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Published on: March 30, 2018
A rare case of methotrexate and primaquine co-administration in a mantle cell lymphoma patient
Alan L Myers1,2, Jitesh D Kawedia2, Ahmed Nader3
1Department of Diagnostic and Biomedical Sciences, The University of Texas Health Sciences Center, School of Dentistry, Houston, Texas.
What Is Known And Objective:
High-dose methotrexate (HD-MTX) is associated with a plethora of adverse drug reactions and potential drug interactions (DIs). But there is a paucity of information regarding the safety of co-administering primaquine with HD-MTX.
Case Summary:
A 65-year-old male patient was diagnosed with mantle cell lymphoma (MCL) with CNS involvement and treated with three cycles of IV HD-MTX. His case was further complicated by fungal pneumonia treated with primaquine during cycle-2. Serial blood sampling and subsequent population pharmacokinetics (PK) modelling suggests a possible distribution-mediated DI between the two drugs.
What Is New And Conclusion:
This is the first case report to highlight the safe co-administration of MTX and primaquine, despite a possible PK interaction.
Insights
This case report shows that primaquine can be safely given with high-dose methotrexate (HD-MTX), even with a potential pharmacokinetic interaction. This finding is important for managing lymphoma patients with co-existing infections.
Area of Science:
- Oncology
- Pharmacology
- Infectious Diseases
Background:
- High-dose methotrexate (HD-MTX) is a cornerstone in treating certain cancers, including mantle cell lymphoma (MCL) with central nervous system (CNS) involvement.
- HD-MTX is associated with numerous adverse drug reactions and potential drug interactions (DIs).
- Limited data exists on the safety of co-administering primaquine with HD-MTX.
Observation:
- A 65-year-old male patient with MCL and CNS involvement received three cycles of intravenous HD-MTX.
- The patient developed fungal pneumonia during the second cycle of HD-MTX and was treated with primaquine.
- Serial blood sampling and population pharmacokinetic (PK) modeling were performed.
Findings:
- The study suggests a possible distribution-mediated drug interaction between HD-MTX and primaquine.
- Despite the potential interaction, the co-administration of HD-MTX and primaquine was deemed safe in this patient.
- This is the first reported case of safe co-administration of these two drugs.
Implications:
- This case report provides crucial safety information for oncologists and infectious disease specialists.
- It suggests that primaquine can be used in patients undergoing HD-MTX therapy when clinically indicated.
- Further research may be warranted to fully elucidate the pharmacokinetic interaction and its clinical significance.
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