Methotrexate Case Studies

Patients intoxicated with methotrexate should be immediately started on leucovorin. As in the above mentioned intoxication case, the 60 year old male should be transfused with blood products including packed red blood cells, platelets, and fresh frozen plasma and should be empirically started on broad spectrum antibiotics for his neutropenic fever while discontinuing MTX. This will improve the patient’s condition significantly and pancytopenia will resolve with almost normal hematologic parameters in less than a week of follow-up. (2)

For all patients on methotrexate, safety precautions must be applied: the creatinine change and CCR (creatinine clearance ratio) level must be evaluated by physicians to determine the MTX elimination status 24