Drug Name Generic Name: Methotre xate Brand Name: Amethop terin

Classifica tion Antimetab olite

Mode of Action

Dosage

Indicatio ns High dose regimen followed by leucovorin rescue for adjuvant therapy of nonmetast atic osteosarco ma (orphan drug designatio n)

Contraindic ations Contraindicat ed with pregnancy, lactation, alcoholism, chronic liver disease, immune deficiencies, blood dyscrasias, hypersensitiv ity to methotrexate Use cautiously with renal disease, infection, peptic ulcer, ulcerative colitis, debility

Adverse Effects CNS: Headache, drowsiness, blurred vision, hemiparesi s, seizures, fatigue, malaise, dizziness Dermatolog ic: Erythemato us rashes, pruritus, urticaria, photosensit ivity, depigment ation

Nursing Responsi bility Arrange for an antiemetic if nausea and vomiting are severe Arrange for adequate hydration during therapy to reduce the risk of hyperurice mia Do not administer any other medication s containing alcohol

Inhibits folic acid reductase, Antineopla leading to stic inhibition of DNA Antipsoriat synthesis ic and inhibition of Antirheum cellular atic replication; selectively affects the most rapidly dividing cells (neoplastic and psoriatic cells)

Osteosarco ma: Starting dose is 12 g/m2 or up to 15 g/m2 IV to give a peak serum concentrati on of 1000 micromol. Must be used as part of a cytotoxic regimen with leucovorin rescue.

GI: Ulcerative stomatitis, gingivitis, pharyngitis, Tell patient anorexia, to report nausea, any

vomiting, adverse diarrhea, affects hematemes is, melena GU: Renal failure Drug Name Classifica tion Mode of Action Active reduced form of folic acid; required for nucleoprotei n synthesis and maintenance of normal hematopoies is. Dosage Indicatio ns Leucovori n rescue after high dose methotrex ate therapy for various cancers To decrease toxicity of methotrex ate caused by decreased eliminatio n or for inadverten t overdose Contraindic ations Contraindicat ed with allergy to leucovorin on previous exposure, pernicious anemia or other megaloblasti c anemias in which vitamin B12 is deficient Use cautiously with pregnancy, lactation Adverse Effects Hypersensit ivity: Allergic reactions Local: Pain, discomfort at injection site Nursing Responsi bility Begin leucovorin rescue within 24 hr of methotrex ate administrat ion. Arrange for fluid loading and urine alkalinizati on during this procedure to decrease methotrex ate

Generic Folic acid Name: derivative Leucovori n Brand Name: Citrovoru m

Rescue after methotrex ate therapy: Begin therapy within 24 hr of methotrex ate dose. 10 mg/m2 PO every 6 hr for 10 doses or until methotrex ate level is less than 0,05 micromolar

of folic acid antagonist s such as trimethopr im

toxicity. Give drug orally unless intolerance to oral route.