Intoxikationen durch Methotrexat - Eine retrospektive Analyse von 249 Fällen des Giftinformationszentrums-Nord

Intoxications with methotrexate - a retrospective analysis of 249 cases by the Poisons Centre for northern Germany

by Lina Schulte-Güstenberg
Doctoral thesis
Date of Examination:2019-06-27
Date of issue:2019-05-28
Advisor:Prof. Dr. Andreas Schaper
Referee:Prof. Dr. Andreas Schaper
Referee:Prof. Dr. Sabine Blaschke-Steinbrecher
Referee:PD Dr. Rotraut Mößner
Persistent Address: http://dx.doi.org/10.53846/goediss-7476

 

 

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Abstract

English

Objective: Methotrexate is an immunosuppressive drug that inhibits the folic acid reductase. It is used for its antineoplastic and immunomodulatoring effects. There were already many poisonings because of the high toxic potential. That is why it is very important to educate the patient in order to avoid misadventure. As an immunomodulatory drug methotrexate is given once weekly in low-dose; in contrast to the antineoplastic indication were it is given in high-doses. Methods: The Poisons Centre for northern Germany has observed an increasing number of methotrexate intoxications, especially due to medication error. We conducted a retrospective study of all intoxications with methotrexate reported to the Poisons Centre between 1996 and 2016. Results: 249 cases met the inclusion criteria. Most cases (96 cases, 39%) were caused by medication errors, particularly involving the use of low-dose methotrexate; five of these patients died. 62 cases (25%) were unintentional ingestions by children, 39 cases (16%) were suicide attempts and in 13 cases (5%) adverse effects occurred in therapeutic doses. Conclusion: On the one hand an acute oral overdose (unintentional or suicidal) does not lead to a severe intoxication, because of the saturable absorption of methotrexate. On the other hand an inadvertently daily rather than a weekly dose of methotrexate can result in severe intoxications or even death. Despite numerous information and warnings about the correct application for methotrexate, medication errors by health staff and patients are still common.
Keywords: methotrexate; intoxication
 
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