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Journal articles on the topic 'High-Dose Methotrexate'

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Published: 3 June 2025

Last updated: 31 July 2025

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1

Dhanushkodi, Manikandan. "High-dose methotrexate." Indian Journal of Medical and Paediatric Oncology 40, no. 3 (2019): 424. http://dx.doi.org/10.4103/ijmpo.ijmpo_157_19.

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2

Hryvkova, L. V. "Anticancer chemotherapy with high-dose methotrexate." Practical oncology 4, no. 1 (2021): 30–38. http://dx.doi.org/10.22141/2663-3272.4.1.2021.229869.

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The literature review is devoted to the use of high doses of methotrexate in oncology. There is a brief historical overview of the use of methotrexate for the treatment of malignant neoplasms; the main mechanism of its cytotoxic effect on tumor cells, the development of resistance to methotrexate, the main indications for the use of high doses of methotrexate and the main side effects of this treatment are considered. The review details the results of using high doses of methotrexate in the treatment of patients with osteosarcoma, non-Hodgkin’s lymphomas, located mainly in the central nervous

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3

Sullivan, M. P., and I. Ramirez. "Curability of Burkitt's lymphoma with high-dose cyclophosphamide-high-dose methotrexate therapy and intrathecal chemoprophylaxis." Journal of Clinical Oncology 3, no. 5 (1985): 627–36. http://dx.doi.org/10.1200/jco.1985.3.5.627.

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Twenty-four children with Burkitt's lymphoma were treated beginning May 1976 with a regimen alternating high doses of cyclophosphamide and methotrexate in induction and consolidation; only high doses of methotrexate were used in the maintenance phase. Throughout therapy, which was planned for 54 weeks, intrathecal chemoprophylaxis using methotrexate, cytosine arabinoside, and hydrocortisone was coordinated with the high-dose methotrexate infusion therapy to provide CNS chemoprophylaxis that maintained therapeutic methotrexate spinal fluid levels (greater than 10(-6) mol/L) for approximately 60

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4

Kamen, Barton A. "High-dose Methotrexate: Insecure Rationale." Journal of Pediatric Hematology/Oncology 30, no. 9 (2008): 639–40. http://dx.doi.org/10.1097/mph.0b013e318185f4ee.

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5

Cheok, Meyling H., William E. Evans, and Leo Kager. "High-dose Methotrexate: The Rationale…" Journal of Pediatric Hematology/Oncology 31, no. 3 (2009): 224–25. http://dx.doi.org/10.1097/mph.0b013e318196a2a6.

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6

Tortajada-Ituren, Juan José, Juan Pablo Ordovás-Baines, Pilar Llopis-Salvia, and N. Victor Jiménez-Torres. "High-Dose Methotrexate–Doxycycline Interaction." Annals of Pharmacotherapy 33, no. 7-8 (1999): 804–8. http://dx.doi.org/10.1345/aph.18236.

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7

Nowak, Thomas J., Aaron H. Lorge, Lisa E. Rein, et al. "Implementation and evaluation of high-dose methotrexate administration guidelines." Journal of Oncology Pharmacy Practice 25, no. 7 (2018): 1675–81. http://dx.doi.org/10.1177/1078155218808866.

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BackgroundHigh-dose methotrexate is used to treat a variety of malignancies. Methotrexate-associated supportive care and the threshold methotrexate level for the discontinuation of supportive care are not consistent among studies. We evaluated the implementation of high-dose methotrexate administration guidelines, which raised the standard threshold methotrexate level for the discontinuation of supportive care from <0.05 to <0.1 µmol.MethodsA single-center, observational analysis of patients receiving high-dose methotrexate from 1 January 2015 to 31 May 2017 was conducted. The primary en

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8

Tran, Hieu X., and Jon D. Herrington. "Effect of ceftriaxone and cefepime on high-dose methotrexate clearance." Journal of Oncology Pharmacy Practice 22, no. 6 (2016): 801–5. http://dx.doi.org/10.1177/1078155215608524.

