tests. Patients with abnormal liver function tests should have more frequent monitoring, and may require liver biopsy if there is a persisting rise in transaminases that does not normalise after cessation of methotrexate.
Due to the toxicity of methotrexate, a reminder system should be put in place to ensure that the laboratory monitoring and subsequent clinical review actually occurs.
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