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Methotrexate pulmonary toxicity.

Omar Lateef¹, Najia Shakoor, Robert A Balk

¹Division of Pulmonary & Critical Care Medicine, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA.

Expert Opinion on Drug Safety

|July 14, 2005

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Methotrexate, used for rheumatoid arthritis and cancer, can cause lung toxicity, often appearing as infiltrates. Early detection and management, including stopping the drug, are key to addressing this adverse reaction.

Area of Science:

Rheumatology
Pulmonology
Oncology

Background:

Methotrexate is a widely used antineoplastic and immune-modulating drug.
It is prescribed for rheumatoid arthritis, psoriasis, sarcoidosis, and various cancers.
While generally safe, methotrexate can cause adverse reactions, notably pulmonary toxicity.

Purpose of the Study:

To discuss low-dose methotrexate pulmonary toxicity.
To outline diagnostic methods including clinical, functional, radiographical, and pathological findings.
To provide recommendations for monitoring and managing methotrexate-induced lung injury.

Main Methods:

Review of clinical manifestations of methotrexate pulmonary toxicity.
Analysis of pulmonary function tests in affected patients.

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Correlation of radiographical and pathological findings with clinical presentation.

Evaluation of management strategies.

Main Results:

Pulmonary infiltrates are the most common presentation of methotrexate pulmonary toxicity, mimicking hypersensitivity lung disease.
Diagnosis relies on a combination of clinical symptoms, pulmonary function tests, imaging, and sometimes biopsy.
Prompt discontinuation of methotrexate and supportive care, potentially with corticosteroids, is the recommended management.

Conclusions:

Low-dose methotrexate can lead to significant pulmonary toxicity.
Early recognition through comprehensive assessment is crucial for effective management.
Management involves drug cessation, supportive care, and possibly corticosteroid therapy to mitigate lung damage.