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Numerous drug interactions with methotrexate have been identified, which can lead to serious life-threatening effects. Up to 90% of methotrexate is excreted unchanged in the urine with primary excretion dependent on organic anion transport in the renal proximal tubule. The two pathways responsible for methotrexate secretion are organic anion transport 1 and primarily organic anion transport 3. Penicillins undergo tubular secretion via organic anion transport, and cephalosporins are believed to also possess a similar risk when administered with methotrexate; however, there are no human studies

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9

NAVARRO, M. "Leukocytoclastic Vasculitis After High-Dose Methotrexate." Annals of Internal Medicine 105, no. 3 (1986): 471. http://dx.doi.org/10.7326/0003-4819-105-3-471_3.

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10

Hendershot, Eleanor, Jocelyn Volpe, Tracey Taylor, et al. "Outpatient High-dose Methotrexate for Osteosarcoma." Journal of Pediatric Hematology/Oncology 41, no. 5 (2019): 394–98. http://dx.doi.org/10.1097/mph.0000000000001238.

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11

Moe, Peter Johan, and Are Holen. "HIGH-DOSE METHOTREXATE IN CHILDHOOD ALL." Pediatric Hematology and Oncology 17, no. 8 (2000): 615–22. http://dx.doi.org/10.1080/08880010050211321.

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12

Chowbay, Balram, and Khoo Kei Siong. "High-Dose Methotrexate in Fibroblastic Osteosarcoma." Annals of Pharmacotherapy 35, no. 12 (2001): 1669. http://dx.doi.org/10.1345/aph.1a093.

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13

Kamen, Barton A., and Naomi J. Winick. "High dose methotrexate therapy: Insecure rationale?" Biochemical Pharmacology 37, no. 14 (1988): 2713–15. http://dx.doi.org/10.1016/0006-2952(88)90032-9.

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14

Batchelor, T. T., G. Kolak, R. Ciordia, C. S. Foster, and J. W. Henson. "High-dose methotrexate for intraocular lymphoma." American Journal of Ophthalmology 137, no. 1 (2004): 215–16. http://dx.doi.org/10.1016/j.ajo.2003.10.009.

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15

TOYOGUCHI, TEIKO, HIDEYO NAGAOKA, SHU ISIKAWA, and YOSHITO NAKAGAWA. "Pharmacokinetics of high dose methotrexate (2)." Japanese Journal of Hospital Pharmacy 16, no. 2 (1990): 101–6. http://dx.doi.org/10.5649/jjphcs1975.16.101.

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16

Kamen, Barton A., and Steven D. Weitman. "High-Dose Methotrexate: Is it Warranted?" Pediatric Hematology and Oncology 11, no. 2 (1994): 135–37. http://dx.doi.org/10.3109/08880019409141647.

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17

Lobelle, C., M. López Rivas, J. Barreiro, M. Rodicio, and J. M. Couselo. "Anaphylactic Reaction to High-Dose Methotrexate." Pediatric Hematology and Oncology 12, no. 2 (1995): 213–14. http://dx.doi.org/10.3109/08880019509029559.

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18

Benitez, B., E. Capilla, L. Gonzalez, et al. "Carboxypeptidase rescue after high-dose methotrexate." European Journal of Hospital Pharmacy 19, no. 2 (2012): 157.1–157. http://dx.doi.org/10.1136/ejhpharm-2012-000074.189.

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19

Ackland, S. P., and R. L. Schilsky. "High-dose methotrexate: a critical reappraisal." Journal of Clinical Oncology 5, no. 12 (1987): 2017–31. http://dx.doi.org/10.1200/jco.1987.5.12.2017.

