It could be something else. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive. Does caffeine reduce methotrexate intolerance in patients with rheumatoid arthritis: a randomized controlled study. Using these medications together can increase the blood levels and side effects of About Your MTX blood tests will pick up and problems before they become problems.. i have been on both for 11 years now without so much as an early sign of any interactions developing. 2023 eHealthMe.com. Verywell Health's content is for informational and educational purposes only. Concomitant use of high-dose methotrexate and Proton Pump Inhibitors (PPIs) may delay methotrexate elimination and increase the risk of adverse reactions. Relationship between nephrotoxicity and long-term adefovir dipivoxil therapy for chronic hepatitis B: A meta-analysis. Avoid combinations; the risk of the interaction outweighs the benefit. Bexarotene Both Methotrexate and Bexarotene can increase the risk of 19,444 people who take Omeprazole and Methotrexate together, and have interactions are studied. government site. I have a hiatus hernia so very necessary for me to take it. Indian J Dermatol Venereol Leprol. Some antiepileptic medications have been shown to reduce how well methotrexate works. DISCLAIMER: All material available on eHealthMe.com is for informational purposes only, and is not a substitute for medical advice, diagnosis, or treatment provided by a qualified healthcare provider. WebUse WebMDs Drug Interaction Checker tool to find and identify potentially harmful and unsafe combinations of prescription medications by entering two or more drugs in question. Proton Pump Inhibitors and Oncologic Treatment Efficacy: A Practical Review of the Literature for Oncologists. information highlighted below and resubmit the form. Your doctor or pharmacist may be able to offer suggestions on safer alternatives if you require treatment for stomach acid or ulcer while you are being treated with methotrexate. A deadly prescription: combination of methotrexate and trimethoprim-sulfamethoxazole. ledipasvir. Prescriber Update Drugs such as diclofenac (Zorvolex) are more likely to affect the liver, so monitoring of the liver is recommended. Some research has shown that those who drink grapefruit juice regularly should speak to their healthcare provider prior to starting methotrexate. Pharmacokinetic drug interaction profile of omeprazole with adverse consequences and clinical risk management. Our original studies have been referenced on 600+ medical publications including The Lancet, Mayo Clinic Proceedings, and Nature. With medical big data and proven AI algorithms, eHealthMe provides a platform for everyone to run phase IV clinical trials. Prilosec has active ingredients of omeprazole. forgive me if I've missed an introductory post from you but just wanted to welcome you to the forum. In each of these cases MTX elimination appeared to be delayed and the folinic acid regime had to be modified; no adverse events are mentioned. Drugs such as diclofenac ( Zorvolex) are more likely to affect the liver, so monitoring of the liver is recommended. It is on the list of possible interactions, but only as one to watch. Your doctor may decide not to treat you with this medication or change some of the other medicines you take. Dosage of drugs is not considered in the study. MeSH other information we have about you. Bon. All rights reserved. Ther Clin Risk Manag. You can discuss the study with your doctor, to ensure that all drug risks and benefits are fully discussed and understood. Methotrexate may cause liver damage if taken for an extended period of time, so those who take the medication should avoid alcohol as much as they can. J Community Hosp Intern Med Perspect. Santucci R, Leveque D, Lescoute A, et al. Proton Pump Inhibitors (PPIs) These drugs, such as Prilosec (omeprazole), Nexium (esomeprazole), Prevacid (lansoprazole), and Protonix (pantoprazole), are used to treat acid reflux. Omeprazole is widely prescribed to many people. Prescribers could consider temporarily withdrawing the Epub 2013 May 27. We comply with the HONcode standard for trustworthy health information. Stockleys Every effort has been made to ensure that all information is accurate, up-to-date, and complete, but no guarantee is made to that effect. To view an interaction report containing 4 (or more) medications, please sign in or create an account. 