METHOTREXATE INTOXICATION IN THE ELDERLY POPULATION: A REPORT OF TWO CASES

Abstract

Methotrexate (MTX), a folate antagonist, is the anchor drug in rheumatoid arthritis (RA) treatment. The low dose is the most preferred therapeutic management, considered safe and generally well-tolerated in many rheumatic patients. Despite being rarely seen, life threatening severe toxicities such as bone marrow suppression may occur especially in the elderly population, most associated with certain risk factors. Management of this event may sometimes be challenging with relatively high mortality rates because of infectious complications. Treatment approach should be including folinic acid replacement, granulocyte-colony stimulation factor as required and antibiotics as well as supportive care. Herein, we report two elderly cases of MTX intoxication (one due to improper usage of MTX and the latter because of forgetting to take folate supplement) and discuss treatment options in the light of literature data.

Keywords

• methotrexate
• elderly population
• toxicity
• management