Methotrexate toxicity - Revision history

ClaireLewis: /* Clinical FeaturesWeidmann A, Foulkes AC, Kirkham N, Reynolds NJ. Methotrexate Toxicity During Treatment of Chronic Plaque Psoriasis: A Case Report and Review of the Literature. Dermatology and Therapy. 2014;4(2):145-156. doi:10.1007/s13555-014-0056-...

2019-01-30T15:59:33Z

/* Clinical FeaturesWeidmann A, Foulkes AC, Kirkham N, Reynolds NJ. Methotrexate Toxicity During Treatment of Chronic Plaque Psoriasis: A Case Report and Review of the Literature. Dermatology and Therapy. 2014;4(2):145-156. doi:10.1007/s13555-014-0056-...

← Revisión anterior		Revisión del 15:59 30 ene 2019
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	==Clinical Features<ref name="Weidmann">Weidmann A, Foulkes AC, Kirkham N, Reynolds NJ. Methotrexate Toxicity During Treatment of Chronic Plaque Psoriasis: A Case Report and Review of the Literature. Dermatology and Therapy. 2014;4(2):145-156. doi:10.1007/s13555-014-0056-z.</ref>==		==Clinical Features<ref name="Weidmann">Weidmann A, Foulkes AC, Kirkham N, Reynolds NJ. Methotrexate Toxicity During Treatment of Chronic Plaque Psoriasis: A Case Report and Review of the Literature. Dermatology and Therapy. 2014;4(2):145-156. doi:10.1007/s13555-014-0056-z.</ref>==
	*[[Nausea/vomiting]]		*[[Nausea/vomiting]]
	*[[~~Folic acid~~ deficiency]]		*[[Folate deficiency]]
	*Myelosuppression, [[pancytopenia]]		*Myelosuppression, [[pancytopenia]]
	*[[Hepatotoxicity]]		*[[Hepatotoxicity]]

ClaireLewis: /* Clinical FeaturesWeidmann A, Foulkes AC, Kirkham N, Reynolds NJ. Methotrexate Toxicity During Treatment of Chronic Plaque Psoriasis: A Case Report and Review of the Literature. Dermatology and Therapy. 2014;4(2):145-156. doi:10.1007/s13555-014-0056-...

2019-01-30T15:59:08Z

← Revisión anterior		Revisión del 15:59 30 ene 2019
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	*[[Nausea/vomiting]]		*[[Nausea/vomiting]]
	*[[Folic acid deficiency]]		*[[Folic acid deficiency]]
	*Myelosuppression		*Myelosuppression, [[pancytopenia]]
	*Hepatotoxicity		*[[Hepatotoxicity]]
	**Acutely - transaminitis		**Acutely - transaminitis
	**Chronic - [[cirrhosis]]/fibrosis		**Chronic - [[cirrhosis]]/fibrosis
	*Pulmonary toxicity		*Pulmonary toxicity
	*Renal injury (ATN) secondary to precipitation of methotrexate crystals<ref name="Schmiegelow" />		*[[acute kidney injury\|Renal injury]] (ATN) secondary to precipitation of methotrexate crystals<ref name="Schmiegelow" />
	*Cutaneous injury (stomatitis, mucositis, ulcerations, SJS and [[TEN]], etc.)		*Cutaneous injury (stomatitis, mucositis, ulcerations, [[SJS]] and [[TEN]], etc.)

	==Differential Diagnosis==		==Differential Diagnosis==

Rossdonaldson1: /* Management */

2017-02-15T13:53:17Z

Management

← Revisión anterior		Revisión del 13:53 15 feb 2017
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	*'''Folinic Acid ([[Leucovorin]])'''<ref name="Weidmann" />		*'''Folinic Acid ([[Leucovorin]])'''<ref name="Weidmann" />
	**20mg IV or IM q6h until MTX serum level <10<sup>−8</sup> M		**20mg IV or IM q6h until MTX serum level <10<sup>−8</sup> M
	*'''Glucarpidase'''		*'''[[Glucarpidase]]'''
	**Works by enzymatic cleaving of MTX into metabolites		**Works by enzymatic cleaving of MTX into metabolites
	*Hydration and urine alkalinization		*Hydration and urine alkalinization

