trimetrexate (Neutrexin)
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Introduction
Tradename: Neutrexin.
Indications
Pneumocystis carinii pneumonia (PCP)
Dosage
- 45 mg/m2 IV QD over 90 minutes for 21 days Must be given with leucovorin:
- 20 mg/mg IV every 6 hours over 5-10 minutes or 20 mg/m2 PO every 6 hours (round up to higher 25 mg increment)
- continue leucovorin for 72 hours past final trimetrexate dose
Powder for injection: 25 mg.
Dosage adjustment for hematologic toxicity:
| neutrophils/uL | platelets/uL | trimetrexate | leucovorin | |
|---|---|---|---|---|
| > 1000 | > 75,000 | 45 mg/m2 QD | 20 mg/m2 every 6 hours | |
| 750-1000 | 50-75,000 | 45 mg/m2 QD | 40 mg/m2 every 6 hours | |
| 500-750 | 25-50,000 | 22 mg/m2 QD | 40 mg/m2 every 6 hours | |
| < 500 | < 25,000 | hold* | 40 mg/m2 every 6 hours |
* hold for 96 hours
Pharmacokinetics
- extensively metabolized in the liver
- elimination 1/2life is 15-17 hours
elimination via liver
1/2life = 15-17 hours
Adverse effects
- not common (1-10%)
- peripheral neuropathy, seizures, rash, neutropenia, thrombocytopenia, anemia, stomatitis, nausea/vomiting, hepatotoxicity, renal toxicity, fever, flu-like syndrome, hypersensitivity
Drug interactions
- decreased effect of pneumococcal vaccine
- increased toxicity (infectious rates) yellow fever vaccine
More general terms
Additional terms
References
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998