High Dose Methotrexate Toxicity and Prevention Strategies

Introduction

High dose methotrexate (HDMTX), while a powerful antineoplastic agent, is associated with potential toxicities. Addressing these toxicities is crucial for ensuring the safe and effective use of HDMTX.

Strategies to Overcome HDMTX Toxicities

Importance of Leucovorin Rescue

Leucovorin, a folic acid analog, plays a critical role in preventing HDMTX toxicity. It works by rapidly eliminating MTX from the body, reducing its toxic effects.

Hyperhydration and Alkalization

Keeping the patient well-hydrated helps maintain adequate renal function and enhance MTX clearance. Alkalinization of the urine promotes MTX excretion.

Additional Measures

Dose Reduction and Monitoring

Adjusting HDMTX dosage and monitoring renal function and serum creatinine levels can minimize the risk of toxic effects.

Combination Therapies

Combining HDMTX with other regimens, such as cyclophosphamide and dexamethasone, can help reduce toxicity while maintaining efficacy.

Conclusion

By employing these strategies, physicians can effectively prevent and manage toxicities associated with HDMTX treatment, ensuring the optimal care and well-being of their patients.