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Delayed low-dose methotrexate excretion in a rheumatoid arthritis patient: A case report and literature review
Qingzi Yan1, Haibo Lei, Ting Gong
1Department of Clinical Pharmacy, Xiangtan central hospital, Xiangtan, China.
Rationale:
Low-dose methotrexate has a relatively good safety profile. However, in cases where patients with multiple risk factors, a delayed excretion has been observed, resulting in the occurrence of severe adverse reactions. It is necessary to supervise and intervene throughout the entire process of treating patients with multiple risk factors for methotrexate, and to strengthen the rational application of methotrexate.
Patient Concerns And Diagnoses:
A 66-year-old male patient was admitted to our hospital with rheumatoid arthritis and underlying conditions such as chronic obstructive pulmonary disease (COPD). This patient received treatment with low-dose MTX (10 mg/week) and experienced adverse reactions including anemia. He was diagnosed with methotrexate-induced bone marrow suppression.
Interventions And Outcomes:
The therapeutic drug monitoring revealed that the serum drug concentration of methotrexate was at a critical level and the patient was rescue with calcium folinate and other adjuvant therapy such as transfusions of red blood cells, plasma, platelets, oral Yixuesheng tablets and Leucogen tablets. We conducted a 1-month follow-up, and there was no recurrence of bone marrow suppression and anemia.
Lessons:
To ensure rational administration of methotrexate, it is important to fully evaluate the clinical manifestations and physical condition of patients and regularly detecting the serum drug concentration of methotrexate when patients with multiple risk factors, Otherwise, even low-dose methotrexate administration may cause delayed excretion, resulting in severe adverse reactions.
Insights
Low-dose methotrexate can cause severe adverse reactions in patients with multiple risk factors due to delayed excretion. Regular monitoring of serum methotrexate levels is crucial for safe and rational drug administration.
Area of Science:
- Pharmacology
- Rheumatology
- Clinical Toxicology
Background:
- Low-dose methotrexate generally has a good safety profile.
- Patients with multiple risk factors may experience delayed methotrexate excretion, leading to severe adverse reactions.
- Supervision and intervention are necessary for patients with multiple risk factors receiving methotrexate therapy.
Approach:
- A case study of a 66-year-old male patient with rheumatoid arthritis and COPD treated with low-dose methotrexate (10 mg/week).
- The patient developed anemia and was diagnosed with methotrexate-induced bone marrow suppression.
- Therapeutic drug monitoring revealed critical serum methotrexate levels.
Key Points:
- The patient was treated with calcium folinate, blood product transfusions, and oral medications.
- A 1-month follow-up showed no recurrence of bone marrow suppression or anemia.
- This case highlights the risk of severe adverse reactions even with low-dose methotrexate in certain patients.
Conclusions:
- Comprehensive evaluation of patient condition and regular monitoring of serum methotrexate concentrations are vital.
- This approach ensures rational methotrexate administration and prevents delayed excretion and severe adverse events in high-risk patients.
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