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Severe renal toxicity due to intermediate-dose methotrexate

✍ Scribed by Allistair N. Stark; Graham Jackson; Peter J. Carey; Shahabul Arfeen; Stephen J. Proctor

Publisher
Springer
Year
1989
Tongue
English
Weight
312 KB
Volume
24
Category
Article
ISSN
0344-5704

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✦ Synopsis

Methotrexate (MTX) is a drug widely used in the treatment of patients with malignant disease. Its well-known side effects include myelosuppression, mucositis and renal damage. These problems are primarily dose-related, tending to occur more frequently when high doses (greater than 1 g/m2) are given. We present four cases in whom severe renal and mucosal toxicity occurred with intermediate doses (200 mg/m2) of MTX despite folinic acid rescue. Possible reasons for this occurrence are discussed and means of avoiding such toxicity are suggested. Three of four patients developed severe loin pain within a few hours of injection; the significance of this symptom in relation to subsequent renal toxicity has implications for early recognition of the problem.

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## Abstract In clinical studies performed during 111 infusions of high dose methotrexate (MTX) we have evolved a clinical and laboratory protocol which permits such therapy without prohibitive risk to the patient. The plasma MTX data obtained indicate that pharmacokinetic disposition is dose relate