Abstract
An 18-year-old man received two high-dose methotrexate cycles for the treatment of an osteosarcoma. Fifteen grams of methotrexate were infused over 6 hours. During the second cycle, co-administration of oxacillin (1g/8h) resulted in prolonged and marked elevation of methotrexate plasma concentrations. The patient experienced acute toxicity with renal failure, myelosuppression, mucitis, fever, and dermatologic abnormalities. After an initial improvement with folinic acid rescue and hemodialysis, the patient died. Oxacillin may thus inhibit the elimination of methotrexate.
MeSH terms
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Adolescent
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Anti-Bacterial Agents / pharmacology*
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Anti-Bacterial Agents / poisoning
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Anti-Bacterial Agents / therapeutic use
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Antimetabolites, Antineoplastic / pharmacokinetics*
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Antimetabolites, Antineoplastic / poisoning
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Antimetabolites, Antineoplastic / therapeutic use
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Drug Interactions
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Fatal Outcome
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Humans
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Lung Neoplasms / drug therapy
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Lung Neoplasms / secondary
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Male
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Methotrexate / pharmacokinetics*
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Methotrexate / poisoning
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Methotrexate / therapeutic use
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Osteosarcoma / drug therapy
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Osteosarcoma / pathology
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Oxacillin / pharmacology*
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Oxacillin / therapeutic use
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Staphylococcal Skin Infections / drug therapy
Substances
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Anti-Bacterial Agents
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Antimetabolites, Antineoplastic
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Oxacillin
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Methotrexate