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In parallel with MTXs most well-known targets, several NAD+-dependent enzymes were inhibited by the antifolate in vitro : 2-oxoglutarate, isocitrate, malate, pyruvate, succinate, 6-phosphogluconate and glucose-6-phosphate dehydrogenases, glutamate-cysteine ligase, glutathione reductase, and glutathione peroxidase (29)

The American Society of Anesthesiologists (ASA) recommends withholding these drugs before surgery, but definitive guidelines remain unclear

Denatured peptide is biologically inactive