Emtricitabine/Tenofovir-DF (FTC/TDF, PrEP)
Quality of Evidence:
Coadministration has not been studied. Methotrexate is predominantly eliminated via the kidneys, including active tubular secretion (OAT1, OAT3 mediate methotrexate transport in the kidney whereas MRP4 and BCRP mediate methotrexate efflux in the urine). No interaction is expected with emtricitabine as emtricitabine is eliminated by other renal transporters. In theory, there is potential for competition for active renal transport mechanisms if tenofovir-DF and methotrexate are coadministered. However, the results of a clinical study evaluating the co-administration of high-dose of intravenous methotrexate with different NRTIs, including tenofovir-DF, showed that methotrexate half-life was not prolonged. However, since methotrexate and tenofovir-DF may both cause tubular toxicity, the use of tenofovir-DF should be avoided with concurrent or recent use of a nephrotoxic medicinal product. If coadministration is unavoidable, renal function should be monitored closely. Note, some methotrexate product labels contraindicate its use or advise caution in immunodeficiency and some contraindicate its use in HIV infection.
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