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Pharmacology · single question

What is a recognized oral manifestation of methotrexate use (an antimetabolite/folate antagonist)?

  1. Oral ulceration (a well-documented toxicity, especially with overdose, drug interactions, or impaired renal clearance)
  2. Tooth discoloration as the primary oral effect
  3. Gingival overgrowth as the primary oral effect
  4. Black hairy tongue as the primary oral effect
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Correct answer: A. Oral ulceration (a well-documented toxicity, especially with overdose, drug interactions, or impaired renal clearance)

Methotrexate, a folate antagonist used for conditions like rheumatoid arthritis and certain malignancies, can cause oral mucosal ulceration as a recognized toxicity, particularly with drug accumulation from renal impairment, drug interactions (e.g., with NSAIDs reducing methotrexate clearance), or inadvertent overdose — this is an important early warning sign of methotrexate toxicity that clinicians should recognize.

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