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High-dose methotrexate (HDMTX) with leucovorin (LV) rescue has been used as a therapeutic strategy in oncology for more than a decade. Administration of HDMTX results in tumoricidal plasma concentrations of the drug without significant host toxicity, provided that plasma MTX levels are monitored and LV rescue is properly administered. The original premise of LV rescue was that the provision of reduced folate to normal cells would circumvent the metabolic block produced by MTX and allow resumption of DNA synthesis, although the presumed therapeutic selectivity of leucovorin has not yet been ade

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20

Lee, Anselm C. W., C. H. Li, and Y. C. Wong. "Transient encephalopathy following high-dose methotrexate." Medical and Pediatric Oncology 41, no. 1 (2003): 101. http://dx.doi.org/10.1002/mpo.1339.

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21

Postovsky, S., R. Elhasid, A. Ben-Barak, K. Levin, and M. Weyl Ben Arush. "Allergic reaction to high-dose methotrexate." Medical and Pediatric Oncology 35, no. 2 (2000): 131–32. http://dx.doi.org/10.1002/1096-911x(200008)35:2<131::aid-mpo9>3.0.co;2-f.

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22

Utomo, Febriansyah Nur, Yulistiani Yulistiani, Nun Zairina, and Bambang Permono. "METHOTREXATE USE IS SAFE IN CHILDREN WITH ACUTE LYMPHOBLASTIC LEUKEMIA." Folia Medica Indonesiana 53, no. 2 (2017): 144. http://dx.doi.org/10.20473/fmi.v53i2.6431.

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Monitoring level of methotrexate is not only aimed at monitoring effectiveness, but also safety aspects of the administration of high-dose methotrexate because the use of high-dose methotrexate is one of the problems associated with toxicity in various organs. In the use of high-dose methotrexate, measurement of methotrexate is important to identify patients with a high risk of toxicity, particularly nephrotoxicity as well as for dosing guidelines for leucovorin therapy. The aim of this study was to analyze the safety of high-dose methotrexate on kidney function during chemotherapy consolidati

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23

Harms, James, Ayaz Khawaja, Maria Taylor, Xiaosi Han, and Michal Mrug. "Recovery of methotrexate-induced anuric acute kidney injury after glucarpidase therapy." SAGE Open Medical Case Reports 5 (January 1, 2017): 2050313X1770505. http://dx.doi.org/10.1177/2050313x17705050.

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Objectives: This case report describes two cases of high-dose methotrexate–induced nephrotoxicity: death in the case of conventional supportive care and successful renal function recovery in a patient treated with glucarpidase and continuous dialysis. Methods: High dose methotrexate is widely used for management of adult and pediatric malignancies. However, high-dose methotrexate–induced renal nephrotoxicity may cause severe, even lethal complications. Here we present examples of such outcomes. Results: We present one case of lethal high-dose methotrexate nephrotoxicity in a patient treated wi

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24

Larsen, Eric C., Meenakshi Devidas, Si Chen, et al. "Dexamethasone and High-Dose Methotrexate Improve Outcome for Children and Young Adults With High-Risk B-Acute Lymphoblastic Leukemia: A Report From Children’s Oncology Group Study AALL0232." Journal of Clinical Oncology 34, no. 20 (2016): 2380–88. http://dx.doi.org/10.1200/jco.2015.62.4544.

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Purpose Survival for children and young adults with high-risk B-acute lymphoblastic leukemia has improved significantly, but 20% to 25% of patients are not cured. Children’s Oncology Group study AALL0232 tested two interventions to improve survival. Patients and Methods Between January 2004 and January 2011, AALL0232 enrolled 3,154 participants 1 to 30 years old with newly diagnosed high-risk B-acute lymphoblastic leukemia. By using a 2 × 2 factorial design, 2,914 participants were randomly assigned to receive dexamethasone (14 days) versus prednisone (28 days) during induction and high-dose m

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25

Pampín, Rubén, Yoar Labeaga, Belén Rodríguez, Beatriz Fernández, Rubén Fernández, and Mónica Carbajales. "Experience with ambulatory high-dose methotrexate administration as CNS prophylaxis in patients with non-Hodgkin lymphoma." Journal of Oncology Pharmacy Practice 26, no. 3 (2019): 549–55. http://dx.doi.org/10.1177/1078155219852412.