ClaireLewis at 22:49, 22 December 2016

2016-12-22T22:49:49Z

← Revisión anterior		Revisión del 22:49 22 dic 2016
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	==Background==		==Background==
	*[[Methotrexate]] blocks dihydrofolate reductase (DHFR) → blocks conversion of folate to folinic acid		*[[Methotrexate]] blocks dihydrofolate reductase (DHFR) → blocks conversion of folate to folinic acid
	*Used in treatment of Non-~~hodgkin~~ lymphoma, ~~ALL~~, certain other malignancies, psoriasis and other dermatological conditions, rheumatoid arthritis (as a DMARD)		*Used in treatment of [[Non-Hodgkin's lymphoma]], [[acute lymphocytic leukemia]], certain other malignancies, [[psoriasis]] and other dermatological conditions, [[rheumatoid arthritis]] (as a DMARD)
	*Folate supplementation is often given with methotrexate, and ↓ risk of toxicity<ref name="Weidmann" />		*[[Folate]] supplementation is often given with methotrexate, and ↓ risk of toxicity<ref name="Weidmann" />
	*Absorbed by saturable transporter in GI tract<ref name="Schmiegelow">Schmiegelow K. Advances in individual prediction of methotrexate toxicity: a review. Br J Haematol. 2009 Sep;146(5):489-503. doi: 10.1111/j.1365-2141.2009.07765.x.</ref>		*Absorbed by saturable transporter in GI tract<ref name="Schmiegelow">Schmiegelow K. Advances in individual prediction of methotrexate toxicity: a review. Br J Haematol. 2009 Sep;146(5):489-503. doi: 10.1111/j.1365-2141.2009.07765.x.</ref>
	**Single large oral dose will have lower bioavailability/toxicity than multiple small doses or chronic toxicity.		**Single large oral dose will have lower bioavailability/toxicity than multiple small doses or chronic toxicity.

	==Clinical Features<ref name="Weidmann">Weidmann A, Foulkes AC, Kirkham N, Reynolds NJ. Methotrexate Toxicity During Treatment of Chronic Plaque Psoriasis: A Case Report and Review of the Literature. Dermatology and Therapy. 2014;4(2):145-156. doi:10.1007/s13555-014-0056-z.</ref>==		==Clinical Features<ref name="Weidmann">Weidmann A, Foulkes AC, Kirkham N, Reynolds NJ. Methotrexate Toxicity During Treatment of Chronic Plaque Psoriasis: A Case Report and Review of the Literature. Dermatology and Therapy. 2014;4(2):145-156. doi:10.1007/s13555-014-0056-z.</ref>==
	*Nausea/vomiting		*[[Nausea/vomiting]]
	*Folic acid deficiency		*[[Folic acid deficiency]]
	*Myelosuppression		*Myelosuppression
	*Hepatotoxicity		*Hepatotoxicity
	**Acutely - transaminitis		**Acutely - transaminitis
	**Chronic - cirrhosis/fibrosis		**Chronic - [[cirrhosis]]/fibrosis
	*Pulmonary toxicity		*Pulmonary toxicity
	*Renal injury (ATN) secondary to precipitation of methotrexate crystals<ref name="Schmiegelow" />		*Renal injury (ATN) secondary to precipitation of methotrexate crystals<ref name="Schmiegelow" />
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	**Works by enzymatic cleaving of MTX into metabolites		**Works by enzymatic cleaving of MTX into metabolites
	*Hydration and urine alkalinization		*Hydration and urine alkalinization
	**~~Bicarb~~ drip at 1.5-2x maintenance rate to maintain urine pH of >7.5		**[[Bicarbonate]] drip at 1.5-2x maintenance rate to maintain urine pH of >7.5
	**MTX is excreted renally		**MTX is excreted renally

Rossdonaldson1: /* Management */

2016-12-19T09:39:04Z

Management

← Revisión anterior		Revisión del 09:39 19 dic 2016
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	==Management==		==Management==
	''Early initiation of therapy is important, so begin treatment once MTX toxicity is strongly suspected''		''Early initiation of therapy is important, so begin treatment once MTX toxicity is strongly suspected''
	*'''Folinic Acid (Leucovorin)'''<ref name="Weidmann" />		*'''Folinic Acid ([[Leucovorin]])'''<ref name="Weidmann" />
	**20mg IV or IM q6h until MTX serum level <10<sup>−8</sup> M		**20mg IV or IM q6h until MTX serum level <10<sup>−8</sup> M
	*'''Glucarpidase'''		*'''Glucarpidase'''

