UMEM Educational Pearls

Category: Toxicology

Title: Methotrexate

Keywords: overdose, methotrexate (PubMed Search)

Posted: 10/27/2011 by Fermin Barrueto, MD (Updated: 2/18/2020)
Click here to contact Fermin Barrueto, MD

Methotrexate is a chemotherapeutic that is utilized in non-Hodgkin lymphoma and breast CA. It is also used as an immunosuppressant for rheumatoid arthritis and psoriasis. Finally, we see it used in the ED for the treatment of ectopic pregnancy. Overdose, often unintentional, can have a lethal outcome.

Toxicity: LFTs rise, N/V, stomatitis, mucositis, leukopenia, thrombocytopenia, renal failure

Antidote: Leukovorin (Folinic Acid)

Other Tx: Carboxypeptidase G2, Charcoal Hemoperfusion, HD (possible)