Methotrexate

Methotrexate. You see the name on a chart and immediately a cascade of protocols comes to mind: baseline labs, folate supplementation, monitoring schedules. It’s one of those agents that’s so foundational in rheumatology, dermatology, and oncology that its complexities become second nature, but that familiarity can sometimes obscure just how remarkable and, frankly, how dangerous this drug can be. This isn’t a simple supplement; it’s a chemotherapeutic agent repurposed as an immunomodulator, and treating it with anything less than profound respect is a mistake.