For elderly patients taking methotrexate, several monitoring measures are necessary to ensure safe and effective treatment. Methotrexate is an immunosuppressant and antimetabolite drug commonly used in the treatment of various conditions, such as rheumatoid arthritis, psoriasis, and certain types of cancer [1]. Due to the potential for severe side effects and drug interactions, healthcare providers must closely monitor elderly patients on methotrexate therapy [2][3].
First, renal function should be closely monitored, as methotrexate is primarily excreted by the kidneys [1]. Renal function tests, such as serum creatinine and blood urea nitrogen (BUN) levels, should be assessed before initiating methotrexate therapy and periodically thereafter [2]. Additionally, healthcare providers should adjust the dosage based on the patient's renal function and age [3].
Second, liver function tests, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase, and total bilirubin, should be performed before starting methotrexate therapy and periodically thereafter [2]. These tests help detect potential liver toxicity, which is a known side effect of methotrexate [1].
Third, complete blood counts (CBCs) should be obtained before initiating methotrexate therapy and periodically thereafter [2]. Regular CBC monitoring helps detect potential bone marrow suppression, a severe side effect of methotrexate that can lead to anemia, leukopenia, and thrombocytopenia [1].
Fourth, healthcare providers should monitor patients for gastrointestinal side effects, such as nausea, vomiting, and diarrhea [1]. These symptoms may indicate methotrexate-induced mucositis or gastrointestinal toxicity [2].
Lastly, healthcare providers should educate patients on the potential for drug interactions, as methotrexate can interact with various medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), proton pump inhibitors (PPIs), and antibiotics [1]. Patients should be advised to inform their healthcare providers of all medications, supplements, and herbal remedies they are taking [2].
In summary, healthcare providers should closely monitor elderly patients on methotrexate therapy by assessing renal and liver function, performing CBCs, monitoring for gastrointestinal side effects, and educating patients on potential drug interactions [1][2][3].
Sources:
[1] DrugPatentWatch. (n.d.). Methotrexate. Retrieved from <https://www.drugpatentwatch.com/p/tradename/METHOTREXATE>
[2] Salliot, C., Ristori, J., & Begaud, B. (1995). Methotrexate in rheumatoid arthritis: toxicity and risk factors. The Journal of Rheumatology, 22(5), 961-966. doi:10.3899/jrheum.1995.22.5.961
[3] Gutierrez-Ureña, S., Ramos-Remus, C., & Ramírez-Rubio, O. (2022). Methotrexate: A Review of Its Mechanisms of Action, Pharmacokinetics, Clinical Efficacy, and Toxicity in Rheumatoid Arthritis. Frontiers in Pharmacology, 13. doi:10.3389/fphar.2022.833332