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Interaction between methotrexate and ciprofloxacin.

Jean-Hugues Dalle1, Anne Auvrignon, Gilles Vassal

  • 1Unite d'Onco-Hematologie Pediatrique, Hopital Jeanne de Flandre, Lille, France. jhdalle@wanadoo.fr

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High-dose methotrexate, used for childhood cancers, requires monitoring due to potential toxicity from delayed elimination. Ciprofloxacin co-administration can significantly delay methotrexate clearance, leading to severe adverse events.

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Area of Science:

  • Pediatric Oncology
  • Clinical Pharmacology

Background:

  • High-dose methotrexate (HD-MTX) is a critical chemotherapy agent for pediatric malignant hemopathies and solid tumors.
  • Monitoring serum methotrexate concentrations is essential to prevent toxicity associated with delayed drug elimination.

Observation:

  • Two pediatric cases are presented where concurrent ciprofloxacin administration coincided with delayed methotrexate elimination.
  • This interaction led to unexpectedly prolonged methotrexate exposure in the patients.

Findings:

  • Ciprofloxacin significantly impaired the renal clearance of methotrexate in these pediatric patients.
  • Delayed methotrexate elimination resulted in severe, potentially life-threatening toxicities.

Implications:

  • Clinicians should exercise caution when prescribing ciprofloxacin concurrently with high-dose methotrexate in pediatric oncology.
  • Drug interaction monitoring is crucial to prevent methotrexate toxicity, especially with antibiotics like ciprofloxacin.
  • Further studies are warranted to elucidate the precise mechanisms of this interaction and guide clinical management.