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Taking methotrexate and alcohol together may increase the risk of liver injury. Pregnant women with psoriasis or rheumatoid arthritis should not receive methotrexate (See CONTRAINDICATIONS). Such patients require especially careful monitoring for toxicity, and require dose reduction or, in some cases, discontinuation of methotrexate administration. This indicates that NSAIDs may enhance the toxicity of methotrexate. Methotrexate elimination is reduced in patients with impaired renal function, ascites, or pleural effusions. Duration of leucovorin administration varies with the dosage of methotrexate and plasma concentrations achieved (including rate of elimination); in general, leucovorin administration is continued until methotrexate concentrations fall to less than 5 � 10 -8 Molar. Leucovorin may limit methotrexate action on normal cells by competing with methotrexate for the same transport processes into the cell. Cutaneous lesions partially remitted following infliximab discontinuation and methotrexate treatment. Patients treated with concomitant methotrexate had a lower rate of antibody development than patients on Humira monotherapy (1% versus 12%). Methotrexate has been reported to cause fetal death and/or congenital anomalies. Necrotizing fasciitis resulting in death has been reported in a 54-year-old man with rheumatoid arthritis receiving infliximab every 8 weeks along with intramuscular methotrexate weekly dosage. Interstitial pneumonitis has been reported in a limited number of patients receiving infliximab concomitantly with a stable dosage of methotrexate.

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