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BackgroundWe describe the feasibility and safety of an oral administration schedule of hydration, alkalinization and leucovorin rescue with an ambulatory high-dose methotrexate regimen.MethodsSingle-centre prospective observational study conducted within a tertiary hospital where all patients have received systemic high-dose methotrexate (3.5 g/m2). Patients were instructed to keep an adequate ambulatory oral hydration and alkalinization to monitor urine pH and to adjust bicarbonate according to our institution's treatment protocol. High-dose methotrexate was infused over 4 h. Urine pH was che

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26

Cerminara, Zak, Alison Duffy, Jennifer Nishioka, James Trovato, and Steven Gilmore. "A single center retrospective analysis of a protocol for high-dose methotrexate and leucovorin rescue administration." Journal of Oncology Pharmacy Practice 25, no. 1 (2017): 76–84. http://dx.doi.org/10.1177/1078155217729744.

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Background Methotrexate has a wide dosing range. High-dose methotrexate is a dose of 1000 mg/m2 or greater. In the 1970s, the incidence of mortality associated with High-dose methotrexate ranged from 4.6 to 6%. In 2012, the University of Maryland Medical Center implemented a standardized high-dose methotrexate protocol. The purpose of this study was to evaluate whether the institution followed recommendations based on the Bleyer nomogram for the administration of high-dose methotrexate more closely after the implementation of the protocol. Methods In this retrospective chart review, 37 patient

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27

Balis, F. M., J. L. Savitch, W. A. Bleyer, G. H. Reaman, and D. G. Poplack. "Remission induction of meningeal leukemia with high-dose intravenous methotrexate." Journal of Clinical Oncology 3, no. 4 (1985): 485–89. http://dx.doi.org/10.1200/jco.1985.3.4.485.

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Twenty children with acute lymphoblastic leukemia who developed meningeal disease were treated with a high-dose intravenous methotrexate regimen that was designed to achieve and maintain CSF methotrexate concentrations of 10(-5) mol/L without the need for concomitant intrathecal dosing. The methotrexate was administered as a loading dose of 6,000 mg/m2 for a period of one hour followed by an infusion of 1,200 mg/m2/h for 23 hours. Leucovorin rescue was initiated 12 hours after the end of the infusion with a loading dose of 200 mg/m2 followed by 12 mg/m2 every three hours for six doses and then

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28

Ferreri, Andrés JM, Michele Reni, Marco Foppoli, et al. "High-dose cytarabine plus high-dose methotrexate versus high-dose methotrexate alone in patients with primary CNS lymphoma: a randomised phase 2 trial." Lancet 374, no. 9700 (2009): 1512–20. http://dx.doi.org/10.1016/s0140-6736(09)61416-1.

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29

TropÉ, C., and J. Carl. "Gestational trophoblastic tumors: cytostatic treatment response evaluated from hCG modelling." International Journal of Gynecologic Cancer 3, no. 5 (1993): 265–70. http://dx.doi.org/10.1046/j.1525-1438.1993.03050265.x.

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Five patients, three high risk and two medium risk, were allocated to a high dose methotrexate regimen. Surviving fractions of hCG-producing cells in high dose methotrexate were a factor of 3–10 times lower than the surviving cell fractions in the low dose regimen, indicating a biphasic dose-response relation for methotrexate. Medium risk patients were found to have an unacceptably high recurrence rate after methotrexate actinomycin-D therapy and should be treated with more intensive chemotherapy. It is recommended that drug dose should be corrected for body-volume in low risk regimes, to avoi

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30

Rastogi, Sameer, Aditi Aggarwal, Akash Tiwari, and Vinod Sharma. "Chemotherapy in Nonmetastatic Osteosarcoma: Recent Advances and Implications for Developing Countries." Journal of Global Oncology, no. 4 (December 2018): 1–5. http://dx.doi.org/10.1200/jgo.2016.007336.

