Methotrexate pulmonary toxicity

Methotrexate, an antimetabolite, is indicated for moderate to severe psoriasis. It is particularly beneficial for psoriatic arthritis. It is also indicated for patients refractory to topical or UV therapy. Methotrexate can be administered orally, subcutaneously, or intramuscularly. The starting dose is 7.5 to 15 mg per week, increased incrementally by 2.5 mg every 2 to 4 weeks until response maximal doses are approximately 25 mg/wk. Adverse effects include nausea, vomiting, mucosal ulceration, stomatitis, malaise, headache, macrocytic anemia, and hepatic and pulmonary toxicity. Nausea and macrocytic anemia can be ameliorated by giving oral folic acid 1 to 5 mg/day. Methotrexate should be avoided in patients with active infections and in those with liver disease. It is contraindicated in pregnancy because it is teratogenic. 

Methotrexate, given as a weekly injection of 5 to 25 mg, has demonstrated efficacy for induction of remission in Crohn s disease as well as for maintenance therapy. The risks are bone marrow suppression, hepatotox-icity, and pulmonary toxicity. 

Methotrexate is a cytotoxic agent that may cause pulmonary toxicity and therefore patients are advised to contact the doctor if cough develops. 

C. The dose-limiting toxicity of bleomycin is pulmonary toxicity and that of cisplatin is renal. Doxorubicin produces cardiotoxicity hematoxicity is dose limiting for methotrexate. 

Adverse Effects. The major problems associated with methotrexate include hepatic and pulmonary toxicity. These problems are dose-related, however, and serious adverse effects tend to occur less frequently at... 

METHOTREXATE PENICILLINS t plasma concentrations of methotrexate and risk of toxic effects of methotrexate, e.g. myelosuppression, liver cirrhosis, pulmonary toxicity Penicillins 1 renal elimination of methotrexate by renal tubular secretion, which is the main route of elimination of methotrexate. Penicillins compete with methotrexate for renal elimination. Displacement from proteinbinding sites may occur and is only a minor contribution to the interaction Avoid concurrent use. If concurrent use is necessary, monitor clinically and biochemically for blood dyscrasia, liver toxicity and pulmonary toxicity. Do FBCs and LFTs prior to concurrent treatment... 

METHOTREXATE PROTON PUMP INHIBITORS -OMEPRAZOLE Likely t plasma concentration of methotrexate and t risk of toxic effects, e.g. blood dyscrasias, liver cirrhosis, pulmonary toxicity, renal toxicity Attributed to omeprazole decreasing the renal elimination of methotrexate Monitor clinically and biochemically for blood dyscrasias and liver, renal and pulmonary toxicity... 

CISPLATIN METHOTREXATE t methotrexate levels with t risk of pulmonary toxicity Cisplatin is the most common anticancer drug associated with renal proximal and distal tubular damage. Cisplatin could significantly l renal elimination of methotrexate It would be best to start with lower doses of methotrexate. It is necessary to assess renal function prior to and during concurrent treatment until stability is achieved. Monitor clinically and with pulmonaiy function tests... 

The prognosis of methotrexate-induced pulmonary toxicity is good, with a 1% or less mortality rate. Pulmonary toxicity has followed intrathecal as well as oral administration and has occurred after single doses as well as long-term daily and intermittent administration. Pneumonitis has been reported to occur up to 4 weeks following discontinuation of therapy. Numerous anecdotal reports have claimed dramatic benefit from corticosteroid therapy. It is unknown whether intermittent (weekly) dosing, as is done for rheumatoid arthritis, decreases the risk of methotrexate-induced pulmonary toxicity because pneumonitis has occurred with this form of dosing. 

Methotrexate 7.5-15 mg per week, increased incrementally by 2.5 mg every 2 to 4 weeks until response maximal doses are approximately 25 mg/wk Anemia, leukopenia, thrombocytopenia, hepatotoxicity, gastrointestinal upset, nausea, vomiting, mucosal ulceration, stomatitis, malaise, headaches, pulmonary toxicity... 

Methotrexate is associated with nausea and vomiting as well as mucosal ulceration, stomatitis, malaise, headaches, macrocytic anemia, and pulmonary toxicity. Nausea and macrocytic anemia can be ameliorated by administering oral folic acid in doses of 1 to 5 mg/day. 

T plasma concentrations of methotrexate, with risk of toxic effects of methotrexate, e.g. liver cirrhosis, bloorJ rJyscrasias which may be fatal, pulmonary toxicity, stomatitis. Haematopoietic suppression can occur abruptly. Other adverse effects include anorexia, dyspepsia, gastrointestinal ulceration and bleeding, and pulmonary oedema... 

---