Safe administration of high dose methotrexate with minimal drug level monitoring- Experience from a center in North India

Dhingra, Himani; Jadhav, Aishwarya; Kalra, Manas; Mahajan, Amita

doi:10.1016/j.phoj.2017.11.137

Cited by 2 publications

(4 citation statements)

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“…A recent Indian study reported that amongst 598 cycles of high dose methotrexate, 88.7% cycles were managed by a single plasma drug level monitoring at 54 hours. Kapoor et al reported similar results at 42 hours of drug level monitoring 34,35 . However, more Indian studies need to be conducted to evaluate the efficacy of TDM for anticancer drugs apart from methotrexate in the Indian population.…”

Section: Resultsmentioning

confidence: 82%

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Past, present and future perspectives of therapeutic drug monitoring in India

et al. 2021

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Therapeutic drug monitoring (TDM) is the clinical practice of performing drug assays and interpreting results to maintain constant therapeutic concentrations in patients' bloodstream. Conventional TDM was started way back in the 1960s and served to optimise pharmacotherapy by maximising therapeutic efficacy by evaluating efficacy failure and monitoring drug compliance, while minimising adverse events, in drugs with a narrow therapeutic range. Currently, the scope of TDM has been extended to additional indications which are of importance to India. Apart from the conventional indications, TDM can also help combat drug resistance amongst patients treated with antimicrobials, including anti-tubercular drugs and critically ill patients with compromised pharmacokinetics. TDM is also indicated for patients on antiretroviral drugs under specific clinical scenarios and is of high importance to India. Target concentration intervention (TCI) and apriori TDM (by merging TDM with pharmacogenomics) are emerging fields explored in developed nations. The authors sought to assess the evolution of TDM in India and evaluate the potential impact of newer indications in rationalising pharmacotherapy. In the mid-1980s, TDM was presented to India.Despite showing some initial progress, its use is limited to conventional indications.Its utility is also challenged by cost and higher reliance on conventional prescribing practices. However, the newer indications such as antimicrobial resistance, tuberculosis and HIV, with their high prevalence in developing nations, present an opportunity for the growth of TDM in these countries. Indian clinician's awareness and buoyant demands alongside expert contributions from clinical pharmacologists could widen its scope.

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Section: Resultsmentioning

confidence: 82%

“…Kapoor et al reported similar results at 42 hours of drug level monitoring. 34,35 However, more Indian studies need to be conducted to evaluate the efficacy of TDM for anticancer drugs apart from methotrexate in the Indian population. It is also not indicated for TDM in clinical practice as commonly as other classes.…”

Section: Classmentioning

confidence: 99%

Past, present and future perspectives of therapeutic drug monitoring in India

et al. 2021

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“…However, it contributes to toxicity, namely oral/intestinal mucositis, that increases the risk of sepsis and toxic deaths, thus requiring a high standard of supportive care available only in HICs. Shortening the duration of MTX intravenous infusion from 24 h to 3–4 h, along with a dose reduction from 5–8 g/m 2 to 1–3 g/m 2 enables its use also in the absence of serum MTX level monitoring 16,22,81,87,93,94 . Yet, even with reduced doses, HD‐MTX can only be safely administered if adequate supportive care is available 66 …”

Section: Epidemiologymentioning

confidence: 99%

“…Shortening the duration of MTX intravenous infusion from 24 h to 3-4 h, along with a dose reduction from 5-8 g/m 2 to 1-3 g/m 2 enables its use also in the absence of serum MTX level monitoring. 16,22,81,87,93,94 Yet, even with reduced doses, HD-MTX can only be safely administered if adequate supportive care is available. 66 Anthracyclines.…”

Section: Sub-saharan Africamentioning

confidence: 99%