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Purpose Osteosarcoma (OS) is a relatively chemosensitive primary bone tumor, with the peak age of onset occurring in late childhood and early adolescence. The treatment paradigm of nonmetastatic OS has typically been multimodality therapy, including neoadjuvant and adjuvant chemotherapy with definitive surgery. Over the years, various permutations and combinations of chemotherapeutic agents have been used. However, the majority of recent trials have still used high-dose methotrexate as the backbone, with cisplatin and doxorubicin (MAP). In the last decade, various strategies targeted to improv

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31

Erttmann, R., S. Bielack, and G. Landbeck. "7-Hydroxy-methotrexate and clinical toxicity following high-dose methotrexate therapy." Journal of Cancer Research and Clinical Oncology 109, no. 1 (1985): 86–88. http://dx.doi.org/10.1007/bf01884261.

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32

Payet, B., N. Tubiana, C. Lejeune, B. Guérin, J. P. Cano, and Y. Carcassonne. "High-dose methotrexate: Methotrexate and 7-hydroxymethotrexate diffusion in cerebrospinal fluid." International Journal of Cancer 42, no. 1 (1988): 135–36. http://dx.doi.org/10.1002/ijc.2910420125.

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33

Wu, Jingjing, Mingzhi Zhang, and Wenhua Wang. "Fotemustine-Containing Regimens Versus Regimens Based on High-Dose Methotrexate in Newly Diagnosed PCNSL." Blood 138, Supplement 1 (2021): 4559. http://dx.doi.org/10.1182/blood-2021-154337.

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Abstract Objective: This study was conducted to compare the effectiveness and safety of fotemustine-containing regimens and high-dose methotrexate-based regimens in newly diagnosed primary central nervous system lymphoma(PCNSL). Methods: From April 2012 to April 2020, 88 patients with PCNSL who received fotemustine-containing regimens and regimens based on high-dose methotrexate were retrospectively assessed in this study.47 patients were treated with fotemustine-containing regimens, of which 25 patients were treated with R-FPD (Rituximab , formustine, pemetrexed, dexamethasone) regimen, and t

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34

&NA;. "High-dose methotrexate clearance inhibited by benzimidazoles." Reactions Weekly &NA;, no. 1117 (2006): 5. http://dx.doi.org/10.2165/00128415-200611170-00010.

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35

Takami, Masatsugu, Yuko Kuniyoshi, Takayoshi Oomukai, Toshitake Ishida, and Yoshiki Yamano. "Severe Complications After High-Dose Methotrexate Treatment." Acta Oncologica 34, no. 5 (1995): 611–12. http://dx.doi.org/10.3109/02841869509094036.

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36

Elit, L., A. Covens, R. Osborne, et al. "High-Dose Methotrexate for Gestational Trophoblastic Disease." Obstetrical & Gynecological Survey 50, no. 3 (1995): 192–93. http://dx.doi.org/10.1097/00006254-199503000-00016.

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37

Al-Quteimat, Osama M., and Mariam A. Al-Badaineh. "Practical issues with high dose methotrexate therapy." Saudi Pharmaceutical Journal 22, no. 4 (2014): 385–87. http://dx.doi.org/10.1016/j.jsps.2014.03.002.

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38

&NA;. "High-dose methotrexate clearance inhibited by benzimidazoles." Inpharma Weekly &NA;, no. 1553 (2006): 19. http://dx.doi.org/10.2165/00128413-200615530-00058.

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39

DeAngelis, L. M., W. P. Tong, S. Lin, M. Fleisher, and J. R. Bertino. "Carboxypeptidase G2 rescue after high-dose methotrexate." Journal of Clinical Oncology 14, no. 7 (1996): 2145–49. http://dx.doi.org/10.1200/jco.1996.14.7.2145.

