Can I Take Methotrexate With Mupirocin?

Bulls2005 asked

Hi. I use Mupirocin frequently for sinus infections. It works extremely well. Do I have to stop using it if I go on methotrexate or another RA drug? If they interact, is there another RA drug you can use together with the Mupirocin? Thanks

Answer

Thank you for your excellent question.

When it comes to drug interactions, there sometimes isn’t always a documented one... but that doesn’t necessarily mean that it’s a good idea to take both medications or there aren't other considerations.

Now, there is no known interaction between methotrexate (brand names Rheumatrex or Trexall) and mupirocin (may go by the brand names Bactroban or Centany) but we need to talk a little more about how methotrexate works for rheumatoid arthritis.

Rheumatoid arthritis is an autoimmune disorder; the immune system is overactive and primarily attacks the joints. Over time, this leads to slow and often irreversible damage.

Methotrexate, among other uses, is commonly utilized to treat rheumatoid arthritis and is typically dosed once weekly. It works by suppressing the immune system, leading to less joint damage. 

However, and this is an important point, due to the immune system being suppressed, methotrexate patients are at a greater risk of infection.

Usually, when an antibiotic is started, the weekly dose of methotrexate is delayed for several days or skipped entirely until the infection is cleared and the immune system needs to be suppressed again.

Mupirocin is available in either a cream or ointment formulation. Due to it being applied to the outside or inside of the nose, you should have minimal absorption throughout your body so drug interactions aren't too much of a concern. More than likely, it’s only being used to either prevent an infection or to help make sure that an infection is not spreading further.

If it’s being used to prevent infection, it’s probably safe to be used with methotrexate.

If you ever have a more severe sinus infection that requires oral antibiotics, you will probably need to temporarily stop your methotrexate as directed by your rheumatologist.