Which monitoring is commonly recommended with methotrexate therapy?

• A. Regular complete blood count and liver function tests.
• B. Annual chest X-ray only.
• C. No laboratory monitoring is required.
• D. Daily eye examinations.

Answer: (A)

Regular complete blood count and liver function tests are commonly recommended with methotrexate therapy. Methotrexate can suppress bone marrow, leading to anemia, leukopenia, and thrombocytopenia, and it can cause hepatotoxicity. A CBC detects decreases in blood cell lines, signaling bone marrow suppression, while liver function tests (AST/ALT, bilirubin) identify liver injury. Baseline labs before starting and periodic monitoring during treatment (often more frequent at first, then every 1–3 months once stable) help catch toxicity early and guide dosing decisions. Renal function is also important since methotrexate is cleared by the kidneys, and pregnancy testing is relevant for women of childbearing potential. Chest imaging or daily eye exams aren’t routine monitoring for methotrexate toxicity and aren’t typically needed unless specific symptoms develop.