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A Rational, Evidence-Based Approach to Methotrexate Poisoning

  • Acute Care Pharmacology and Toxicology (A King, Section Editor)
  • Published:
Current Emergency and Hospital Medicine Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Our 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 Findings

A 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.

Summary

Pharmacokinetics 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.

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Authors and Affiliations

  1. Division of Medical Toxicology, Department of Emergency Medicine, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA, 15213, USA

    Rachael Westover, Andrew F. Micciche, Carin King Malley & Anthony F. Pizon

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  1. Rachael Westover
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  2. Andrew F. Micciche
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Correspondence to Anthony F. Pizon.

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Westover, R., Micciche, A.F., Malley, C.K. et al. A Rational, Evidence-Based Approach to Methotrexate Poisoning. Curr Emerg Hosp Med Rep 8, 160–167 (2020). https://doi.org/10.1007/s40138-020-00223-4

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