Understanding and Managing Methotrexate Nephrotoxicity

Widemann, Brigitte C.; Adamson, Peter C.

doi:10.1634/theoncologist.11-6-694

Cited by 611 publications

(642 citation statements)

References 54 publications

Supporting

Mentioning

597

Contrasting

Unclassified

Order By: Relevance

“…Hemodialysis, hemoperfusion, or a combination of the two in this condition have been repeatedly investigated, but these invasive procedures require prolonged application, might add treatment-related morbidity, and result in a limited decline in blood MTX levels with frequent rebound increases [8].…”

Section: Discussionmentioning

confidence: 99%

“…Precipitation of methotrexate (MTX) in renal tubules is thought to be the main mechanism causing HD-MTX-induced renal failure, and consequently, prolonged exposure to toxic blood MTX concentrations. Various types of renal replacement therapies have been used to enhance MTX clearance, but these require invasive access, have a limited effect in lowering blood MTX levels with rebound increase in MTX levels on termination, and are not always readily available [8].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Glucarpidase (Carboxypeptidase G2) Intervention in Adult and Elderly Cancer Patients with Renal Dysfunction and Delayed Methotrexate Elimination After High-Dose Methotrexate Therapy

et al. 2007

View full text Add to dashboard Cite

After completing this course, the reader will be able to:1. Identify risk factors for kidney failure associated with high-dose MTX therapy.2. Discuss the therapeutic options in patients with delayed MTX elimination.3. Discuss the potential risks and benefits of glucarpidase intervention.Access and take the CME test online and receive 1 AMA PRA Category 1 Credit ™ at CME.TheOncologist.com CME CME Conclusions. Glucarpidase is well tolerated and produces a rapid inactivation of substantial amounts of MTX. However, overall results are still unsatisfactory in adult and elderly patients, suggesting that earlier recognition of delayed MTX elimination and more rapid intervention are needed. The Oncologist ABSTRACT

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Glucarpidase (Carboxypeptidase G2) Intervention in Adult and Elderly Cancer Patients with Renal Dysfunction and Delayed Methotrexate Elimination After High-Dose Methotrexate Therapy

et al. 2007

View full text Add to dashboard Cite

show abstract

“…5 The safe and timely administration of single-agent, high-dose methotrexate is also conditional on the coordinated timing of ancillary treatments, such as antiemetics and leucovorin. [4][5][6][7] Alkaline hydration can be initiated upon the patient's arrival to the nursing unit so that target values for urine output and pH are achieved in a timely manner. At Spectrum Health Hospitals, Grand Rapids, Michigan, the time from start of alkaline hydration to urine pH greater than 7 in this population ranges from 5.4 to 11.8 hours.…”

Section: New Methods For Order Entry Of Methotrexatementioning

confidence: 99%

Improved Pharmacy Department Workflow with New Method of Order Entry for Single-Agent, High-Dose Methotrexate

et al. 2014

View full text Add to dashboard Cite

Purpose To determine whether a process change impacted the proportion of orders for single-agent, high-dose methotrexate entered by chemotherapy pharmacists instead of general pharmacy staff. Coordination of antiemetic premedication and leucovorin rescue with the new method of order entry was evaluated. Methods Adults treated with single-agent, high-dose methotrexate were identified retrospectively. Order entry of methotrexate and ancillary medications was examined to determine whether the old or new method was used and whether it was performed by a chemotherapy pharmacist. The fundamental difference between the old and new methods for order entry is use of the “unscheduled” frequency of medication administration to replace the administration frequency of “once” with a specified date and time. Timing of antiemetic premedication and leucovorin rescue relative to methotrexate administration were tallied for the new method. Chi-square analysis was performed for the primary objective. Observational statistics were performed otherwise. Results The number of evaluable encounters identified was 158. A chemotherapy pharmacist entered a greater proportion of orders when the new method was utilized (P < .0001). The proportion of orders entered by a chemotherapy pharmacist increased during the hours of 0700 and 2259 with the new method. Appropriate coordination of antiemetic and leucovorin administration was documented for 96% and 100% of cases with the new method of order entry. Conclusion The proportion of orders for single-agent, high-dose methotrexate entered by a chemotherapy pharmacist was significantly greater with the use of the new method. Administration of antiemetic premedication and leucovorin rescue were appropriately coordinated with the use of the new method for order entry of single-agent, high-dose methotrexate.

show abstract

“…. Unfortunately, MTX therapy may lead to myelosuppression, acute liver toxicity, nephrotoxicity, mucositis, and neurotoxicity [4,[6][7][8][9][10][11].MTX-associated toxicity is associated with several factors including dose, the duration of administration, patient risk factors, and genetic factors [12,13]. There are no sufficient data involving the use of HDMTX pharmacokinetic and toxicity information to anticipate hematologic toxicity in children with ALL.…”

Section: High-dose Methotrexate (Hdmtx) Chemotherapy With Leucovorin mentioning

confidence: 99%

Effects of High Dose Methotrexate and Delayed Elimination on Myelotoxicity Progression in Children with Acute Lymphoblastic Leukemia

El-Azzazy

Fathy

Elsafy

et al. 2017

Afro-Egyptian Journal of Infectious and Endemic Diseases

View full text Add to dashboard Cite

Understanding and Managing Methotrexate Nephrotoxicity

Cited by 611 publications

References 54 publications

Glucarpidase (Carboxypeptidase G2) Intervention in Adult and Elderly Cancer Patients with Renal Dysfunction and Delayed Methotrexate Elimination After High-Dose Methotrexate Therapy

Glucarpidase (Carboxypeptidase G2) Intervention in Adult and Elderly Cancer Patients with Renal Dysfunction and Delayed Methotrexate Elimination After High-Dose Methotrexate Therapy

Improved Pharmacy Department Workflow with New Method of Order Entry for Single-Agent, High-Dose Methotrexate

Effects of High Dose Methotrexate and Delayed Elimination on Myelotoxicity Progression in Children with Acute Lymphoblastic Leukemia

Contact Info

Product

Resources

About