Delayed Elimination of High Dose Methotrexate due to Co-Administration of Omeprazole: A Case Report

Imen Aouinti, Emna Gaies, Issam Salouage, Sameh Trabelsi, Nadia Jebabli, Rim Charfi, Mohamed Lakhal, Anis Klouz

Abstract


Methotrexate High Doses (HD-MTX) is indicated for the treatment of cancer diseases and its use requires strict precautions to prevent toxic side effects. It has also numerous drug interactions, the most known are interaction with trimethoprim - sulfamethoxazole (TMP-SMX) and Non Steroidal Anti-Inflammatory drugs (NSAIDs), which can exacerbate toxicity of MTX. We report herein a case of delayed elimination of HD-MTX due to co-administraion of omeprazole. B.A, a 17-year-old female having acute lymphoblastic leukemia (ALL). She is treated since September 2011 by HD-MTX every month for 6 months. The elimination of MTX was usually averaged at H72. Because of epigastralgia, the sixth cycle of HD-MTX was associated this time to omeprazole 20 mg/d during the entire cycle. MTX monitoring showed a high concentration at H36 (23 µmol/L) and a delayed elimination. In fact, MTX remained above 0.2 µmol/L until H164. The patient’s serum creatinin was normal but the liver function was altered marked by transaminases increase observed at H48 (AST = 2N, ALT = 5N). Delayed elimination of MTX was not observed in every patient receiving PPIs and the reason remains unclear. Mechanisms may include the H+/K+ ATPase pump. It seems also that inhibition of renal transporters of MTX is involved in this interaction. Genetic factors may be associated with an accentuated risk of toxicity. Because of the severity of this type of drug interaction and the frequent ambulatory use of PPIs, it is important to mention such drug-drug interaction and to find an alternative for omeprazole during HD-MTX cycles.




doi: http://dx.doi.org/10.4021/jh71w


Keywords


Methotrexate; Omeprazole; Drug interaction; Hepatotoxicity

Full Text: HTML PDF
 
Home     |     Log In     |      About     |      Search     |      Current     |      Archives     |      Submit      |     Subscribe


 

     

Aims and Scope

Current Issues

Conflict of Interest

About Publisher

Editorial Board

Archives

Copyright

Company Profile

Editorial Office

Misconduct and Retraction

Permissions

Company Registration

Contact Us

Abstracting and Indexing

ICMJE

Ownership

Instructions to Authors

Access

Declaration of Helsinki

Contact Publisher

Submission Checklist

Reprints

Terms of Use

Company Address

Submit a Manuscript

Open Access Policy

Privacy Policy

Browse Journals

Publishing Fee

Publishing Policy

Disclaimer

Recent Highlights

Peer-Review Process

Publishing Quality

Code of Ethics

Advertising Policy

Manuscript Tracking

Advanced Search

For Librarians

Careers

Publishing Process

Publication Frequency

For Reviewers

Propose a New Journal

       
       

Journal of Hematology, quarterly, ISSN 1927-1212 (print), 1927-1220 (online), published by Elmer Press Inc.            
The content of this site is intended for health care professionals.
This is an open-access journal distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted
non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Creative Commons Attribution license (Attribution-NonCommercial 4.0 International CC BY-NC 4.0)



This journal follows the International Committee of Medical Journal Editors (ICMJE) recommendations for manuscripts submitted to biomedical journals,
the Committee on Publication Ethics (COPE) guidelines, and the Principles of Transparency and Best Practice in Scholarly Publishing.

website: www.thejh.org    editorial contact: editor@thejh.org
Address: 9225 Leslie Street, Suite 201, Richmond Hill, Ontario, L4B 3H6, Canada
 

© Elmer Press Inc. All Rights Reserved.

IMPORTANT: THIS JOURNAL SITE OUTLOOK IS DESIGNED BY THE PUBLISHER AND COPYRIGHT PROTECTED. DO NOT COPY!