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Methotrexate. II. Use in pediatric chemotherapy
The American Journal of Pediatric Hematology/Oncology
|January 1, 1984
Summary
Methotrexate toxicity can be reduced through urine alkalinization, hydration, and folate rescue. Intravenous infusion ensures reliable plasma concentrations, optimizing methotrexate therapy and minimizing high doses.
Area of Science:
- Pharmacology
- Oncology
Background:
- Methotrexate is a widely used chemotherapy agent.
- Managing methotrexate's toxic effects is crucial for patient safety and treatment efficacy.
Purpose of the Study:
- To outline methods for reducing methotrexate toxicity.
- To establish optimal administration routes and dosing strategies for methotrexate.
Main Methods:
- Urine alkalinization and increased hydration to mitigate toxicity.
- Use of reduced folates (leucovorin) for metabolic rescue.
- Intravenous infusion over 24 hours or more for consistent plasma levels.
- Pharmacokinetic calculations for precise methotrexate and leucovorin dosing.
Main Results:
- Alkalinization, hydration, and folate rescue effectively reduce methotrexate toxicity.
- Intravenous infusion provides reliable and reproducible plasma concentrations, unlike oral administration.
- Local administration requires specific dosing intervals (≥14 days).
- Pharmacokinetic principles allow for accurate dose calculation to achieve target plasma and tissue concentrations.
Conclusions:
- Optimized methotrexate administration, including intravenous infusion and supportive care, enables comprehensive use.
- Accurate pharmacokinetic dosing prevents unnecessarily high methotrexate doses, enhancing safety and efficacy.