@midniteangelcloudjum

Again I asked Copilot about an ICD and this is what it told me -
"No — methotrexate is not contraindicated in patients with an implantable cardioverter‑defibrillator (ICD). None of the authoritative prescribing information lists an ICD as a contraindication. Contraindications are limited to pregnancy (for non‑oncologic use), severe hypersensitivity to methotrexate, and certain severe organ‑system conditions — but not implanted cardiac devices. "

I am not sure where you are finding information to the contrary. I don't want to say you are wrong, simply that what I am finding is not agreeing with what you are saying.

Many drugs are used off label and in reality, Methotrexate is used a lot in rheumatology as an anti-inflammatory. It is not a chemo cancer drug, so the side effects are very different.

Again, here is what my AI tool says about it's use -
"Yes — methotrexate is a core component of multiple standard, guideline‑based protocols for autoimmune and inflammatory diseases. It is one of the most widely used conventional synthetic DMARDs (csDMARDs) and appears as first‑line or foundational therapy in several major rheumatologic treatment algorithms."

"All authoritative historical sources agree that its earliest clinical use was in childhood leukemia in the late 1940s, and only years later was it repurposed for autoimmune and inflammatory diseases."

My understanding is that it was first used in the autoimmune world in the 1950's and it is low dose, not at the high dose level needed to treat cancer patients. It appears to me that it is both a cancer drug (high dose) and an autoimmune drug (low dose).