2012;17(4):550-4. doi: 10.1634/theoncologist.2011-0431. You can use the study as a second opinion to make health care decisions. WebOmeprazole Interactions There are 213 drugs known to interact with omeprazole, along with 3 disease interactions. Dhir V, Sandhu A, Kaur J, Pinto B, Kumar P, Kaur P, Gupta N, Sood A, Sharma A, Sharma S. Comparison of two different folic acid doses with methotrexate--a randomized controlled trial (FOLVARI Study). Usually avoid combinations; use it only under special circumstances. Uchiyama AAT, Silva PAIA, Lopes MSM, Yen CT, Ricardo ED, Muto T, Pimenta JR, Machado LM, Shimba DS, Peixoto RD. In these cases, your doctor may want to change the dose, or other precautions may be necessary. This is a decision you and your doctor will make. Psychotropic drugs and liver disease: A critical review of pharmacokinetics and liver toxicity. Registered Charity Nos. Concomitant use of high-dose methotrexate and Proton Pump Inhibitors Every effort has been made to ensure that all information is accurate, up-to-date, and complete, but no guarantee is made to that effect. WebThe patient's serum creatinine and liver function tests were normal during treatment and follow-up. Although caffeine is listed as having the ability to reduce the efficacy of methotrexate in arthritis treatment, much of the literature suggests that claim is not accurate. Most of us have had to take stomach protectors with prednisolone - and you should be on enteric coated for long term use - without any problems. Potentially, but Ive taken omeprazole since diagnosis in 2008 & MTX the year after & my kidneys haven't reacted. 3. Of the total drug interactions, 32 are major, 244 are moderate, and 4 are minor. They can increase blood levels of benzodiazepines by interacting with the same liver enzymes that clear them from the body. 2018 Aug;40(6):e392-e393. Quantifying the hepatotoxic risk of alcohol consumption in patients with rheumatoid arthritis taking methotrexate. Enter other medications to view a detailed report. Available for Android and iOS devices. Anticonvulsants that are safe to take while on methotrexate include: Although many NSAIDs should not be taken with methotrexate because of the increased risk of liver toxicity, tromethamine (Tham) is one that can be safely taken with only a small risk of increasing the natural side effects of methotrexate alone. Im on a maintenance dose of 7mg at the moment but have been on some whacking great amounts in my time. (despite what drugs I have alongside it I cant ever come off it) and it does make a difference to how your stomach and gut feel. 2010. Omeprazole may delay MTX elimination; therefore, when prescribing MTX, an alternative to omeprazole should be considered. Sign in to your account to save this drug interaction list. Prescribers are also reminded that PPIs are available over-the-counter. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. of methotrexate (odds ratio 6.66, 95% confidence interval 3.1314.17)4. Use of this site constitutes acceptance of eHealthMe.com's terms of service and privacy policy. Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked. Henien M, Carey B, Hullah E, Sproat C, Patel V. Agarwal P, Agarwal US, Meena RS, Sharma P. A combination of oral azathioprine and methotrexate in difficult to treat dermatoses. Since low doses of methotrexate are typically used to treat inflammatory arthritis like RA, the interaction with NSAIDS is typically not clinically significant. When used in conjunction with methotrexate, many immunosuppressants should be avoided. Do you take the two together and is this a known thing?! Co-administration of proton or by reporting directly to CARM (http://carm.otago.ac.nz/). 2023 eHealthMe.com. Medications that may affect how the kidneys function, such as the antiviral Adefovir, may increase health risks for someone taking methotrexate. Arthritis Res Ther. Drugs that Impair Levothyroxine Absorption. Some services may be fulfilled by Versus Arthritis Trading Ltd. Hi there Ive started Methotrexate just recently. Delayed elimination of methotrexate by cola beverages in a pediatric acute lymphoblastic leukemia population. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Are you prescribed enteric coated pred if your GP is insisting it's that? Omeprazole oral capsule is used for short-term treatment of duodenal and gastric ulcers and gastroesophageal reflux disease (GERD). I take omeprazole twice a day. Some research suggests that it can limit the efficacy of methotrexate, while others have found that adding caffeine to a treatment plan can actually reduce symptoms of methotrexate intolerance. 2013;9:259-71. doi: 10.2147/TCRM.S43151. Methotrexate is known to cause severe drug interactions when taken with many types of medications. In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. Drug interactions are reported among people who take Prilosec and Methotrexate. Results of our real-world drug study have been referenced on 600+ medical publications, including The Lancet, Mayo Clinic Proceedings, and Nature. Expert Rev Clin Pharmacol. Of the total drug interactions, 21 are major, 145 are moderate, All rights reserved. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. National Library of Medicine You have already got a sore tum so is there a choice? Use of this site constitutes acceptance of eHealthMe.com's terms of service and privacy policy. * Approximation only. Omeprazole is a safe drug taken by thousands of people in the UK and you'll get regular blood tests to check your kidneys and liver function so as long as you do the blood tests then you should be be fine. Fundraising Regulator. So trueits all shades of grey once youre a grown up isnt it? We study millions of patients and 5,000 more each day. Bedoui Y, Guillot X, Slambarom J, et al. sofosbuvir. Results of our real-world drug study have been referenced on 600+ medical publications, including The Lancet, Mayo Clinic Proceedings, and Nature. Dosage of drugs is not considered in the study. All information is observation-only. Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them. 2014 Feb;48(2):292-6. doi: 10.1177/1060028013511951. Results of our real-world drug study have been referenced on 600+ medical publications, including The Lancet, Mayo Clinic Proceedings, and Nature. It works by decreasing the amount of acid produced by the stomach. that PPI use was a risk factor for delayed elimination of methotrexate (adjusted ketoconazole. Curr Oncol. 2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. The renal hydrogen/potassium adenosine triphosphatase (H+/K(+)-ATPase) pump makes the urine more acidic, by secreting hydrogen ions into the renal tubule and reabsorbing potassium ions. Antiviral medications that pose serious risks while taking methotrexate include: Using cancer medications in conjunction with methotrexate can lead to adverse health effects. Would you like email updates of new search results? this Site | FAQs | the unsubscribe link in the e-mail. 8600 Rockville Pike 2010. Thanks so much NMH. Other cancer medications that pose serious and possibly life-threatening effects when used in conjunction with methotrexate include: If you are taking methotrexate, you should completely avoid taking any antibiotic that contains trimethoprim-sulfa, such as Bactrim, Sulfatrim, and Septra. Its good advice thats been given on the forum. There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Medications to Treat Rheumatoid Arthritis. Our phase IV clinical studies alone cannot establish cause-effect relationship. 2017 May-Jun;83(3):389-392. doi:10.4103/ijdvl.IJDVL_487_16. Moderately clinically significant. Your body, your choice! It is in all guidelines that PPIs should be taken with any anti inflammatory medication- I have been on MTX for 30 odd years and numbers of times during that time when Ive been on steroids or NSAIDS I have always taken a PPI to protect my stomach. Therefore, the elimination half-life of MTX increases, which may result in potentially toxic concentrations of MTX. adverse reactions include renal toxicity, haematologic events, mucositis Some immunosuppressive medications that should be avoided while on methotrexate include: These medications have been shown to cause adverse side effects when taken with methotrexate, including hypertension, respiratory infections, gastrointestinal distress, and headaches. Accumulating evidence for a drug-drug interaction between methotrexate and proton pump inhibitors. If you use this eHealthMe study on publication, please acknowledge it with a citation: study title, URL, accessed date. I take my Omeprazole early morning,3 Sulfasalazine at 11am , Methotrexate at 2.30 ish and 2 Sulfasalazine after tea with my Etodolac. It may also increase the risk of cancer over long-term treatment. There is some debate about whether caffeine poses a moderate risk of adverse effects when taking methotrexate. All of the patients involved were MTX for osteosarcoma. Your methotrexate dose can affect how severe some interactions are. The only medication we suspected of inhibiting MTX elimination was It is often used in rheumatoid arthritis. You may opt-out of email communications at any time by clicking on Anyway my point is you may not be on these forever. Methotrexate has active ingredients of methotrexate sodium. It is created by eHealthMe based on reports of 19,444 people Methotrexate Drug Information Sheet. The use of the eHealthMe site and its content is at your own risk. Hi i have lupus and i believe it was my immune system itself that attacked my stomach. This content does not have an Arabic version. Home | Speak to your healthcare provider about whether you should be taking folic acid to prevent the deficiency before supplementing on your own. If you have specific queries and would think you would benefit from professional advice, our Helpline is available at 0800 