Antimetabolites and Cytotoxic Drugs

Azathioprine in dermatology: The past, the present, and the future

“…Moreover, previously published dosing strategies based on TPMT activity 75,189,190 underdose patients, in our collective experience. Some have postulated that the lack of statistical significance in prior studies to substantiate the efficacy of azathioprine as an adjuvant may arise from underdosing patients with high TMPT activity.…”

Suggested Guidelines for Patient Monitoring: Hepatic and Hematologic Toxicity Attributable to Systemic Dermatologic Drugs

“…It follows that prophylactic administration of folic acid 1 to 5 mg daily may lessen toxicity, especially nausea, with minimal interference with efficacy [39]. Alternatively, folinic acid (leucovorin) 2.5 to 5 mg orally 24 hours after methotrexate administration can be used [40]. Higher doses of folinic acid (''Leucovorin rescue'') may be used if more severe hematologic toxicity (agranulocytosis or pancytopenia) occurs.…”

“…Occasional hematologic toxicities occur, including relatively infrequent leukopenia, anemia, and thrombocytopenia [40,58,59].…”

Use of Transcutaneous Nerve Stimulation Wristband to Treat Methotrexate-Induced Nausea

“…2 Nausea and vomiting may be ameliorated or controlled with the concomitant administration of folic acid or an antiemetic, a reduction in the weekly dose of methotrexate, a switch from oral to parenteral administration, or utilization of divided doses of methotrexate. 3,4 Folic acid (1-5 mg q.d.) appears to minimize methotrexate-induced nausea and vomiting without decreasing methotrexate effectiveness in treating psoriasis.…”

“…appears to minimize methotrexate-induced nausea and vomiting without decreasing methotrexate effectiveness in treating psoriasis. 4 The use of folinic acid may be as effective as folic acid in controlling the gastrointestinal side effects associated with methotrexate therapy. 4 The following case report and discussion present acupressure via electrical transcutaneous nerve stimulation as a novel, nonpharmacologic antiemetic that may prove useful in controlling the nausea associated with methotrexate therapy.…”