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Significant interaction between high-dose methotrexate and high-dose piperacillin-tazobactam causing reversible neurotoxicity and renal failure in an osteosarcoma patient.
- Source :
-
Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners [J Oncol Pharm Pract] 2021 Jun; Vol. 27 (4), pp. 1000-1004. Date of Electronic Publication: 2020 Sep 02. - Publication Year :
- 2021
-
Abstract
- Introduction: Pharmacokinetic interaction of high-dose methotrexate (MTX) and other concomitantly administered renally secreted medicinal products may lead to insufficient methotrexate serum level decrease and significant MTX toxicity.<br />Case Report: We report the case of an 18-year-old male patient treated with high-dose MTX for an osteosarcoma and with high-dose piperacillin-tazobactam at the same time. MTX serum levels were severely elevated 24 hours after the MTX infusion and did not decrease in accordance with the specific calcium folinate rescue protocol. The patient experienced renal failure accompanied by neurological symptoms, most consistent with MTX-related renal and CNS toxicity. Management and outcome: After discontinuation of piperacillin-tazobactam, intensified calcium folinate rescue therapy, and IV hydration, the MTX serum levels decreased appropriately, and toxicity symptoms resolved.<br />Discussion: Severe MTX-related toxicity, caused by drug-drug interaction, suggests that the concomitant use of high-dose MTX and high-dose piperacillin-tazobactam should be avoided generally.
- Subjects :
- Adolescent
Anti-Bacterial Agents administration & dosage
Anti-Bacterial Agents adverse effects
Antimetabolites, Antineoplastic administration & dosage
Antimetabolites, Antineoplastic adverse effects
Bone Neoplasms diagnosis
Drug Interactions
Humans
Male
Methotrexate administration & dosage
Osteosarcoma diagnosis
Piperacillin administration & dosage
Renal Insufficiency diagnosis
Bone Neoplasms drug therapy
Methotrexate adverse effects
Neurotoxicity Syndromes diagnosis
Osteosarcoma drug therapy
Piperacillin adverse effects
Renal Insufficiency chemically induced
Subjects
Details
- Language :
- English
- ISSN :
- 1477-092X
- Volume :
- 27
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners
- Publication Type :
- Academic Journal
- Accession number :
- 32878553
- Full Text :
- https://doi.org/10.1177/1078155220953878