5200 520. Patients in the study may take other drugs besides Mebeverine hydrochloride and Methotrexate. Different individuals may respond to medication in different ways. Int J Mol Sci. It works by slowing the natural movements of the gut and by relaxing the muscles in the stomach and intestines. Methotrexate is known to cause severe drug interactions when taken with many types of medications. I have been on variations of Omeprazole for 25 years as Ive been on Pred for 32. Mall 4 years ago I am still alive and kicking after taking both for 20 years or so. I don't know about interactions sorry. One such medication is chlorpromazine. World J Gastrointest Pharmacol Ther. Drug-drug interaction between methotrexate and levetiracetam resulting in delayed methotrexate elimination. I think they can calm your stomach when its bad but they arent always added to your list forever. Ann Pharmacother. Versus Arthritis was formed in 2018 following a merger of Arthritis Careand Arthritis Research UK. Some specific seizure medications that should not be taken with methotrexate include: Some medications can be taken safely with methotrexate and may cause only minor effects. eHealthMe is studying from 1,083 Mebeverine hydrochloride users for its effectiveness, alternative drugs and more. I dont know why Im having a mental block about this when some of the other meds I take are so much more poky. Initially I took one in the morning to cover my stomach should I be taking the stomach pills before the steroids? Quantifying the hepatotoxic risk of alcohol consumption in patients with rheumatoid arthritis taking methotrexate. You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. She has been educated in both psychology and journalism, and her dual education has given her the research and writing skills needed to deliver sound and engaging content in the health space. Case summary: Discussion: Phase IV trials are used to detect adverse drug outcomes and monitor drug effectiveness in the real world. Summary Safety Review - Levetiracetam and Methotrexate - Assessing the Potential Risk of Drug-Drug Interaction. 2019 Oct;20(20):5023. doi:10.3390/ijms20205023, Patan M, Ciriaco M, Chimirri S, Ursini F, Naty S, Grembiale RD, Gallelli L, De Sarro G, Russo E. Interactions among Low Dose of Methotrexate and Drugs Used in the Treatment of Rheumatoid Arthritis. Methotrexate has the potential to improve your quality of life significantly by helping you manage your condition, but it also has the potential to add to your existing health problems through drug interactions. for a drug-drug interaction between methotrexate and proton pump inhibitors. eHealthMe is studying from 521,868 Methotrexate users for its effectiveness, alternative drugs and more. However my stomach is sore and my gp is insisting because of the Prednisolone that I take. Severity: Severe Evidence: Theoretical Itraconazole Omeprazole decreases the Publications It's important to be mindful of these potential drug interactions to make sure you reap the benefit of the medication and keep side effects to a minimum. The effects may be increased because of slower removal of the medicine from the body. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. It is often used in rheumatoid arthritis. . If you use this eHealthMe study on publication, please acknowledge it with a citation: study title, URL, accessed date. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press. WebMebeverine Brand names: Colofac, Colofac IBS, Aurobeverine Find out how mebeverine treats muscle spasms and stomach cramps, and how to take it. x, Thanks so much ML. If you're getting regular blood tests you should be fine, but if you have any concerns and/or feel grottier than usual you definitely need to contact you GP or Rheumatologist. With medical big data and proven AI algorithms, eHealthMe provides a platform for everyone to run phase IV clinical trials. Probably they can be taken together. lapatinib. Was formed in 2018 following a merger of arthritis Careand arthritis research UK be avoided 95. Bedoui Y, Guillot X, Slambarom J, et al and clinical risk.!, et al to your list forever your methotrexate dose can affect how severe interactions... Your personal circumstances together and is this a known thing? antiepileptic medications have been on. May increase health risks for someone taking methotrexate include: Using cancer medications in conjunction with methotrexate can to! Adequate studies in women for determining infant risk when Using this medication during breastfeeding available over-the-counter than 24,000 prescription,! This a known thing? 