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Journal of Toxicology
Volume 2014 (2014), Article ID 214574, 5 pages
Clinical Study

Acute Methotrexate Ingestions in Adults: A Report of Serious Clinical Effects and Treatments

1Medical Toxicology, San Antonio Military Medical Center, San Antonio, TX 78234, USA
2San Antonio Military Medical Center, San Antonio, TX 78234, USA
3School of Pharmacy, Concordia University, Mequon, WI, USA

Received 3 February 2014; Accepted 18 March 2014; Published 16 April 2014

Academic Editor: Orish Ebere Orisakwe

Copyright © 2014 Vikhyat S. Bebarta et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objective. Limited reported data have reports effects after acute ingestion of methotrexate. Treatment recommendations do not differentiate between exposure routes. Our objective was to determine the frequency of significant toxicity effects and use of therapy after methotrexate ingestion in adults. Methods. We performed a retrospective study on adult cases reported to 6 poison centers over 6 years (2000–2005) which exceed 180,000 exposures/year. Variables collected included demographics, dosages ingested, coingestions, clinical effects, and therapies with outcomes. Results. Sixty-three patients examined over the 6-year period met inclusion criteria. No patient in the series received dialysis or died. The mean dose ingested for all patients was 24 mg (range 2.5–100 mg) and the mean dose for suicidal ingestions was 47.5 mg (12.5–100 mg). The most common clinical effects were abdominal pain, oral irritation, throat irritation, nausea, dizziness, and headache. Nine patients received folinic acid and 3 patients received sodium bicarbonate. No patient developed renal failure, bone marrow suppression, seizure, or coma. No patient died or received dialysis. Conclusion. In our series of patients from 6 poison centers over six years, 63 cases of acute adult methotrexate ingestions were reported. Methotrexate toxicity from ingestion in adults was uncommon and rarely toxic.