A presentation of methotrexate in a toxicological view

1. MUSTANSIRIYAH UNIVERSITY
COLLAGE OF PHARMACY
TOXICOLOGY
AMETHOPTRIN
STUDENTS NAME
‫عبيد‬ ‫سهيل‬ ‫محمد‬ ‫مريم‬
‫عاتي‬ ‫حميد‬ ‫فاطمة‬
‫كاظم‬ ‫استبرق‬
‫علي‬
‫المنعم‬ ‫عبد‬ ‫حسنين‬
‫جاسم‬ ‫الكريم‬ ‫عبد‬ ‫فاطمة‬

2. Introduction
The immune system normally protects the body from infections by causing inflammation
to fight them. Inflammation can cause swelling, heat, redness and pain.But in some
conditions, the immune system can attack parts of the body, such as the joints, by
mistake causing illness.
Drug classification Methotrexate (formerly,amethopterin) is a type of disease-modifying
anti-rheumatic drug (DMARD). It’s used to reduce the activity of the immune system for
people who have certain conditions by an anti-folate action.
It’s synthesized chemically and given in many routes which is: orally, intravenously, and
intrathecally.

3. Dosage form:

4. How it works?
Inhibits dihydrofolate reductase, leading to decreased DNA, RNA, and protein synthesis.
This affects rapidly dividing cells and undergoes intracellular polyglutamation, enhancing
its retention and activity with wide distribution with hepatic metabolism and renal
excretion.
After all basic information let’s discover what great indications of it.

5. It is used to treat cancer include breast cancer, leukemia, lung cancer, types of
autoimmune diseases it is used for include psoriasis, rheumatoid arthritis, and Crohn's
disease, and ectopic pregnancies.
But remember all that glitters is not gold, because as it’s great in this difficult cases,
but according to reducing immunity many side effects and toxicities can rise and that’s
include:
1) organ toxicity like liver and renal impairment and lung toxicity which is known as
methotrexate-induced lung injury.
2) HematologicalToxicity by suppressing bone marrow function, leading to anemia,
leukopenia andThrombocytopenia

6. 3) MucocutaneousToxicity as it cause Inflammation and ulceration of the oral and
gastrointestinal mucosa and Skin reactions, including erythema, rash, and
pruritus.
4) GastrointestinalToxicity like Stomatitis, Diarrhea, Nausea andVomiting.And at
least.
5) It is category D in pregnancy and excreted in breast milk.Despite all high risk
accompanied by using methotrexate but is still one of first choices in treating
cancers and autoimmune diseases and as it’s said:
A drowning man will clutch at a straw

7. Figure 2:Ocular toxicity

8. Management
Monitoring:
Frequent medical follow-up is necessary during methotrexate treatment.
Regular blood tests (complete blood count, liver function tests) help assess
toxicity.
Liver Biopsy orChest X-rayAntidotes of methotrexate
Leucovorin: Used to counteract methotrexate toxicity.
Glucarpidase: Effective in some cases of intrathecal overdose.

9. Safer Use Recommendations:
Hydration: Adequate hydration helps prevent kidney damage.
Avoid Alcohol: Alcohol exacerbates liver toxicity.
Avoid lived vaccinations.
Avoid things make you susceptible to infections (e.g. good hygiene).
Sun Protection: Methotrexate increases sensitivity to sunlight; use sunscreen and
protective clothing.
Drug Interactions: Methotrexate interacts with various medications (e.g., NSAIDs,
sulfonamides).

10. Risk factor:

12. References:
1/versusarthritis.org/methotrexate information.
2/www.drugs.com/methotrexate introduction.
3/en.m.Wikipedia.org/side effect & mechanism of action.

13. THANKYOU FOR LISTINING