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Methotrexate Elimination When Coadministered With Levetiracetam
David Reeves1,2, Sarah DiDominick3, Suzanne Finn3
1Butler University, Indianapolis, IN, USA dreeves@butler.edu.
The Annals of Pharmacotherapy
|August 12, 2016
Summary
This study found no significant interaction between levetiracetam and methotrexate, suggesting it is unlikely to cause delayed methotrexate elimination in most patients. Further research is needed for those with additional risk factors.
Area of Science:
- Pharmacology
- Oncology
- Clinical Pharmacy
Background:
- Previous case reports suggested a potential interaction between levetiracetam and methotrexate, leading to delayed methotrexate elimination.
- This prompted an investigation into the safety and efficacy of concomitant use in high-dose methotrexate regimens.
Purpose of the Study:
- To investigate the potential drug interaction between levetiracetam and methotrexate in patients undergoing high-dose methotrexate therapy.
- To determine if levetiracetam affects the elimination of methotrexate.
Main Methods:
- A retrospective study analyzed data from 81 adult patients receiving 280 cycles of high-dose methotrexate.
- Methotrexate elimination was assessed by measuring drug concentrations at 24, 48, and 72 hours.
- Statistical analyses, including Cox and logistic regression, were used to evaluate the effect of levetiracetam.
Main Results:
- Patients receiving levetiracetam had lower initial 24-hour methotrexate concentrations, but concentrations at 48 and 72 hours were similar between groups.
- The time to reach nontoxic methotrexate concentrations (<0.1 µmol/L) and the frequency of delayed elimination were not significantly different.
- Levetiracetam was not identified as a significant predictor of delayed methotrexate elimination.
Conclusions:
- The study does not support a clinically significant interaction between levetiracetam and methotrexate.
- A significant interaction is unlikely in patients without additional risk factors for delayed methotrexate elimination.
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