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Methotrexate intoxication: Beyond the adverse events

Ediz Dalkilic1, Belkıs Nihan Coskun1, Burcu Yağız1

  • 1Division of Rheumatology, Faculty of Medicine, Uludağ University, Bursa, Turkey.

International Journal of Rheumatic Diseases
|August 28, 2018
PubMed
Abstract

Insights

Improper use of methotrexate (MTX) can lead to severe toxicity and death, even though it is an effective treatment for rheumatoid arthritis. Patients must be educated on correct MTX dosage and administration to prevent adverse events.

Area of Science:

  • Rheumatology
  • Clinical Pharmacology
  • Toxicology

Background:

  • Methotrexate (MTX) is a primary treatment for rheumatoid arthritis (RA).
  • MTX can cause a range of adverse effects, from mild nausea to fatal outcomes.
  • Clinical manifestations and risk factors for MTX toxicity require further investigation.

Purpose of the Study:

  • To identify predisposing factors for MTX toxicity.
  • To characterize the clinical outcomes of MTX toxicity in a patient cohort.

Main Methods:

  • Retrospective analysis of 31 patients with immune-mediated inflammatory diseases and significant MTX toxicity.
  • Data collection included patient demographics, MTX usage patterns, and clinical outcomes.

Main Results:

  • 19.4% of patients used MTX daily; 41.9% had renal insufficiency.
  • Common reasons for hospitalization included mucositis (90.3%) and fever (71%).
  • While 87.1% of patients were discharged, 12.9% died due to MTX toxicity.

Conclusions:

  • Despite MTX's efficacy, incorrect usage and dosage significantly increase toxicity risks.
  • Patient education on proper MTX use is crucial for mitigating harm.
  • Understanding risk factors like daily dosing and renal insufficiency can improve patient safety.
Keywords:
methotrexatemethotrexate toxicityrenal insufficiency

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