Warning. Mean age was significantly higher in the second group (Chronic MTX poisoning is more serious than acute toxicity and accompanies higher dermatologic, hematologic, and hepatic complications necessitating more aggressive treatments including administration of higher doses of leucovorin or bone marrow stimulants such as G-CSF.


What is Methotrexate Toxicity? Different organs may be involved in these two entities. 2008;4:149–50.Howard SC, McCormick J, Pui CH, Buddington RK, Harvey RD. Cerner Multum, Inc. "Australian Product Information." A Of the total 27 patients admitted during the study period, 13 had referred with acute (group 1) and 14 had referred with chronic (group 2) poisoning (Table Patients with acute toxicity were generally those who had ingested their relatives’ medication to attempt suicide or those with accidental exposure to oral MTX. 3. "Product Information. BMJ Case Rep. 2011;26:2011.Dhir V, Sandhu A, Kaur J, Pinto B, Kumar P, Kaur P, et al. Cerner Multum, Inc. "UK Summary of Product Characteristics." 1979;5:57-61. The majority of cases of cutaneous MTX toxicity have been reported in patients with psoriasis, exceptionally in patients with rheumatoid arthritis (RA). Data is limited on comparison of acute and chronic methotrexate (MTX) poisoning. In: Hoffman RS, Howland MA, Lewin NA, Nelson LS, Goldfrank LR, editors. You can also search for this author in Although signs and symptoms were classified to acute and chronic manifestations, no cut-off level of ingested dose of MTX or duration of use was defined to distinguish acute from chronic toxicity.We considered those with acute single ingestions as acutely poisoned patients. New York: McGraw-Hill; 2015. p. 689–92.This study was supported by Social Determinants of Health Research Center, Shahid Beheshti University of Medical sciences, Tehran, Iran (no 10307).Department of Internal Medicine, Division of Rheumatology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IranSocial Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IranDepartment of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, South Karegar Street, Tehran, IranSchool of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IranYou can also search for this author in
J Rheumatol. Those with acute poisoning on chronic use were considered to be acutely poisoned, as well, because their signs and symptoms implied acute toxicity in most of these cases. Bell R(1), Sullivan JR, Burdon JG, Sinclair R. Author information: (1)Department of Haemato-Oncology, Royal Melbourne Hospital, Victoria, Australia. Background: Skin lesions due to acute methotrexate (MTX) toxicity are rare. 1995;22:1009–12.Kremer JM, Alarcon GS, Lightfoot RW Jr, Willkens RF, Furst DE, Williams HJ, et al (1994) Methotrexate for rheumatoid arthritis. Dermatology and Therapy. Teva Pharmaceuticals (formerly IVAX), Miami, FL. It is generally considered to be safe and therefore, it is not unusual to prescribe doses as high as 25 to 30 mg per week in modern rheumatology [Methotrexate toxicity is mainly due to its effects on folate metabolism. 2009;18:654–8.Doolittle GC, Simpson KM, Lindsley HB. American College of Rheumatology [see comments]. Back pain 2014;4(2):145-156 Dermatology and Therapy. Methotrexate in rheumatoid arthritis: an update with focus on mechanisms involved in toxicity.

Thus, discrete treatment approaches must be taken with consideration of the type of toxicity. In this group, three, one, and five were poisoned due to incorrect dose consumption, wrong medication consumption, and incorrect time of consumption of the medication (daily instead of weekly). Chronic MTX poisoning is more serious and accompanies higher muco-cutaneous, hematologic, and hepatic complications necessitating more aggressive treatments including administration of higher doses of leucovorin or bone marrow stimulants including G-CSF. We have no data on possible adverse effects if the patients have developed complications and referred to other health care facilities. 1986;29:832–5.Bleyer WA. Although they are more common after administration of high dose MTX (HDMTX; > 500 mg/mLo Vecchio and colleagues evaluated 13 cases with acute MTX poisoning, all of whom survived. Advise patients to use effective contraception during and after treatment with methotrexate.Only use for life-threatening neoplastic disease or severe Along with its needed effects, methotrexate may cause some unwanted effects. J Med Toxicol. Glucarpidase for the treatment of life-threatening methotrexate … Severe Toxic Reactions, Including Embryo-Fetal ToxicityMethotrexate can cause severe or fatal toxicities. 2017;55(2):88–96.Ferner RE. Comparison of two different folic acid doses with methotrexate—a randomized controlled trial (FOLVARI study). NZ, SHK and PP did the literature research. 1989;149:1430–1.Chan BS, Dawson AH, Buckley NA. What can clinicians learn from therapeutic studies about the treatment of acute oral methotrexate poisoning? Arthritis Res Ther. Preventing and managing toxicities of high-dose methotrexate. Arch Intern Med. Clin Toxicol (Phila). Methotrexate is a medication that is utilized in the treatment of several medical conditions. Table 3 Significant Risk factors determining odds of being acute vs. chronic Methotrexate toxicity (n = 27) Full size table Mucosal ulcers and skin manifestations with odds ratios (95% CI) of 14 (2.1, 92.5) and 1.7 (1.1, 2.7) ( P < 0.001 and 0.02, respectively) were the only symptoms significantly different between the two groups. COVID-19 is an emerging, rapidly evolving situation. Monitor closely and modify dose or discontinue for the following toxicities: bone marrow suppression, infection, renal, gastrointestinal, hepatic, pulmonary, hypersensitivity and dermatologic.Methotrexate can cause embryo-fetal toxicity … Toxic rash associated with high dose methotrexate therapy. Methotrexate is an anti-folate drug that may be prescribed in some malignant or chronic inflammatory conditions. 10th ed.

2016;21:1471–82.Badurdeen S, Kang SL, Saravanan M. Accidental methotrexate ingestion in a 19-month-old child.