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-24T17:27:05Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Revisión anterior		Revisión del 17:27 24 jul 2016
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	==~~Diagnosis~~==		==Evaluation==

Rossdonaldson1: Text replacement - "gtt" to "drip"

2016-07-22T10:09:55Z

Text replacement - "gtt" to "drip"

← Revisión anterior		Revisión del 10:09 22 jul 2016
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	**Works by enzymatic cleaving of MTX into metabolites		**Works by enzymatic cleaving of MTX into metabolites
	*Hydration and urine alkalinization		*Hydration and urine alkalinization
	**Bicarb ~~gtt~~ at 1.5-2x maintenance rate to maintain urine pH of >7.5		**Bicarb drip at 1.5-2x maintenance rate to maintain urine pH of >7.5
	**MTX is excreted renally		**MTX is excreted renally

Neil.m.young: Text replacement - "0 mg" to "0mg"

2016-07-19T20:16:43Z

Text replacement - "0 mg" to "0mg"

← Revisión anterior		Revisión del 20:16 19 jul 2016
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	''Early initiation of therapy is important, so begin treatment once MTX toxicity is strongly suspected''		''Early initiation of therapy is important, so begin treatment once MTX toxicity is strongly suspected''
	*'''Folinic Acid (Leucovorin)'''<ref name="Weidmann" />		*'''Folinic Acid (Leucovorin)'''<ref name="Weidmann" />
	**~~20 mg~~ IV or IM q6h until MTX serum level <10<sup>−8</sup> M		**20mg IV or IM q6h until MTX serum level <10<sup>−8</sup> M
	*'''Glucarpidase'''		*'''Glucarpidase'''
	**Works by enzymatic cleaving of MTX into metabolites		**Works by enzymatic cleaving of MTX into metabolites

ClaireLewis: /* Background */

2016-07-15T00:18:53Z

Background

← Revisión anterior		Revisión del 00:18 15 jul 2016
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	==Background==		==Background==
	*Methotrexate blocks dihydrofolate reductase (DHFR) → blocks conversion of folate to folinic acid		*[[Methotrexate]] blocks dihydrofolate reductase (DHFR) → blocks conversion of folate to folinic acid
	*Used in treatment of Non-hodgkin lymphoma, ALL, certain other malignancies, psoriasis and other dermatological conditions, rheumatoid arthritis (as a DMARD)		*Used in treatment of Non-hodgkin lymphoma, ALL, certain other malignancies, psoriasis and other dermatological conditions, rheumatoid arthritis (as a DMARD)
	*Folate supplementation is often given with methotrexate, and ↓ risk of toxicity<ref name="Weidmann" />		*Folate supplementation is often given with methotrexate, and ↓ risk of toxicity<ref name="Weidmann" />

Rossdonaldson1: Text replacement - "tx" to "treatment"

2016-07-14T05:06:45Z

Text replacement - "tx" to "treatment"

← Revisión anterior		Revisión del 05:06 14 jul 2016
Línea 1:		Línea 1:
	==Background==		==Background==
	*Methotrexate blocks dihydrofolate reductase (DHFR) → blocks conversion of folate to folinic acid		*Methotrexate blocks dihydrofolate reductase (DHFR) → blocks conversion of folate to folinic acid
	*Used in tx of Non-hodgkin lymphoma, ALL, certain other malignancies, psoriasis and other dermatological conditions, rheumatoid arthritis (as a DMARD)		*Used in treatment of Non-hodgkin lymphoma, ALL, certain other malignancies, psoriasis and other dermatological conditions, rheumatoid arthritis (as a DMARD)
	*Folate supplementation is often given with methotrexate, and ↓ risk of toxicity<ref name="Weidmann" />		*Folate supplementation is often given with methotrexate, and ↓ risk of toxicity<ref name="Weidmann" />
	*Absorbed by saturable transporter in GI tract<ref name="Schmiegelow">Schmiegelow K. Advances in individual prediction of methotrexate toxicity: a review. Br J Haematol. 2009 Sep;146(5):489-503. doi: 10.1111/j.1365-2141.2009.07765.x.</ref>		*Absorbed by saturable transporter in GI tract<ref name="Schmiegelow">Schmiegelow K. Advances in individual prediction of methotrexate toxicity: a review. Br J Haematol. 2009 Sep;146(5):489-503. doi: 10.1111/j.1365-2141.2009.07765.x.</ref>