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Lookup NU author(s): Dr Frederik van DelftORCiD,
Professor Roderick Skinner
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
Methotrexate administration is associated with frequent adverse neurological events during treatment for childhood acute lymphoblastic leukemia. Here, we present evidence to support the role of common drug interactions and low vitamin B-12 levels in potentiating methotrexate neurotoxicity.We review the published evidence and highlight key potential drug interactions as well as present clinical evidence of severe methotrexate neurotoxicity in conjunction with nitrous oxide anesthesia and measurements of vitamin B-12 levels among pediatric leukemia patients during therapy.We describe a very plausible mechanism for methotrexate neurotoxicity in pediatric leukemia patients involving reduction in methionine and consequential disruption of myelin production. We provide evidence that a number of commonly prescribed drugs in pediatric leukemia management interact with the same folate biosynthetic pathways and/or reduce functional vitamin B-12 levels and hence are likely to increase the toxicity of methotrexate in these patients. We also present a brief case study supporting out hypothesis that nitrous oxide contributes to methotrexate neurotoxicity and a nutritional study, showing that vitamin B-12 deficiency is common in pediatric leukemia patients.Use of nitrous oxide in pediatric leukemia patients at the same time as methotrexate use should be avoided especially as many suitable alternative anesthetic agents exist. Clinicians should consider monitoring levels of vitamin B-12 in patients suspected of having methotrexate-induced neurotoxic effects.
Author(s): Forster VJ, van Delft FW, Baird SF, Mair S, Skinner R, Halsey C
Publication type: Article
Publication status: Published
Journal: Cancer Chemotherapy and Pharmacology
Print publication date: 01/11/2016
Online publication date: 22/09/2016
Acceptance date: 02/09/2016
Date deposited: 06/01/2017
ISSN (print): 0344-5704
ISSN (electronic): 1432-0843
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