Acute bone marrow suppression and gastrointestinal toxicity following acute oral methotrexate overdose

Isoardi, Katherine Z; Harris, Keith; Carmichael, Kate E; Dimeski, Goce; Chan, Betty; Page, Colin B.

doi:10.1080/15563650.2018.1484128

Cited by 15 publications

(11 citation statements)

References 5 publications

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“…Bidaki et al (9) published a report of two geriatric patients mistakenly given MTX instead of digoxin at the pharmacy, in which one patient died due to development of toxicity. Publications on MTX toxicity are often case reports of oral overdose or mistaken use in place of another drug (10). Cases like ours, where daily parenteral administration of MTX as a presumed analgesic and development of severe neutropenia and neutropenic enterocolitis ending in patient death, are less frequently reported.…”

Section: Discussionmentioning

confidence: 85%

Fatal Neutropenic Enterocolitis Following Methotrexate Overdose: A Case Report

İnce

Tunca

Yekenkurul

2019

Düzce Tıp Fakültesi Dergisi

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Methotrexate, a folic acid antagonist, is widely used in the treatment of neoplasms in addition to diseases such as psoriasis and rheumatoid arthritis. Although well tolerated under normal conditions, the use of more than the recommended doses may cause life-threatening toxicities. Toxicity due to high doses of methotrexate is manifested by bone marrow inhibition, gastrointestinal mucosal damage and pancytopenia. Most cases result from overdose. However, serious adverse events that result in mortality, in particular those of mixing medication in elderly patients, are rare. Herein, we present the case of a 72-year-old man who admitted to the emergency department with painful oral ulcers, inability to swallow and a general impaired condition, and died of sepsis after developing neutropenic enterocolitis following a fever and neutropenia.

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Section: Discussionmentioning

confidence: 85%

Fatal Neutropenic Enterocolitis Following Methotrexate Overdose: A Case Report

İnce

Tunca

Yekenkurul

2019

Düzce Tıp Fakültesi Dergisi

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“…Due to saturable intestinal absorption, MTX absorption is 90% at an oral dose of less than 30 mg/m 2 , whereas it is less than 10-20% when MTX is taken at a dose greater than 80 mg/m 2 . 16 This is another reason why repeated taking of a oral low dose MTX could be more dangerous than an acute single oral overdose, as described in cases of pediatric accidental ingestion and acute overdose [17][18][19] after a reported ingestion of approximately 1000 mg/m 2 . On the other hand, in case of parenteral administration, there is no difference in absorption because MTX is all absorbed.…”

Section: Discussionmentioning

confidence: 99%

Poisoning related to therapeutic error in prolonged low‐dose methotrexate treatment

Schicchi

Scaravaggi

Petrolini

et al. 2020

Brit J Clinical Pharma

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To study the predictive factors for the development of clinical manifestations in poisoning due to the erroneous taking of low-dose methotrexate (MTX).Methods: A retrospective observational study was performed. Only cases of erroneous administration in non-oncologic outpatients were included (July 2008-March 2020).Results: Forty-one cases were included. All patients were taking MTX for the first time. In 36 cases, patients took MTX daily instead of weekly. In the other five patients, MTX was sold instead of methylergometrine. Clinical manifestations were absent in 12/41 patients (29.3%). All 29 (70.7%) symptomatic patients recognized the medication error when they developed clinical manifestations: dermatological, haematological and gastrointestinal symptoms. Statistical results showed that symptomatic patients were older, received a higher amount of total dose and were treated for longer. Moreover, the probability of being symptomatic increases as a function of age and of total dose. Asymptomatic patients were treated with folinic acid (30 mg/ m 2 /day) for 5 days. Symptomatic patients were treated with folinic acid together with treatments for the specific clinical manifestations. No patients were treated with glucarpidase. All patients fully recovered.Conclusions: When MTX is prescribed for the first time, it is important to clearly communicate with patients to avoid therapeutic errors. In our experience, age, total dose taken and number of days of assumption are predictive for the presence/ absence of clinical manifestations. These parameters must be evaluated together to identify patients needing maximum starting treatment with folinic acid and closer monitoring. K E Y W O R D S methotrexate, poison control centre, therapeutic error 1 | INTRODUCTION Methotrexate (MTX) is a reversible inhibitor of dihydrofolate reductase and thymidylate synthase. High doses of MTX are used as an antineoplastic drug given its antimetabolite action, which leads to an impairment of cellular replication and repair. At low doses, ranging from 7.5 to 30 mg/weekly, MTX has antiphlogistic and immunosuppressive activities and is used to treat autoimmune/rheumatic diseases. 1,2Even if some adverse reactions are reported, MTX is considered the drug of choice in rheumatic diseases due to its effectiveness and

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“…The main objective of the SR is to evaluate the efficacy and safety of acupuncture for chemotherapy induced marrow suppression; therefore, the primary outcomes are as follows: white blood cell (WBC) counts, [ 24 ] platelet counts, [ 25 ] hemoglobin counts, [ 26 ] or other validated outcome measures.…”

Section: Methodsmentioning

confidence: 99%

Acupuncture for the treatment of marrow suppression after chemotherapy

Geng

Yin²,

Sun³

et al. 2020

Medicine

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Background: Cancer continues to be a severe global health problem and the leading cause of death worldwide. Chemotherapy as the main treatment has various side effects, of which marrow suppression is the most common one. Acupuncture had shown clinical effects for marrow suppression after chemotherapy in many studies. However, the efficacy and safety of acupuncture therapy for marrow suppression after chemotherapy remains unclear. Objective: This protocol aims to evaluate the efficacy and safety of acupuncture for marrow suppression after chemotherapy according to the existing randomized controlled trials. Methods and analysis: The randomized controlled trials on acupuncture therapy for marrow suppression after chemotherapy will be searched in the database of Embase, PubMed and Cochrane Library, Allied and Complementary Medicine Database (AMED), Chinese Biomedical Literature Database (CBM), China Science and Technology Journal Database (VIP), China National Knowledge Infrastructure (CNKI), WanFang Database (WF), and related registration platforms (WHO ICTRP, Clinical Trials, and Chinese Clinical Trial Register [ChiCTR]), Grey Literature Database from inception to 1 August 2020. The primary outcomes will be assessed using white blood cell (WBC) count, platelet count, hemoglobin count and the number of neutrophils (N). Review Manager V.5.3 software will be applied for statistical analyses. We will measure the risk of bias of the included studies with Cochrane Collaboration Risk of Bias Tool. Finally, Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) will be used to grade the overall quality of evidence. And we will use the intra-group correlation coefficient to assess the consistency of reviewers. Result: This systematic review and meta-analysis will put a high-quality synthesis of the efficacy and safety of acupuncture treatment in marrow suppression after chemotherapy. Conclusion: The conclusion of this systematic review will provide evidence to assess acupuncture therapy is an efficacy and safe intervention to treat and control marrow suppression after chemotherapy. PROSPERO registration number: PROSPERO CRD42020163336

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Acute bone marrow suppression and gastrointestinal toxicity following acute oral methotrexate overdose

Cited by 15 publications

References 5 publications

Fatal Neutropenic Enterocolitis Following Methotrexate Overdose: A Case Report

Fatal Neutropenic Enterocolitis Following Methotrexate Overdose: A Case Report

Poisoning related to therapeutic error in prolonged low‐dose methotrexate treatment

Acupuncture for the treatment of marrow suppression after chemotherapy

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