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PURPOSE This study was a pilot project to assess the safety and efficacy of carboxypeptidase G2 (CPG2) rescue from high-dose (HD) methotrexate (MTX) in patients with recurrent cerebral lymphoma. PATIENTS AND METHODS Four patients with recurrent primary CNS lymphoma (PCNSL) were studied. Patients received 3.0 g/m2 MTX infused over 2 hours. Twelve hours after the start of MTX, 50 U/kg CPG2 was infused; a second dose of CPG2 was given 6 hours after the first. Blood and CSF were collected and assayed for levels of MTX, CPG2, and 2,4-diamino-N10-methylpteroic acid (DAMPA), a cleavage product of MTX

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40

Jaffe, N. "Cerebral dysfunction secondary to high-dose methotrexate." Journal of Clinical Oncology 5, no. 4 (1987): 681–82. http://dx.doi.org/10.1200/jco.1987.5.4.681.

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41

Toverud, Else-Lydia, Sverre Landaas, and Marit Hellebostad. "Repeated achilles tendinitis after high dose methotrexate." Medical and Pediatric Oncology 37, no. 2 (2001): 156. http://dx.doi.org/10.1002/mpo.1191.

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42

Elit, L., A. Covens, R. Osborne, et al. "High-Dose Methotrexate for Gestational Trophoblastic Disease." Gynecologic Oncology 54, no. 3 (1994): 282–87. http://dx.doi.org/10.1006/gyno.1994.1211.

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43

Phillips, Peter C., H. Tzvi Thaler, Jeffrey C. Allen, and David A. Rottenberg. "High-dose leucovorin reverses acute high-dose methotrexate neurotoxicity in the rat." Annals of Neurology 25, no. 4 (1989): 365–72. http://dx.doi.org/10.1002/ana.410250408.

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44

Periyasamy, Manimekalai, and Arvindh Manohar. "METHOTREXATE TOXICITY AS MYELOSUPPRESSION IN 66-YEAR-OLD FEMALE WITH RHEUMATOID ARTHRITIS IN CHENNAI, TAMIL NADU, INDIA." Gomal Journal of Medical Sciences 20, no. 2 (2022): 110–11. http://dx.doi.org/10.46903/gjms/20.02.1123.

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Methotrexate can cause a range of toxicities. It is usually not life threatening in low dose even when taken for long term. Life threatening complications are usually seen in high dose methotrexate therapy which could even lead to malignancies. Life threatening complications and adverse effects can be seen at any dose except for nephrotoxicity which is most commonly seen in high dose methotrexate treatment. This case report deals with a case of rheumatoid arthritis on long term methotrexate therapy, who unknowingly took excessive dosage of methotrexate leading to myelosuppression. Patient was

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45

Csordás, Katalin, Olivér Eipel, Márta Hegyi, Monika Csóka, Éva Pap, and Gábor Kovács. "Pharmacokinetic analysis of high-dose methotrexate treatments in children with hematologic malignancies." Orvosi Hetilap 152, no. 40 (2011): 1609–17. http://dx.doi.org/10.1556/oh.2011.29143.

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Monitoring the pharmacokinetic parameters of different anticancer drugs is necessary because they might have several side effects. Aim: Pharmacokinetic and toxicity evaluation of high-dose methotrexate treatments in children with acute lymphoblastic leukemia. Patients and methods: 43 children (28 boys, 15 girls, mean age: 7.03 years) in 147 cases were treated with 5 g/m2/24h MTX according to ALL-BFM 1995 and 2002 protocols. Methotrexate and 7-hydroxi-methotrexate levels were measured with high pressure liquid chromatography at 24, 36, 48 hours. Authors registered the development of hepatotoxic

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46

Ayalon, Itay, Shirley Friedman, Yoav Binenbaum, et al. "A Case of Methotrexate Neurotoxicity Presented as Status Epilepticus, Encephalopathy, and High Fever." Journal of Investigative Medicine High Impact Case Reports 7 (January 2019): 232470961986231. http://dx.doi.org/10.1177/2324709619862311.

