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A blood thinner such as warfarin coumadin; a diuretic water pill such as furosemide lasix ; cyclosporine gengraf, neoral, sandimmune ; lithium eskalith, lithobid ; methotrexate rheumatrex, trexall ; steroids prednisone and others ; or aspirin or nsaids.

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Methotrexate, therefore, inhibits the synthesis of dna, rna, thymidylates, and proteins.

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Anticoagulants eg, warfarin , aspirin, clopidogrel, corticosteroids eg, prednisone , heparin and other blood thinners eg, dalteparin , or selective serotonin reuptake inhibitors ssris eg, fluoxetine because the risk of stomach bleeding may be increased acetaminophen because the risk of liver problems may be increased probenecid because it may increase the risk of diclofenac s side effects cyclosporine, lithium, metformin, methotrexate, oral nsaids eg, ibuprofen , or quinolones eg, ciprofloxacin because the risk of their side effects may be increased by diclofenac angiotensin-converting enzyme ace inhibitors eg, enalapril or diuretics eg, furosemide, hydrochlorothiazide because their effectiveness may be decreased by diclofenac.

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Pulmonary reactions are rare but usually occur during the initial period of methotrexate therapy.

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Methotrexate in high doses followed by leucovorin rescue in combination with other chemotherapeutic agents is effective in prolonging relapse-free survival in patients with non-metastatic osteosarcoma who have undergone surgical resection or amputation for the primary tumor.

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