Repeated daily dosing of weekly methotrexate therapy causing multiorgan toxicity: a case report
AbstractMethotrexate toxicity following intravenous (IV) methotrexate is well reported, but there is less information on accidental daily dosing of a prescribed weekly dose of oral methotrexate. A 70 year old female presented following accidentally taking 20 mg methotrexate for five days, with multi...
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2023-12-01
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| Series: | Toxicology Communications |
| Subjects: | |
| Online Access: | https://www.tandfonline.com/doi/10.1080/24734306.2023.2221508 |
| _version_ | 1797372322031599616 |
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| author | Emma Davey Geoffrey K. Isbister |
| author_facet | Emma Davey Geoffrey K. Isbister |
| author_sort | Emma Davey |
| collection | DOAJ |
| description | AbstractMethotrexate toxicity following intravenous (IV) methotrexate is well reported, but there is less information on accidental daily dosing of a prescribed weekly dose of oral methotrexate. A 70 year old female presented following accidentally taking 20 mg methotrexate for five days, with multiple oral ulcers, thrombocytopenia (platelets 80 x 109/L [reference range[RR]:150-400 x 109/L]) and an alanine aminotransferase 820 U/L [RR:10-35 U/L]. Methotrexate was undetectable [<0.04 µmol/L]. She was treated with folinic acid, 15 mg orally and then 15 mg IV every six hours. She became progressively pancytopenic, with the lowest counts occurring days 3-6: Hb, 87 g/L, platelets, 22 x 109/L, neutrophils, 0.0 x 109/L [RR:2-8 x 109/L] and white cell count, 0.6 x 109/L [RR:4-11 x 109/L]. She received 2 units of platelets, filgrastim 300 mcg daily for days 3-7 and IV ceftazidime/gentamicin for a fever. On day 6, her platelet and neutrophil counts began to recover, and her ALT was almost normal on discharge day 9. She had alopecia in the 3 months post-discharge. Our patient developed severe toxicity, consistent with complete absorption and cellular uptake of methotrexate, with slow cellular elimination. She was treated with folinic acid, granulocyte-colony stimulating factor and blood product transfusions. |
| first_indexed | 2024-03-08T18:34:04Z |
| format | Article |
| id | doaj.art-d64e0b6cd70345a3b68f9789cbd8ce0d |
| institution | Directory Open Access Journal |
| issn | 2473-4306 |
| language | English |
| last_indexed | 2024-03-08T18:34:04Z |
| publishDate | 2023-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Toxicology Communications |
| spelling | doaj.art-d64e0b6cd70345a3b68f9789cbd8ce0d2023-12-29T17:11:43ZengTaylor & Francis GroupToxicology Communications2473-43062023-12-017110.1080/24734306.2023.2221508Repeated daily dosing of weekly methotrexate therapy causing multiorgan toxicity: a case reportEmma Davey0Geoffrey K. Isbister1Department of Clinical Toxicology, Calvary Mater Newcastle, Waratah, New South Wales, AustraliaDepartment of Clinical Toxicology, Calvary Mater Newcastle, Waratah, New South Wales, AustraliaAbstractMethotrexate toxicity following intravenous (IV) methotrexate is well reported, but there is less information on accidental daily dosing of a prescribed weekly dose of oral methotrexate. A 70 year old female presented following accidentally taking 20 mg methotrexate for five days, with multiple oral ulcers, thrombocytopenia (platelets 80 x 109/L [reference range[RR]:150-400 x 109/L]) and an alanine aminotransferase 820 U/L [RR:10-35 U/L]. Methotrexate was undetectable [<0.04 µmol/L]. She was treated with folinic acid, 15 mg orally and then 15 mg IV every six hours. She became progressively pancytopenic, with the lowest counts occurring days 3-6: Hb, 87 g/L, platelets, 22 x 109/L, neutrophils, 0.0 x 109/L [RR:2-8 x 109/L] and white cell count, 0.6 x 109/L [RR:4-11 x 109/L]. She received 2 units of platelets, filgrastim 300 mcg daily for days 3-7 and IV ceftazidime/gentamicin for a fever. On day 6, her platelet and neutrophil counts began to recover, and her ALT was almost normal on discharge day 9. She had alopecia in the 3 months post-discharge. Our patient developed severe toxicity, consistent with complete absorption and cellular uptake of methotrexate, with slow cellular elimination. She was treated with folinic acid, granulocyte-colony stimulating factor and blood product transfusions.https://www.tandfonline.com/doi/10.1080/24734306.2023.2221508Methotrexatetoxicityfolinic acidpancytopenianeutropeniacase report |
| spellingShingle | Emma Davey Geoffrey K. Isbister Repeated daily dosing of weekly methotrexate therapy causing multiorgan toxicity: a case report Toxicology Communications Methotrexate toxicity folinic acid pancytopenia neutropenia case report |
| title | Repeated daily dosing of weekly methotrexate therapy causing multiorgan toxicity: a case report |
| title_full | Repeated daily dosing of weekly methotrexate therapy causing multiorgan toxicity: a case report |
| title_fullStr | Repeated daily dosing of weekly methotrexate therapy causing multiorgan toxicity: a case report |
| title_full_unstemmed | Repeated daily dosing of weekly methotrexate therapy causing multiorgan toxicity: a case report |
| title_short | Repeated daily dosing of weekly methotrexate therapy causing multiorgan toxicity: a case report |
| title_sort | repeated daily dosing of weekly methotrexate therapy causing multiorgan toxicity a case report |
| topic | Methotrexate toxicity folinic acid pancytopenia neutropenia case report |
| url | https://www.tandfonline.com/doi/10.1080/24734306.2023.2221508 |
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