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High-dose methotrexate is used to treat a range of adult and childhood cancers including osteosarcoma. Significant neurotoxicity is reported in 1% to 4.5% of patients treated with high-dose methotrexate and can present in a wide variety of symptoms. We present a case of a 14-year-old boy with a recent diagnosis of osteosarcoma who presented to the emergency department with status epilepticus, altered mental status, and very high fever secondary to methotrexate neurotoxicity. We review current literature and discuss some controversies related to this state. We also describe high fever as one of

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47

Sasaki, Nobuyoshi, Keiichi Kobayashi, Kuniaki Saito, et al. "Consecutive single-institution case series of primary central nervous system lymphoma treated by R-MPV or high-dose methotrexate monotherapy." Japanese Journal of Clinical Oncology 50, no. 9 (2020): 999–1008. http://dx.doi.org/10.1093/jjco/hyaa073.

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Abstract Objective The optimal regimen for use of high dose-methotrexate-based chemotherapy in primary central nervous system lymphoma is still under debate. We conducted a retrospective study to evaluate the treatment outcome of a combination immunochemotherapy consisting of rituximab, methotrexate, procarbazine and vincristine followed by with or without whole brain radiotherapy and consolidation cytarabine, in comparison with high dose-methotrexate monotherapy followed by full dose whole brain radiotherapy. Methods Newly diagnosed primary central nervous system lymphoma patients treated wit

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48

Tariq, Muhammad, Sehrish Sarwar Baloch, Saqib Raza Khan, et al. "Efficacy of Furosemide in Methotrexate Clearance in Patients Treated with High Dose Methotrexate: A Cohort Study." Pakistan Journal of Medical and Health Sciences 16, no. 4 (2022): 485–87. http://dx.doi.org/10.53350/pjmhs22164485.

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Background: Methotrexate was first used in 1947 as a chemotherapeutic drug in the treatment of acute lymphoblastic leukemia (ALL). Methotrexate has been extensively explored as an anticancer drug since that time. High dose methotrexate is a term used for doses above 1000mg/m2. Objective: To determine efficacy of Furosemide in methotrexate clearance in patients treated with high dose methotrexate Methodology: The current study was prospective cohort study carried out at the Oncology department of tertiary care hospitals of Peshawar for a period of one year from January 2020 to January 2021. A t

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49

Kameyama, Shun, Yuko Kase, Saori Kurihara, et al. "Influence of High-Dose Folic Acid on Methotrexate Efficacies and Safety in Japanese Rheumatoid Arthritis Patients." Drug Research 67, no. 12 (2017): 705–9. http://dx.doi.org/10.1055/s-0043-117498.

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Abstract Backgrounds Folic acid dose at ≦5 mg/week has been recommended for rheumatoid arthritis (RA) patients to decrease risk of methotrexate adverse effects. However, higher doses of folic acid is used in some cases. We examined the influence of high-dose folic acid on methotrexate efficacies and safety in Japanese RA patients. Methods 502 RA patients of four hospitals prescribed methotrexate and folic acid were included. These patients were divided into two subgroups according to the threshold of folic acid dose by 5 mg/week. Basic patient characteristics, methotrexate doses, and the effic

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Tel, Burcin Meryem Atak, Satilmis Bilgin, Ozge Kurtkulagi, et al. "Severe Pancytopenia and Stomatitis Case due to the Treatment with High Dose Methotrexate." National Journal of Health Sciences 6, no. 1 (2021): 32–34. http://dx.doi.org/10.21089/njhs.61.0032.

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Abstract:

Abstract: Objective: Methotrexate is used to suppress inflammation in many rheumatologic conditions. Here we present an elderly patient who developed serious side effects due to methotrexate. A 78 year old male admitted to emergency department with oral mucosal bleeding, skin rash, decrease in oral nutrition intake and weakness. He had been using 5 milligrams of methotrexate as 2 tablets twice a day for 10 days, after he was diagnosed with psoriatic arthritis 15 days ago. A diagnosis of methotrexate intoxication established with history, physical examination and laboratory analysis, which reve

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