Dextromethorphan and Methylxanthines Might Be Useful in the Treatment of Methotrexate-Induced Neurotoxicity

Fernández–Fernández, Francisco José; Ameneiros-Lago, Eugenia; Lijó-Carballeda, Cristina; Sesma, Pascual

doi:10.1097/pec.0000000000001128

Cited by 2 publications

(1 citation statement)

References 10 publications

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“…It is widely believed that MTX can cause direct toxic damage to the CNS, potentially by the accumulation of adenosine after MTX inhibition on purine synthesis (15). Methylxanthines have therefore been used in some cases based on their ability to displace adenosine from the central receptors (16). We did not employ methylxanthines in the treatment of our patient but we had continued on folinic acid for another week.…”

Section: Discussionmentioning

confidence: 99%

Successful therapeutic rechallenge after a severe episode of high dose methotrexate‑induced choreoathetosis: A case report

et al. 2019

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Methotrexate (MTX) is an essential chemotherapy drug used in the treatment of malignancies, but it is known to cause complications to the central nervous system. We report a case of severe MTX neurotoxicity in an adult presenting with choreoathetosis despite a normal clearance of MTX. High dose-MTX has been successfully rechallenged without any neurological sequelae. We reviewed the relevant literature of similar manifestations and summarized their clinical data, magnetic resonance imaging features and treatment given. None of them has recurrence of neurotoxicity. We concluded that it is safe to persist with MTX even after a previous episode of toxic leukoencephalopathy.

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Section: Discussionmentioning

confidence: 99%

Successful therapeutic rechallenge after a severe episode of high dose methotrexate‑induced choreoathetosis: A case report

et al. 2019

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Dextromethorphan Administration on Day 0 and Day 7 for Secondary Prevention of Methotrexate-induced Neurotoxicity in Childhood Acute Lymphoblastic Leukemia: A Retrospective Case Series

Fustino¹,

Juhl²,

Leister

2021

Journal of Pediatric Hematology/Oncology

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Acute lymphoblastic leukemia is the most common malignancy in children. Long-term survival exceeds 90%; however, therapy-induced toxicity remains a concern. Methotrexate neurotoxicity (MTX-NT) is common, often necessitating alterations in chemotherapy regimens. Dextromethorphan has been used as an abortive and prophylactic treatment for MTX-NT. The authors report a case series of 7 pediatric patients with acute lymphoblastic leukemia with prior episodes of MTX-NT given a single dose of dextromethorphan (1 to 2 mg/kg) on the day of MTX administration and 7 days later. No subsequent episodes of MTX-NT occurred after 40 intravenous and 81 intrathecal administrations. This specific regimen of secondary prophylaxis may prevent MTX-NT.

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Dextromethorphan and Methylxanthines Might Be Useful in the Treatment of Methotrexate-Induced Neurotoxicity

Cited by 2 publications

References 10 publications

Successful therapeutic rechallenge after a severe episode of high dose methotrexate‑induced choreoathetosis: A case report

Successful therapeutic rechallenge after a severe episode of high dose methotrexate‑induced choreoathetosis: A case report

Dextromethorphan Administration on Day 0 and Day 7 for Secondary Prevention of Methotrexate-induced Neurotoxicity in Childhood Acute Lymphoblastic Leukemia: A Retrospective Case Series

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