Methotrexate toxicity: Difference between revisions
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==Background== | ==Background== | ||
*Methotrexate blocks dihydrofolate reductase (DHFR) → blocks conversion of folate to folinic acid | |||
*Used in tx of Non-hodgkin lymphoma, ALL, certain other malignancies, psoriasis and other dermatological conditions | |||
*Folate supplementation is often given with methotrexate, and ↓ risk of toxicity<ref name="Weidmann" /> | |||
*Absorbed by saturable transporter in GI tract<ref name="Schmiegelow">Schmiegelow K. Advances in individual prediction of methotrexate toxicity: a review. Br J Haematol. 2009 Sep;146(5):489-503. doi: 10.1111/j.1365-2141.2009.07765.x.</ref> | |||
**Single large oral dose will have lower bioavailability/toxicity than multiple small doses or chronic toxicity. | |||
==Clinical Features<ref name="Weidmann">Weidmann A, Foulkes AC, Kirkham N, Reynolds NJ. Methotrexate Toxicity During Treatment of Chronic Plaque Psoriasis: A Case Report and Review of the Literature. Dermatology and Therapy. 2014;4(2):145-156. doi:10.1007/s13555-014-0056-z.</ref>== | |||
==Clinical Features== | *Nausea/vomiting | ||
*Folic acid deficiency | |||
*Myelosuppression | |||
*Hepatotoxicity | |||
**Acutely - transaminitis | |||
**Chronic - cirrhosis/fibrosis | |||
*Pulmonary toxicity | |||
*Renal injury (ATN) 2/2 precipitation of methotrexate crystals<ref name="Schmiegelow" /> | |||
*Cutaneous injury (stomatitis, mucositis, ulcerations, SJS and [[TEN]], etc.) | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Revision as of 08:32, 17 July 2015
Background
- Methotrexate blocks dihydrofolate reductase (DHFR) → blocks conversion of folate to folinic acid
- Used in tx of Non-hodgkin lymphoma, ALL, certain other malignancies, psoriasis and other dermatological conditions
- Folate supplementation is often given with methotrexate, and ↓ risk of toxicity[1]
- Absorbed by saturable transporter in GI tract[2]
- Single large oral dose will have lower bioavailability/toxicity than multiple small doses or chronic toxicity.
Clinical Features[1]
- Nausea/vomiting
- Folic acid deficiency
- Myelosuppression
- Hepatotoxicity
- Acutely - transaminitis
- Chronic - cirrhosis/fibrosis
- Pulmonary toxicity
- Renal injury (ATN) 2/2 precipitation of methotrexate crystals[2]
- Cutaneous injury (stomatitis, mucositis, ulcerations, SJS and TEN, etc.)
Differential Diagnosis
Diagnosis
Management
Disposition
- Admit
See Also
References
- ↑ 1.0 1.1 Weidmann A, Foulkes AC, Kirkham N, Reynolds NJ. Methotrexate Toxicity During Treatment of Chronic Plaque Psoriasis: A Case Report and Review of the Literature. Dermatology and Therapy. 2014;4(2):145-156. doi:10.1007/s13555-014-0056-z.
- ↑ 2.0 2.1 Schmiegelow K. Advances in individual prediction of methotrexate toxicity: a review. Br J Haematol. 2009 Sep;146(5):489-503. doi: 10.1111/j.1365-2141.2009.07765.x.