Abstract

AN OVERVIEW ON METHOTREXATE TOXICITY IN CLINICAL PRACTICE

Anjana Sailan, Sowparnika Treasa Sabu* and Prof. (Dr.) Shaiju S. Dharan

Abstract

Background: Methotrexate, the folic acid analogue is a highly efficacious drug that is commonly prescribed for a wide range of diseases like rheumatoid arthritis, severe psoriasis, Crohn’s disease and some cancers. Since the drug has a narrow therapeutic index and once weekly dosage regimen, high doses or accidental overdose can result in potential life threatening toxicity. Due to the potential toxicity, the drug needs to be continuously and carefully monitored for the serious toxic events including bone marrow suppression, liver toxicity etc. Methods: Previously published literatures regarding the use and toxicity of methotrexate was collected and reviewed. Observations: The widely prescribed drug methotrexate poses large range of toxic events related to overdose. The toxicities include bone marrow suppression, hepatotoxicity, hematologic toxicities, nephrotoxicity, neurotoxicity, dermatologic toxicities including ulceration during treatment of severe psoriasis, oral mucositis and also gastrointestinal toxicities. Methotrexate overdose has complex toxicokinetics characteristics and produces clinical conditions that are of less severity but the occurrence of organ damage due to bone marrow suppression, nephrotoxicity, hepatotoxicity, neurotoxicity can be fatal. As per the quote “prevention is better than cure” proper patient education and rational treatment can avoid the toxic effects due to methotrexate overdose.

Keywords: methotrexate, overdose, toxicity.