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Jerome L. Shupack, MD; Guy F. Webster, MD, PhD
New York University School of Medicine

JAMA. 1988;260(20):3005.

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In Reply. —

The foregoing letters report two additional cases of pancytopenia from low-dose methotrexate therapy and propose three different explanations for its occurrence. Dr Nierenberg's thoughtful letter emphasizes drug interaction between methotrexate and nonsteroidal drugs as the cause of pancytopenia. This is indeed possible; however, only five of the eight patients were taking nonsteroidal drugs, and a vast number of individuals routinely combine the two drugs without adverse effect. The answer cannot be quite so simple.

Drs Burke and Jones report a patient who had the coincidence of folate deficiency and pancytopenia while taking methotrexate. The patient had no further episodes of cytopenia after his folate level was corrected. This letter presents an intriguing possibility and a subject worthy of organized investigation.

Drs Grigg and Hare report a woman with chronic renal insufficiency who developed pancytopenia while being treated with methotrexate, sulfonamides, and captopril. They invoke displacement from plasma . . . [Full Text PDF of this Article]

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