Red clover causing symptoms suggestive of methotrexate toxicity in a patient on high-dose methotrexate

2013 ◽  
Vol 19 (3) ◽  
pp. 133-134 ◽  
Author(s):  
A. Orr ◽  
R. Parker
Keyword(s):  
Red Clover ◽  
High Dose ◽  
High Dose Methotrexate ◽  
Dose Methotrexate ◽  
Methotrexate Toxicity

Re-challenge with High Dose Methotrexate vs. Reduced Dose After Methotrexate Toxicity in Pediatric Osteosarcoma:Case Report

2020 ◽  
Vol 2 (2) ◽  
Author(s):  
Walid Ibrahim ◽  
Alam Alhuda Mohamed ◽  
Nawaf Alkhayat ◽  
Yasser Elborai
Keyword(s):  
Renal Impairment ◽  
Supportive Care ◽  
High Dose ◽  
High Dose Methotrexate ◽  
Reduced Dose ◽  
Dose Methotrexate ◽  
Methotrexate Toxicity ◽  
Renal Complications ◽  
Leucovorin Rescue ◽  
Pediatric Osteosarcoma

Introduction: Methotrexate (MTX), a classic antifolate, is one of the most widely used and well-studied anticancer agents. High-dose methotrexate (HD-MTX) with folinic acid (leucovorin) rescue is one of the standard therapies for osteosarcoma. High-dose methotrexate (HDMTX) can exert significant toxicity and requires complex pharmacokinetic monitoring and leucovorin rescue. The side effect profile of MTX varies markedly according to the dose. Regimens containing MTX are classified as high, intermediate, or low-dose. High-dose methotrexate (HD-MTX; 12 g/m2) is a part of the golden standard therapy for pediatric osteosarcoma (OS). Risk factors associated with MTX toxicity in children with OS are not well defined. Case Presentation: We report here a case of pediatric osteosarcoma with nephrotoxicity associated with delayed MTX excretion who was successfully managed using supportive measures that encouraged us to re-challenge with a full dose of MTX then we reduced the dose to 50% to attain the final critical decision about continuation or changing the regimen of treatment for the patient. Our patient developed moderate renal complications during therapy that improved with supportive care, so we challenged with more cycles of a high dose MTX, but the patient developed serious renal complications. A reduced dose of MTX with 50% was given successfully without any renal impairment. Conclusion: Methotrexate toxicity that might not occur during the initial courses of high-dose MTX is not a predictive of the tolerability of further courses and re-challenging with HDMTX is risky, but reduced dose methotrexate is a good option rather than changing the regimen, with good tolerability and rapid clearance of HDMTX. HDMTX-induced renal impairment occurs in a low percentage of patients with osteosarcoma and can be managed successfully by maximum supportive care. MTX clearance can be affected by gender and age.

Modulation of high-dose methotrexate toxicity by a non-toxic level of 5-fluorouracil

Toxicology ◽  
1986 ◽  
Vol 41 (1) ◽  
pp. 61-73 ◽  
Author(s):  
Terry J. Robbins ◽  
Donnell Bowen ◽  
Quang Q. Bui ◽  
Minh-Tam Tran
Keyword(s):  
High Dose ◽  
High Dose Methotrexate ◽  
Toxic Level ◽  
Dose Methotrexate ◽  
Methotrexate Toxicity

scholarly journals High-dose methotrexate toxicity in elderly patients with primary central nervous system lymphoma

2005 ◽  
Vol 16 (3) ◽  
pp. 445-449 ◽  
Author(s):  
K. Jahnke ◽  
A. Korfel ◽  
P. Martus ◽  
M. Weller ◽  
U. Herrlinger ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Elderly Patients ◽  
Central Nervous System Lymphoma ◽  
High Dose ◽  
High Dose Methotrexate ◽  
Dose Methotrexate ◽  
Methotrexate Toxicity

scholarly journals Accidental high-dose methotrexate toxicity due to an electronic prescribing error

2014 ◽  
Vol 80 (3) ◽  
pp. 268 ◽  
Author(s):  
Ercan Çaliskan ◽  
Mustafa Tunca ◽  
Gürol Açikgöz ◽  
Ercan Arca ◽  
Ahmet Akar
Keyword(s):  
Electronic Prescribing ◽  
High Dose ◽  
High Dose Methotrexate ◽  
Prescribing Error ◽  
Dose Methotrexate ◽  
Methotrexate Toxicity

Suspected Methotrexate Toxicity From Omeprazole

2012 ◽  
Vol 25 (4) ◽  
pp. 477-485 ◽  
Author(s):  
Ali McBride ◽  
Scott J. Antonia ◽  
Eric B. Haura ◽  
Dawn Goetz
Keyword(s):  
Drug Interaction ◽  
Stress Ulcer ◽  
Elevated Serum ◽  
High Dose ◽  
High Dose Methotrexate ◽  
Carboxypeptidase G2 ◽  
Dose Methotrexate ◽  
Methotrexate Toxicity ◽  
Ulcer Prophylaxis ◽  
To Receive

We report a case of methotrexate toxicity potentially induced by a drug interaction between methotrexate and omeprazole in a 25-year-old man with osteosarcoma. The patient was placed on omeprazole after his first cycle of high-dose methotrexate for stress ulcer prophylaxis, and it was discontinued before the start of the first day of the patient’s second round of high-dose methotrexate. The 24-hour methotrexate level was elevated and he continued to have sustained levels for 18 days. Side effects due to elevated serum methotrexate included seizures, mucositis, acute renal failure, and thrombocytopenia. Aggressive hydration, urinary alkalinization, and leucovorin were continued during the period of elevated methotrexate levels, with the patient receiving a course of hemodialysis and a dose of carboxypeptidase G2. The patient’s symptoms resolved, and his renal function returned to baseline within 2 months. The patient was able to receive future courses of chemotherapy without methotrexate. Although use of the Naranjo adverse reaction probability scale indicated a probable relationship (score of 6) between the patient’s development of methotrexate toxicity and omeprazole use, we believe this was a drug-drug interaction case consistent with previous reports in the literature.

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