A Rational, Evidence-Based Approach to Methotrexate Poisoning

AbstractPurpose of ReviewOur primary aim was to create a succinct yet thorough evidence-based review of the pharmacokinetics, pharmacodynamics, clinical presentation, evaluation, and treatment of methotrexate poisoning that may serve as a useful reference for practitioners and researchers.Recent FindingsA significant amount of recent research has studied various aspects of intravenous high-dose methotrexate, particularly prevention and management of toxicity. Less substantial evidence exists concerning the management of intrathecal methotrexate overdoses, repeated oral ingestions, and the outcomes of acute oral methotrexate overdoses.SummaryPharmacokinetics studies in children have highlighted the importance of body surface area for dosing and the monitoring of methotrexate concentrations to prevent complications after administration of intravenous high-dose methotrexate. Other studies have documented the efficacy of glucarpidase and leucovorin for some of these patients. Similarly, glucarpidase has been shown to be effective in case reports of intrathecal overdoses, even when administration is delayed. Recent retrospective reviews in adult and pediatric patients have shown that most acute oral overdoses of methotrexate rarely result in toxicity. However, chronic oral ingestions are more likely to develop toxic effects. This review generated management and treatment recommendations for various exposure types.
Source: Current Emergency and Hospital Medicine Reports - Category: Emergency Medicine Source Type: research