Iatrogenically-related, fatal methotrexate intoxication: A series of four cases

Moisa, Adina; Fritz, Péter; Benz, David; Wehner, Heinz‐Dieter

doi:10.1016/j.forsciint.2004.12.031

Cited by 32 publications

(31 citation statements)

References 8 publications

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“…Moisa et al [1] reported four fatal cases due to liver necrosis, pancytopenia and mucositis during the use of high-dose MTX and emphasized that physicians must be aware of possible fatal side effects of MTX.…”

Section: Discussionmentioning

confidence: 99%

“…Through this mechanism, it blocks the synthesis of timidilate required for deoxyribonucleic acid (DNA). [1] Methotrexate can be used in high doses in the treatment of many malignant diseases together with other cytostatic drugs used as anticancer agents.…”

mentioning

confidence: 99%

“…[3] Bone myelosuppression, pancytopenia, agranulocytosis, inflammation and necrotic changes in mucous tissues, liver cell necrosis and hepatic cirrhosis, pulmonary fibrosis, disorders of kidney function, vasculitis and skin lesions are some side effects that may occur during the use of MTX. [1] When MTX is used in high doses, calcium folinate is the recommended rescue therapy.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Intoxication Due to High Dose Methotrexate in a Patient with Rheumatoid Arthritis: A Case Report

Altindag

Küçükoğlu

2011

Turk J Rheumatol

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Intoxication Due to High Dose Methotrexate in a Patient with Rheumatoid Arthritis: A Case Report

Altindag

Küçükoğlu

2011

Turk J Rheumatol

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“…Zatrucia te wynikały z wydania nieprawidłowych zaleceń przez lekarza, omyłkowego przyjęcia tabletek o więk-szej dawce leku niż zamierzona lub podania większej dawki leku w iniekcji [1,3,4,5,6,7,8,9]. W jednej z prac opisano cztery przypadki śmiertelnego zatrucia u chorych leczonych metotreksatem z powodu reumatoidalnego zapalenia stawów.…”

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“…Objawy zatrucia pojawiły się po 7-9 dniach stosowania leku. U wszystkich chorych doszło do rozwoju pancytopenii i ostatecznie do zgonu [1]. Z drugiej strony opisywano również przypadki zatrucia metotreksatem u osób hemodializowanych z powodu skrajnej niewydolności nerek, które nie zakończyły się zgonem.…”

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Przypadkowe zatrucie metotreksatem –

Smędra¹,

Jurczyk²,

Szram³

et al. 2013

amsik

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Development of an algorithm to detect methotrexate wrong frequency error using computerized health care data

Herrinton

Woodworth

Eworuke

et al. 2019

Pharmacoepidemiology and Drug

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Purpose We validated an algorithm to detect frequency errors in computerized healthcare data and estimated the incidence of these errors in an integrated healthcare system. Methods We applied Sentinel System analytic tools on the electronic health records of Kaiser Permanente, Northern California, January 1, 2010, through May 30, 2015,to identify rheumatoid arthritis (RA) patients with new use of methotrexate (365‐day baseline period). We identified potential methotrexate frequency errors using ICD‐9 code 995.20 (adverse drug event), Current Procedural Terminology (CPT) code 96409 for injection of leucovorin and prescription refill patterns. We performed chart review to confirm the frequency errors, assessed performance for detecting frequency errors, and estimated the incidence of chart‐confirmed errors. Results The study included 24,529 methotrexate dispensings among 3,668 RA patients. Among these, 722 (3%) had one dispensing and 23,807 (97.1%) had ≥2 dispensings during 1‐year follow‐up period. We flagged 653 (2.7%) with a potential medication error (46 with one dispensing and 607 with ≥2 dispensings). We sampled 94 for chart review, and confirmed three methotrexate errors. All three confirmed frequency errors involved a first methotrexate dispensing followed by injected rescue therapy, leucovorin, (positive predictive value, 60%; 95% confidence interval [CI], 15‐95%). No potential errors were found among patients with ≥2 dispensings. We estimated the frequency error incidence among one methotrexate dispensing to be 0.4% (95%CI, 0.1% to 1.2%). Conclusion Rescue therapy is a specific indicator of methotrexate overdose among first methotrexate dispensings. This method is generalizable to other medications with serious adverse events treated with antidotes.

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Iatrogenically-related, fatal methotrexate intoxication: A series of four cases

Cited by 32 publications

References 8 publications

Intoxication Due to High Dose Methotrexate in a Patient with Rheumatoid Arthritis: A Case Report

Intoxication Due to High Dose Methotrexate in a Patient with Rheumatoid Arthritis: A Case Report

Przypadkowe zatrucie metotreksatem –

Development of an algorithm to detect methotrexate wrong frequency error using computerized health care data

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