Risk of liver disease in methotrexate treated patients

Table 1 Management of suspected methotrexate toxicity

Transaminase monitoring	Commencing	Every 2 wk
	Adjusting dose	Every 2 wk
	Stable dose	Every 12 wk
Elevated transaminases	New persistent elevation	Reduce methotrexate, investigate
	New elevation greater than 3 times upper limit normal	Withdraw methotrexate, investigate, methotrexate may be restarted after normalisation
Liver biopsy	Indication	Investigation of other potential causes of elevated transaminases
		Very rarely for confirmation of methotrexate induced toxicity