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Introduction to dermatological treatment
Published in Richard Ashton, Barbara Leppard, Differential Diagnosis in Dermatology, 2021
Richard Ashton, Barbara Leppard
Fibrosis of the liver can occur after several years of treatment so do not give to a patient with pre-existing liver disease or anyone who has a history of alcohol abuse. Patients on methotrexate should not drink any alcohol. The development of liver fibrosis can be monitored by measuring blood levels of type 3 procollagen (P3NP) every 6 months. This is a non specific marker of fibrosis and can be raised by other causes of fibrosis making it less useful, e.g. in patients with psoriatic arthritis. In the psoriatic population other causes of liver fibrosis are also common such as alcoholic and non alcoholic fatty liver disease.
Respiratory, endocrine, cardiac, and renal topics
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Methotrexate can be administered orally, intra-muscularly, intravenously, intrathecally and even intra-arterially. Following oral administration, the drug is rapidly absorbed and the peak plasma concentration is obtained at approximately 1 hour. Bioavailability is greater for small doses. Following intravenous administration, methotrexate distributes mainly into the liver, kidneys and, to a lesser degree, the GIT. Methotrexate is highly bound to plasma protein. It diffuses equally into the pleural effusions and ascites, from which it can be slowly released again into the circulation. Methotrexate does not distribute into the central nervous system, except following high doses. The CSF to plasma ratio ranges from 0.01 to 0.03.
Cervical Ectopic Pregnancy
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
Methotrexate is an immunosuppressive and chemotherapeutic agent that is often used to treat a wide range of different malignancies; autoimmune diseases, such as rheumatoid arthritis and other inflammatory types of arthritis; and ectopic pregnancies. Common side effects include nausea, fatigue, fever, increased risk of infection, low white blood cell counts, and breakdown of the skin inside the mouth [21]. Other side effects may include liver disease, lung disease, lymphoma, and severe skin rashes [21]. People on long-term treatment should be regularly checked for side effects [21]. It is not safe to use during breastfeeding [21]. In patients with kidney problems, lower doses may be needed; it acts by blocking the body's use of folic acid [21]. During pregnancy, methotrexate is an abortifacient and is commonly used to terminate pregnancies during the early stages, generally in combination with misoprostol. As mentioned earlier, it is also used to treat ectopic pregnancies, provided the fallopian tube has not ruptured [21]. Methotrexate with dilatation and curettage is used to treat molar pregnancy.
Pharmacological management of severe plaque psoriasis in patients with cardiovascular disease
Published in Expert Opinion on Pharmacotherapy, 2022
Stefano Piaserico, Francesco Messina
In a patient with psoriasis and CHF: IL-17 inhibitors can be considered a safe and possibly beneficial option.Methotrexate can be used with some potential benefit, but it carries a risk of organ toxicity with long-term use.Acitretin, fumarates, apremilast, ustekinumab, and IL-23 inhibitors appear to be safe to useTNFa inhibitors are contraindicated in class 3 or 4 CHF. An echocardiogram should be done before treatment initiation in class 1 or 2 CHF and TNFa inhibitors should be avoided in patients with ejection fraction < 50%. TNFa inhibitors should be discontinued in patients with new onset CHF.
Amelioration of Bleomycin and Methotrexate-Induced Pulmonary Toxicity by Serratiopeptidase and Fisetin
Published in Nutrition and Cancer, 2021
Muhammad Shahbaz, Sairah Hafeez Kamran, Rukhsana Anwar
Methotrexate (MTX) identified as a drug in 1946 was used in the treatment of childhood leukemia in 1948 due to its antiproliferative, anti-inflammatory, and immunomodulating properties. It is used in many kinds of malignancies and connective tissue diseases. Methotrexate was found to be the most frequently used chemotherapeutic agent in autoimmune diseases (AID) in a recent survey. The precise mechanism by which MTX causes pulmonary injury is not fully understood; however, AID patients receiving MTX treatment frequently have pulmonary complications. MTX pneumonitis may occur after just a single MTX dose and is not impeded by folinic acid therapy. Around 1–8% patients taking MTX develop lung toxicity. Some studies reported MTX-induced pneumonitis as the hypersensitivity type of reaction and direct toxic effect induces injury to alveolar epithelial wall (4, 5). Methotrexate immunosuppressive therapy for longer period may provoke lymphoproliferative diseases (LPD). In MTX Classical Hodgkins Lymphoma (MTX-CHL), standard chemotherapy is the A (Adriamycin), B (Bleomycin), V (Vinblastine), D (Dacarbazine) regimen containing Bleomycin, a pneumotoxic agent, thereby increasing the incidence of lung toxicity (6).
Verrucous hyperplasia and verrucous carcinoma in head and neck: use and benefit of methotrexate
Published in Acta Clinica Belgica, 2021
Stijn De Keukeleire, Astrid De Meulenaere, Philippe Deron, Wouter Huvenne, Duprez Fréderic, Olivier Bouckenooghe, Liesbeth Ferdinande, David Creytens, Sylvie Rottey
Systemic approaches, methotrexate in particular, have been a topic of debate in VH and VC. A retrospective case review from Karkazoglou et al. [9] examined the outcome of 12 patients diagnosed with oral VC between 1972 and 2010 and declared unfit for surgery or radiotherapy due to poor general condition or extensive lesions. Alternatively, patients were treated with methotrexate via various routes (intravenous, intra-arterial or intramuscular administration). Eleven patients had good to partial responses of which two patients received additional resection and two other patients received adjuvant radiotherapy [9]. The benefit of continuous intra-arterial infusion of methotrexate was also evaluated as a primary therapy in a prospective study of 15 Taiwanese patients with oral VC. Although this is an invasive and intensive treatment schedule, all patients obtained complete remission at a mean follow-up of 42 months (range 24–69 months) with preserved local functionality and excellent aesthetic results [21].