Early initiation of therapy is important, so begin treatment once MTX toxicity is strongly suspected
Folinic Acid (Leucovorin)
20mg IV or IM q6h until MTX serum level <10−8 M
Glucarpidase
Works by enzymatic cleaving of MTX into metabolites
Hydration and urine alkalinization
Bicarbonate drip at 1.5-2x maintenance rate to maintain urine pH of >7.5
MTX is excreted renally
20mg IV or IM q6h until MTX serum level <10−8 M
Works by enzymatic cleaving of MTX into metabolites
Bicarbonate drip at 1.5-2x maintenance rate to maintain urine pH of >7.5
MTX is excreted renally
Methotrexate toxicity
Platinum toxicity
Colchicine toxicity
NSAID toxicity
Xylazine toxicity
Depleted uranium toxicity
Aconitum toxicity
Paraneoplastic syndromes