Steroids may be reduced gradually in patients who respond to methotrexate. Laboratory studies demonstrate that it may be displaced from plasma albumin by various compounds including sulfonamides, salicylates, tetracyclines, chloramphenicol, and phenytoin.Methotrexate does not penetrate the blood-cerebrospinal fluid barrier in therapeutic amounts when given orally or parenterally. Delayed drug clearance has been identified as one of the major factors responsible for methotrexate toxicity. However, high doses of leucovorin may reduce the efficacy of intrathecally administered methotrexate.Folate deficiency states may increase methotrexate toxicity. Each 10 mg/mL, 2 mL vial contains methotrexate sodium equivalent to 20 mg methotrexate.Methotrexate Injection, USP, Isotonic Liquid, Preservative Free, for Single Use Only. A. Guidelines for monitoring serum methotrexate levels, and for adjustment of leucovorin dosing to reduce the risk of methotrexate toxicity, are provided below in Methotrexate has been detected in human breast milk. A. Cardizem I.V. To report SUSPECTED ADVERSE REACTIONS, contact Hikma Pharmaceuticals USA Inc. at 1-877-845-0689, or the FDA at 1-800-FDA-1088 or Serum methotrexate level approximately 10 micromolar at 24 hours after administration, 1 micromolar at 48 hours, and less than 0.2 micromolar at 72 hours.15 mg PO, IM or IV q 6 hours for 60 hours (10 doses starting at 24 hours after start of methotrexate infusion).Serum methotrexate level remaining above 0.2 micromolar at 72 hours, and more than 0.05 micromolar at 96 hours after administration.Continue 15 mg PO, IM or IV q 6 hours, until methotrexate level is less than 0.05 micromolar.Serum methotrexate level of 50 micromolar or more at 24 hours, or 5 micromolar or more at 48 hours after administration, OR; a 100% or greater increase in serum creatinine level at 24 hours after methotrexate administration (e.g., an increase from 0.5 mg/dL to a level of 1 mg/dL or more).
With IV administration, 80% to 90% of the administered dose is excreted unchanged in the urine within 24 hours. Generally speaking, neither hemodialysis nor peritoneal dialysis has been shown to improve methotrexate elimination. Accumulation of this metabolite may become significant at the high doses used in osteogenic sarcoma. When a patient has delayed drug elimination due to compromised renal function, a third space effusion, or other causes, methotrexate serum concentrations may remain elevated for prolonged periods.The potential for toxicity from high-dose regimens or delayed excretion is reduced by the administration of leucovorin calcium during the final phase of methotrexate plasma elimination.Pharmacokinetic monitoring of methotrexate serum concentrations may help identify those patients at high risk for methotrexate toxicity and aid in proper adjustments of leucovorin dosing.
Your list will be saved and can be edited at any time.The above information is provided for general Acutely, liver enzyme elevations are frequently seen. 4. Methotrexate in high doses, followed by leucovorin rescue, is used as a part of the treatment of patients with non-metastatic osteosarcoma. IV skill Video, Cardizem. These studies were not designed to demonstrate the specific contribution of high-dose methotrexate/leucovorin rescue therapy to the efficacy of the combination. Nonlinear elimination due to saturation of renal tubular reabsorption has been observed in psoriatic patients at doses between 7.5 and 30 mg. More recently corticosteroid therapy, in combination with other antileukemic drugs or in cyclic combinations with methotrexate included, has appeared to produce rapid and effective remissions. If necessary, acute, intermittent hemodialysis with a high-flux dialyzer may also be beneficial in these patients.CAUTION: DO NOT ADMINISTER LEUCOVORIN INTRATHECALLY.Psoriasis, Rheumatoid Arthritis, and Juvenile Rheumatoid ArthritisFor either adult RA or polyarticular-course JRA, dosages may be adjusted gradually to achieve an optimal response. Combination chemotherapy regimens that include intravenous methotrexate administered at higher doses with leucovorin rescue have been utilized in advanced stages of the disease. Pretreatment liver biopsy should be performed for patients with a history of excessive alcohol consumption, persistently abnormal baseline liver function test values or chronic hepatitis B or C infection. More recently corticosteroid therapy, in combination with other antileukemic drugs or in cyclic combinations with methotrexate included, has appeared to produce rapid and effective remissions. Methotrexate given by the intrathecal route appears significantly in the systemic circulation and may cause systemic methotrexate toxicity. Reactions were noted after single or multiple low, intermediate, or high doses of methotrexate in patients with neoplastic and non-neoplastic diseases.Methotrexate should be used with extreme caution in the presence of debility.Methotrexate exits slowly from third space compartments (e.g., pleural effusions or ascites). Methods: We reviewed the records of 358 patients with low-risk GTN (FIGO stage I and stages II-III, score<7) treated initially with methotrexate 0.4 mg/kg (max 25mg) IV push daily × 5 days every 14 days between 1979 and 2009. Methotrexate Injection, USP Isotonic Liquid, Contains Preservative is available in 25 mg/mL, 2 mL (50 mg) vials. Limited experience shows a significant increase in the incidence and severity of serious toxic reactions, especially bone marrow suppression, at doses greater than 20 mg/wk in adults.