Acute Methotrexate Ingestions in Adults: A Report of Serious Clinical Effects and Treatments

Abstract

Objective. Limited reported data have reports effects after acute ingestion of methotrexate. Treatment recommendations do not differentiate between exposure routes. Our objective was to determine the frequency of significant toxicity effects and use of therapy after methotrexate ingestion in adults. Methods. We performed a retrospective study on adult cases reported to 6 poison centers over 6 years (2000–2005) which exceed 180,000 exposures/year. Variables collected included demographics, dosages ingested, coingestions, clinical effects, and therapies with outcomes. Results. Sixty-three patients examined over the 6-year period met inclusion criteria. No patient in the series received dialysis or died. The mean dose ingested for all patients was 24 mg (range 2.5–100 mg) and the mean dose for suicidal ingestions was 47.5 mg (12.5–100 mg). The most common clinical effects were abdominal pain, oral irritation, throat irritation, nausea, dizziness, and headache. Nine patients received folinic acid and 3 patients received sodium bicarbonate. No patient developed renal failure, bone marrow suppression, seizure, or coma. No patient died or received dialysis. Conclusion. In our series of patients from 6 poison centers over six years, 63 cases of acute adult methotrexate ingestions were reported. Methotrexate toxicity from ingestion in adults was uncommon and rarely toxic.

Methotrexate Toxicity from Unintentional Dosing Errors: Calls to a Poison Center and Death Descriptions

“…Methotrexate ingestion in this study period (111 cases) is similar to previous poison center studies. 4,5 However, we note a higher incidence of unintentional therapeutic errors (79% vs 13.7%) than reported in the National Poison Data System (NPDS) for all ingestions in 2019. 6 This discrepancy in incidence is likely multifactorial and may be accounted for by regional incidence of rheumatologic disease, differences in regional prescribing patterns, and variation in recognizing methotrexate toxicity during the study period.…”

“…Previous poison center studies noted leucovorin treatment rates of 14%. 4 One potential reason for increased treatment rates may be increased awareness around leucovorin's lowcost, low-side-effect benefits, as well as difference in poison center recommendations by area. We strongly support leucovorin treatment for patients hospitalized for suspected methotrexate toxicity.…”

Medication Error: A Case Report of Misadventure with Methotrexate

“…2 Single oral dose usually does not result in significant toxicity in a patient with normal renal functions. 3,4,5 We present a case of MTX toxicity occurring as a result of prescription error, and the challenges associated with its management, in a patient with multiple comorbidities. The present case emphasizes on a note of caution on the part of the prescriber and the suggestions regarding the measures which can be taken to avoid MTX toxicity.…”

Ärztliche Compliance hinsichtlich Empfehlungen des Giftinformationszentrums-Nord

“…Methotrexat ist ein Folinsäure-Antagonist und greift, wie im Abschnitt 4.4.3.9 beschrieben, in die schnelle Zellteilungsrate ein. Eingesetzt wird es in der onkologischen-und rheumatologischen Therapie, bei M. Bechterew, der Regenbogenhautentzündung, schwerer Psoriasis und nach Organtransplantationen (Bebarta et al 2014).…”

“…Damit der Antifolat-Effekt des MTX erfolgreich antagonisiert werden kann, ist eine möglichst frühzeitige Gabe von Calciumfolinat erforderlich(Reich et al 2011). Eine neue Therapie-Option ist bei Versagen von Calciumfolinat die Behandlung mit dem rekombinanten Enzym Glucarpidase, das Methotrexat zu dem atoxischen Metaboliten DAMPA metabolisiert(Schwartz 2008;Silas et al 2008;Bebarta et al 2014).In der vorliegenden Untersuchung wurde das Antidot Calciumfolinat bei zwei Methotrexat-Intoxikationsfällen empfohlen. In beiden Fällen wurde das Antidot nicht verabreicht.Im ersten Fall wurde nur eine leichte klinische Symptomatik berichtet.…”