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November 10, 1969, Vol 210, No. 6 >
ARTICLE | November 10, 1969

Absorption of Methotrexate And Hepatotoxicity

Howard V. Dubin, MD; E. Richard Harrell, MD
JAMA. 1969;210(6):1104. doi:10.1001/jama.1969.03160320086036.
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To the Editor:—  Recently interest has been aroused in hepatotoxicity in psoriasis patients with methotrexate.1,2 One factor which may be of importance in the development of hepatotoxicity is the rate of intestinal absorption of the drug.Freeman-Narrod3 showed that there were at least two distinct patterns of intestinal absorption of methotreaxate. The first pattern showed quite slow absorption, with low peak blood levels and slow clearing from the blood. The second pattern showed rapid absorption with high peak blood levels and rapid clearing. In addition, after several weeks of treatment, in many of the patients with the second (rapid) absorption pattern, the absorption curve altered in such a way that they became slow absorbers.The same author3 also showed that the patient who retained a rapid methotrexate absorption pattern throughout the course of therapy did not develop signs of toxic effects. Those who were slow absorbers, or

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