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Delayed MTX elimination & risks factors

Abbreviations: AKI, acute kidney injury; HDMTX, high dose methotrexate; IV, intravenous; MTX, methotrexate.

HDMTX-INDUCED NEPHROTOXICITY 

  • May lead to delayed MTX elimination
  • Resulting in sustained elevated plasma MTX concentrations3


Patient RISK FACTORS FOR DELAYED MTX ELIMINATION2,3:


Nephrotoxic
 pharmacodynamic
 interactions
Body mass index (BMI)
 ≥25 kg/m2
Renal insufficiency
 prior to HDMTX
Prior toxicity with HDMTX
Adult and elderly patients
Volume depletion 
(vomiting, diarrhoea)
Third spacing
 (pleural effusions, ascites, 
intracranial fluid)
Polyuria, urine pH <7,
 creatinine clearance (CrCl) 
<60 mL/min

Abbreviations: BMI, body mass index; CrCl, creatinine clearance; HDMTX, high dose methotrexate; MTX, methotrexate. 

Delayed MTX elimination increases the risk of systemic toxicity

Delayed MTX elimination can lead to potentially
IRREVERSIBLE LIFE-THREATENING
SYSTEMIC TOXICITY AND ORGAN DAMAGE.1,2,3,5 

Abbreviations: AKI, acute kidney injury; GI, gastrointestinal; HDMTX, high dose methotrexate; MTX, methotrexate.