Metoxate

Methotrexate

Acute lymphocytic leukemia, meningeal leukemia prophylaxis, Non-Hodgkin's lymphomas, osteogenic sarcoma, adjuvant & in advanced disease of breast cancer, metastatic or recurrent head & neck cancer, choriocarcinoma & similar trophoblastic diseases, & advanced cancer of urinary bladder.

Conventional low dose therapy 15-50 mg/m² in single dose. Intermediate dose therapy 100-1,000 mg/m² in a single dose. Advanced squamous epithelial & bladder cancer Up to 100-200 mg/m². High dose therapy Several malignant diseases, including malignant lymphoma, acute lymphatic leukemia, osteogenic sarcoma & metastatic choriocarcinoma ≥1,000 mg/m² over 24-hr period. Begin folinic acid administration w/ 10-15 mg (6-12 mg/m²) 12-24 hr after starting methotrexate treatment.

Alcohol abuse; preexisting blood dyscrasias eg, bone marrow hypoplasia, leukopenia, thrombocytopenia, or significant anemia; serious acute or chronic infections eg, TB & HIV; ulcers of the oral cavity & known active GI ulcer disease. Concurrent vaccination w/ live vaccine. Severe liver & renal (CrCl <20 mL/min) impairment. Pregnancy & lactation.

Use only in life-threatening neoplastic diseases due to risk of severe toxic reactions. Not recommended in women of childbearing potential. Affects spermatogenesis & oogenesis during treatment (may be reversible on discontinuation). Fetal death &/or congenital malformations.

Bone marrow depression, leucopenia, thrombocytopenia, anemia; mouth ulcer, GI disturbances, stomatitis, diarrhea; acute/chronic liver damage, hepatic fibrosis & cirrhosis. Renal failure & tubular necrosis after high doses, pulmonary reactions including life-threatening interstitial lung disease, skin reactions (sometimes severe), alopecia, & ocular irritation; leukoencephalopathy, paresis, demyelination. Intrathecal: Arachnoiditis, an acute syndrome of headache, nuchal rigidity, back pain, & fever.

Reduced excretion (increased risk of toxicity) w/ ciprofloxacin. Elevated & prolonged serum levels w/ NSAIDs. Reduced tubular section w/ NSAIDs prep & salicylates. Increased risk of pancytopenia w/ leflunomide. Diminished renal tubular transport w/ probenecid. Reduced renal clearance w/ penicillins. May decrease intestinal absorption or interfere w/ the enterohepatic circulation by inhibiting bowel flora & metabolism by bacteria w/ oral antibiotics eg, tetracycline, chloramphenicol & non-absorbable broad-spectrum antiobiotics. Increased myelosuppression w/ trimethoprim/sulfamethoxazole (isolated cases). Increased renal toxicity w/ potentially nephrotic chemotherapeutic agents (eg, cisplatin). Increased risk of soft tissue necrosis & osteonecrosis w/ radiotherapy. Increased risk of severe neurological side effects w/ cytarabine. Hepatoxicity w/ drugs w/ known hepatotoxic effect (eg, leflunomide, azathioprine, sulfasalazine, retinoids). Reduced theophylline clearance. Increased mercaptopurine plasma content. Increased toxicity w/ other highly bound drugs eg, salicylates, phenylbutazone, phenytoin & sulfonamides. Increased levels w/ furosemide. Reduced response & increased toxicity w/ vit prep containing folic acid or its derivatives. Elevated & prolonged plasma levels w/ proton pump inhibitors.

Cytotoxic Chemotherapy

L01BA01 - methotrexate ; Belongs to the class of antimetabolites, folic acid analogues. Used in the treatment of cancer.

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