Version 1
: Received: 9 February 2024 / Approved: 12 February 2024 / Online: 12 February 2024 (10:25:33 CET)
Version 2
: Received: 20 February 2024 / Approved: 20 February 2024 / Online: 21 February 2024 (09:30:30 CET)
Version 3
: Received: 29 March 2024 / Approved: 29 March 2024 / Online: 1 April 2024 (11:53:15 CEST)
How to cite:
Duwor, S.; Aboe, M.; Mensah, D. Acute Methotrexate Toxicity under Low Dose Therapy. Preprints2024, 2024020658. https://doi.org/10.20944/preprints202402.0658.v2
Duwor, S.; Aboe, M.; Mensah, D. Acute Methotrexate Toxicity under Low Dose Therapy. Preprints 2024, 2024020658. https://doi.org/10.20944/preprints202402.0658.v2
Duwor, S.; Aboe, M.; Mensah, D. Acute Methotrexate Toxicity under Low Dose Therapy. Preprints2024, 2024020658. https://doi.org/10.20944/preprints202402.0658.v2
APA Style
Duwor, S., Aboe, M., & Mensah, D. (2024). Acute Methotrexate Toxicity under Low Dose Therapy. Preprints. https://doi.org/10.20944/preprints202402.0658.v2
Chicago/Turabian Style
Duwor, S., Michael Aboe and Daniel Mensah. 2024 "Acute Methotrexate Toxicity under Low Dose Therapy" Preprints. https://doi.org/10.20944/preprints202402.0658.v2
Abstract
Objective: We report a case of acute pancytopenia and liver injury after concomitant administration of low-dose methotrexate (MTX), and high-dose esomeprazole and metamizole. Case summary: A 71-year-old patient with chronic systemic idiopathic erosive arthritis was admitted after a pelvic ring fracture. After hospital admission, she received MTX in addition to esomeprazole and metamizole. Subsequent laboratory tests revealed pancytopenia and elevated liver enzymes. The follow-up clinical examinations were unremarkable, with the exception of sub-febrile temperatures. Further investigations did not detect a definitive etiology. Due to the suspicion of methotrexate-induced hematotoxicity and hepatotoxicity, antagonizing therapy with calcium folinate was administered, after which the blood counts and liver parameters normalized. Discussion: Due to the administration of high-dose metamizole immediately before the administration of low-dose MTX, the pre-existing hematotoxic pharmacodynamic effect of MTX was acutely enhanced by that of metamizole, although folic acid was administered preemptively. In addition, the concomitant administration of high-dose esomeprazole and normal dose torasemide resulted in a pharmacokinetic interaction with MTX by decreasing its renal secretion and elimination, further enhancing the concentration-dependent hematotoxic and hepatotoxic side effects of MTX. Conclusions: The relatively high demand for analgesics in patients with chronic rheumatic diseases already being treated with MTX and proton pump inhibitors necessitates that clinicians consider drug-drug interactions as potential causes of adverse drug reactions after the administration of metamizole or nonsteroidal anti-inflammatory drugs. In this category of patients, it is strongly recommended to switch to analgesics of other classes, consider dose adjustment of relevant concomitant medications.
Medicine and Pharmacology, Medicine and Pharmacology
Copyright:
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
