A Rare Drug Reaction to Methotrexate After Treatment for Ectopic Pregnancy

Abstract

Methotrexate is a commonly used therapy for ectopic pregnancies in the outpatient setting. Practitioners should be aware of the potential adverse reactions to methotrexate.

Delayed Renal Excretion of Methotrexate After a Severe Anaphylactic Reaction to Methotrexate in a Child With Osteosarcoma

“…Alkins et al 5 described an anaphylactic reaction in a 30-year-old patient with osteosarcoma receiving the first HDMTX infusion. Straka et al 12 Our case is the first pediatric patient who developed an anaphylactic reaction during the first infusion of MTX. The patient developed a severe cardiovascular collapse during the reaction.…”

“…Although most cases involve intravenous infusion, anaphylaxis may also develop after intrathecal, intramuscular, or subcutaneous administration. 3,[11][12][13] So far, only 4 adult cases have been reported with anaphylaxis to the first dose of MTX. Alkins et al 5 described an anaphylactic reaction in a 30-year-old patient with osteosarcoma receiving the first HDMTX infusion.…”

Role of routine monitoring of liver and renal function during treatment of ectopic pregnancies with single-dose methotrexate protocol

“…This review also documented rare and serious side effects including febrile neutropenia, transient interstitial pneumonitis, anaphylaxis, and alopecia (5,(9)(10)(11). Notably, these side effects were not observed in patients with abnormal pretreatment liver or kidney function tests (9)(10)(11).…”

Management and successful desensitization in methotrexate‐induced anaphylaxis

“…In most patients, the reactions occur after several courses of chemotherapy, suggesting that they may result from allergic (specific) hypersensitivity. However, in other patients, the reactions occur during the first administration of MTX, and probably result from non‐allergic (non‐specific) hypersensitivity 2, 9, 12, 13. Positive immediate responses in skin (prick and intradermal) tests have been reported in several patients with MTX‐induced anaphylaxis 9, 14.…”

“…Its major adverse effects are mucositis, renal and hepatic damage. Hypersensitivity reactions, including anaphylactic/anaphylactoid reactions, have also been occasionally reported 1–14.…”