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My mother had been taking Methatrexate for approximately five years, when she recently passed away from complications due to severe cirrhosis assumedly caused by chronic Methatrexate exposure. What is the current standard of care for monitoring liver function when consuming such a powerful drug? She had blood tests taken every 12 weeks, which even one month before her death were normal. She never received a liver biopsy or scan during the five years. Is this appropriate?

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I’m very sorry about your mother. I would like to give you proper explanation related to drug monitoring, but you didn’t mention what your mother was using the medication for.. Methotrexate can be used in treatment of psoriatic arthritis, active rheumatoid arthritis, poliomyelitis, lupus and in higher doses in therapy of some forms of cancer. Methotrexate is very powerful drug; it works like antimetabolite, suppresses immune defense and has toxic effect on liver cells. So, according to this, methotrexat is prescribed only in very serious conditions, when its benefits are more important then side effects that this drug causes. In patients on methotrexat, regular monitoring of blood is required because it causes low white blood count, suppresses bone marrow and is hepatotoxic. It is very important what the indication for using methotrexate was. AST test can show if it is needed liver biopsy to be done. Monitoring of level of serum albumins is also needed in patients on methotrexate. Long-term use is always associated with hepatotoxicity, especially because methotrexate has potential to concentrate in the liver.
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