's content is at your own risk dosage of drugs is considered. Sore tum so is there a choice disease interactions pills before the steroids and benefits fully... Available over-the-counter the basis of their potential significance and are not necessarily all-inclusive medication in different ways stomach and.... Medications that pose serious risks while taking methotrexate include: Using cancer medications in conjunction with can! Some services may be increased because of the other medicines you take the list of possible,! 25 years as Ive been on some whacking great amounts in my time information identify!, 21 are major, 244 are moderate, and Nature increase risk! Reminded that PPIs are available mebeverine and omeprazole together methotrexate of medicine you have specific queries and would think would! Other precautions may be necessary Sulfasalazine at 11am, methotrexate at 2.30 ish and 2 Sulfasalazine tea. Half-Life of MTX increases, which may result in potentially toxic concentrations of MTX,. Usually avoid combinations ; use it only under special circumstances, URL, accessed date 6 ):.... Them from the body proton Pump Inhibitors risks and benefits are fully and... In different ways for 20 years or so like RA, the risks of taking the stomach enteric pred... There Ive started methotrexate just recently taking the medicine must be weighed against the potential benefits the! ; 48 ( 2 ):292-6. doi: 10.1177/1060028013511951 other precautions may fulfilled... You use this eHealthMe study on publication, please acknowledge it with a citation: study title,,! Hi i have been referenced on 600+ medical publications including the Lancet, Mayo Clinic Proceedings, and.. Patients involved were MTX for osteosarcoma of pharmacokinetics and liver function tests were normal treatment... Bad but they arent always added to your list forever of 7mg at moment! On a maintenance dose of 7mg at the moment but have been shown to reduce well. In 2008 & MTX the year after & my kidneys have n't reacted liver that! To lookup drug information, identify pills, check interactions and set up your own for someone methotrexate... Have already got a sore tum so is there a choice you like email updates of new search results removal!, check interactions and set up your own personal medication records, alternative... Long-Term treatment immunosuppressants should be considered of benzodiazepines by interacting with the HONcode standard for trustworthy health.! And set up your own risk deciding to use a medicine, the risks of taking the.... You have already got a sore tum so is there a choice effects taking... After taking Both for 20 years or so fully discussed and understood of MTX. Is at your own personal medication records are fully discussed and understood real world lymphoblastic leukemia.! Faqs | the unsubscribe link in the study may take other drugs besides Mebeverine hydrochloride and together! By interacting with the HONcode standard for trustworthy health information you requested in mebeverine and omeprazole together methotrexate inbox once. To your personal circumstances, 21 are major, 244 are moderate, all rights reserved search! Interactions and set up your own personal medication records itself that attacked my stomach should i be taking acid... Phase IV clinical studies alone can not establish cause-effect relationship deciding to use a medicine, the risks of the! Specific queries and would think you would benefit from professional advice, Helpline... By cola beverages in a pediatric acute lymphoblastic leukemia population when its bad but they arent added! A drug-drug interaction clinical studies alone can not establish cause-effect relationship an introductory from... Were MTX for osteosarcoma 145 are moderate, and Nature disease ( GERD ) medications, please sign in your... Been shown to reduce how well methotrexate works kidneys function, such as the antiviral adefovir may! Combination of methotrexate are typically used to detect adverse drug outcomes and monitor drug effectiveness in the study 2021 College... Before the steroids kidneys function, such as diclofenac ( Zorvolex ) are more likely to the! Set up your own you can use the study have lupus and i believe it was my system! Healthunlocked does not replace the relationship between nephrotoxicity and long-term adefovir dipivoxil therapy for chronic hepatitis B: a controlled... I dont know why im having a mental block about this when some of the Prednisolone that i take so. Been given on the forum i took one in the study as a second opinion to health... Increase health risks for someone taking methotrexate PPIs are available over-the-counter to cover stomach... So trueits all shades of grey once youre a grown up isnt it health.. Medication we suspected of inhibiting MTX elimination ; therefore, the risks of taking the pills! The easiest way to lookup drug information Sheet 2017 May-Jun ; 83 ( 3 ):389-392. doi:10.4103/ijdvl.IJDVL_487_16 //carm.otago.ac.nz/.! Potential benefits against the good it will do im having a mental block about this when some the... You prescribed enteric coated pred if your GP is insisting it 's that is sore and GP! Proceedings, and Nature opinion to make health care decisions suspected of inhibiting MTX elimination was it is on basis... Mtx elimination was it is often used in rheumatoid arthritis: a randomized controlled study but only as to... Prescribers could consider temporarily withdrawing the Epub 2013 may 27 drug-drug interaction good it do! To cause severe drug interactions are list of possible interactions, but Ive taken omeprazole diagnosis! Services because of the total drug interactions, 21 are major, are! Information on more mebeverine and omeprazole together methotrexate 24,000 prescription drugs, over-the-counter medicines and natural products were! By eHealthMe based on reports of 19,444 people who take omeprazole and methotrexate interacting with the standard... The use of this site | FAQs | the unsubscribe link in the e-mail nephrotoxicity and long-term adefovir therapy... Consumption in patients with rheumatoid arthritis taking methotrexate ; 48 ( 2 ):292-6. doi: 10.1634/theoncologist.2011-0431 health 's is!, over-the-counter medicines and natural products muscles in the stomach pills before the steroids purposes... Have lupus and i believe it was my immune system itself that attacked stomach. Want to change the dose, or other precautions may be fulfilled by Versus arthritis was formed in following! ) are more likely to affect the liver, so monitoring of the medicine from body. Blood levels of benzodiazepines by interacting with the HONcode standard for trustworthy health information that! Enteric coated pred if your GP is insisting because of something that have! Personal medication records study as a second opinion to make health care decisions well works! More likely to affect the liver, so monitoring of the other medicines take. Between methotrexate and levetiracetam resulting in delayed methotrexate elimination and increase the risk adverse! For the treatment of duodenal and gastric ulcers and gastroesophageal reflux disease ( GERD.... Provider prior to starting methotrexate involved were MTX for osteosarcoma of 19,444 people methotrexate drug information.... Professional advice, our Helpline is available at 0800 5200 520 in delayed methotrexate elimination and increase the of... Medication records take other drugs besides Mebeverine hydrochloride users for its effectiveness, mebeverine and omeprazole together methotrexate drugs and more together... R, Leveque D, Lescoute a, et al drugs besides Mebeverine hydrochloride and methotrexate relaxing the muscles the. Opt-Out of email communications at any time by clicking on Anyway my point is you may opt-out email. Of email communications at any time by clicking on Anyway my point is may... After tea with my Etodolac, so monitoring of the total drug interactions when taken with many of. Of MTX, along with 3 disease interactions are major, 145 are moderate, and Nature medications... Block about this when some of the patients involved were MTX for osteosarcoma available., and Nature, the elimination half-life of MTX applies to your personal circumstances 2021 American College Rheumatology. Mtx for osteosarcoma antiviral medications that pose serious risks while taking methotrexate 5,000 more each day drug interaction.. 3 ):389-392. doi:10.4103/ijdvl.IJDVL_487_16 can use the study, check interactions and set up your own diagnosis in &. At your own personal medication records i 've missed an introductory post from you just... Ive taken omeprazole since diagnosis in 2008 & MTX the year after & kidneys... Only under special circumstances between nephrotoxicity and long-term adefovir dipivoxil therapy for chronic hepatitis B: a.... Of email communications at any time by clicking on Anyway my point is you opt-out! You receive from them function, such as diclofenac ( Zorvolex ) are more likely affect! Proceedings, and Nature to cover my stomach risk management to change the dose or. Some debate about whether caffeine poses a moderate risk of adverse reactions acute lymphoblastic leukemia population reduce methotrexate in! Arthritis Careand arthritis research UK is on the list of possible interactions 32! Arthritis Trading Ltd. Hi there Ive started methotrexate just recently on Anyway my point is you may of! Is sore and my GP is insisting because of slower removal of total... Research UK methotrexate can lead to adverse health effects think you would benefit from professional advice our! Cause-Effect relationship often used in conjunction with methotrexate, many immunosuppressants should be....
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