Analysis and pharmaceutical practices of factors of HD-MTX delayed excretion
ZHANG Xia-lan
SHEN Xi-kun
HUANG Li-feng
CHEN Wan-sheng
Abstract：Three non-hodgkin's lymphoma patients accepted chemotherapy with high-dose methotrexate (HD-MTX). Their routine blood tests, renal function and hepatic function were normal before chemotherapy. The ifrst patient developed fever, diarrhea, severe oral mucosa ulcer and acute renal insufifciency after chemotherapy of MTX 2 g. The second patient developed spinal cord damage, agranulocytosis, fever and oral mucosa after chemotherapy of MTX 1 g. TDM results of MTX showed there was delayed excretion of MTX. Considering what happened to the above two patients, we monitored the blood concentrations of MTX on 48 h and 72 h in time during the therapeutic period of the third patient with MTX 3 g. The third patient didn't develop serious adverse drug reaction. Clinical pharmacists analyzed the factors of MTX delayed excretion might be the urine pH < 7 before chemotherapy, insufifcient hydration and combination of proton pump inhibitors. We should pay more attention to alkalization, hydration and blood drug concentration monitoring. We ought to adjust the dosage of leucovorin according to the concentrations of the 48 h and 72 h, in order to avoid the adverse drug reactions of HD-MTX.
Keywords：MethotrexateAdverse drug reactionDelay excretionMTHFR genotypePharmaceutical care
Publication Date：2016-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：4( 342-344,345 )