Drug General Information (ID: DDI3OX2WR7)
Drug Name			Vancomycin		Drug Info		Methotrexate		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antiinfective Agents				Antimetabolites
Structure

Mechanism of Vancomycin-Methotrexate Interaction (Severity Level: Moderate)
Increased risk of nephrotoxicity Click to Show/Hide Mechanism Graph
Drug Name		Vancomycin				Methotrexate
Mechanism		Nephrotoxicity				Nephrotoxicity
Key Mechanism Factor 1
		Factor Name		Nephrotoxicity
		Factor Description		The combination of drugs that can induce nephrotoxicity may increase the risk of kidney injury. When kidney injury occurs, the inability to remove excess urine and waste from the body can lead to high levels of urea nitrogen, creatinine, and electrolytes (such as potassium and magnesium) in the blood.
Mechanism Description		Increased risk of nephrotoxicity by the combination of Vancomycin and Methotrexate

Recommended Action
Management		Methotrexate, particularly in high dosages, should be administered cautiously in patients who have recently received or are receiving treatment with intravenous vancomycin, even in the absence of overt renal impairment (e.g., abnormal BUN or serum creatinine). The author of the case report recommends assessing GFR in these patients to allow for dose modification of MTX if necessary. Patients should be monitored closely for development of MTX toxicity such as myelosuppression and mucositis.

References
1	Ann Oncol "Significant impairment of high-dose methotrexate clearance following vancomycin administration in the absence of overt renal impairment." Ann Oncol 13 (2002): 327-30. [PMID: 11886013]