Managing methotrexate toxicity: a case report

High-dose methotrexate is included in chemotherapy regimens used to treat a number of malignant neoplasms. Methotrexate plasma concentration is considered the best toxicity predictor. Monitoring methotrexate plasma concentrations is standard practice in the identification of at-risk patients, the ti...

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Bibliographic Details
Published inFarmacia hospitalaria Vol. 28; no. 5; p. 371
Main Authors Fernández Megía, M J, Alós Almiñana, M, Terol Castera, M J
Format Journal Article
LanguageSpanish
Published Spain 01.09.2004
Subjects
Acute Kidney Injury - chemically induced
Acute Kidney Injury - diagnosis
Acute Kidney Injury - drug therapy
Aged
Anion Exchange Resins - administration & dosage
Antimetabolites, Antineoplastic - administration & dosage
Antimetabolites, Antineoplastic - adverse effects
Cholestyramine Resin - administration & dosage
Humans
Hydrogen-Ion Concentration
Leucovorin - therapeutic use
Lymphoma, Non-Hodgkin - drug therapy
Male
Methotrexate - administration & dosage
Methotrexate - adverse effects
Treatment Outcome
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Summary:High-dose methotrexate is included in chemotherapy regimens used to treat a number of malignant neoplasms. Methotrexate plasma concentration is considered the best toxicity predictor. Monitoring methotrexate plasma concentrations is standard practice in the identification of at-risk patients, the titration of folinic acid doses, and the establishment of corrective measures. Methotrexate is a kidney-cleared weak acid, and renal function impairment may retard methotrexate clearance. A case of severe methotrexate-induced toxicity secondary to renal failure is reported in a patient with non-Hodgkin s lymphoma receiving methotrexate at a dose of 1 g/m2. Corrective measures included folinic acid rescue therapy, cholestyramine resin administration, hydration and urine alkalinization, urine pH monitoring, and extracorporeal clearance techniques.
ISSN:1130-6343