How often do you monitor labs in patients taking methotrexate?

Lab monitoring for patients taking MTX should be based on a few key principles. It should be done at least on a quarterly basis, ie every 3 months, if the patient is prescribed a stable dose and does not belong to one of the higher risk categories for the development of toxicities. These risk factor...

@Dr. First Last: I agree, especially when you look at the Nakafero data.

I am from the same school as @Dr. First Last and others in my generation; we were taught to check labs q 4-12 weeks. These recommendations for timing of labs were not based upon any sound medical evidence, other than noting tha...

Many of our patients are on methotrexate for decades without events or laboratory abnormalities. If a patient has had stable labs every 2 to 3 months for the first year (e.g. are low risk for toxicity), I stretch out the intervals to every six months. I would never do this in a patient with steatosi...

Can those who have answered above comment on how much they "tolerate" elevated LFTs? Does any elevation in LFTs make you stop MTX, how many "transient elevations" do you tolerate before stopping MTX? In a q 3 month MTX monitoring scenario, what percentage of transient elevations would have you stop ...