Although a clinically significant interaction does not occur in all patients, numerous case reports are available that demonstrate possible problems following the coadministration of MTX and NSAIDs. To date, the specific circumstances during which the reaction may occur have not been well defined.

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Both urinary alkalinization and multiple doses of activated charcoal are effective for the enhancement of phenobarbital elimination but multiple-dose charcoal was superior to urinary alkalinization in our study population.