High-Dose Methotrexate: Nursing Considerations for Administration and Supportive Care

Breanne Roche

Patricia A. Clarke

Danielle Ford

Shannon Collins Shaver

Joanna Thompson

high-dose methotrexate, acute kidney injury, glucarpidase, leucovorin, toxicity
CJON 2023, 27(1), 47-54. DOI: 10.1188/23.CJON.47-54

Background: High-dose methotrexate (HDMTX) is the backbone of many pediatric and adult oncology treatment protocols. It requires appropriate monitoring and supportive care because delayed elimination of MTX can lead to serious toxicities. No reviews specifically addressing nursing management regarding standard treatment protocols and delayed MTX elimination exist.

Objectives: This article provides an overview of HDMTX treatment and nursing considerations, including toxicities, components of supportive care management, and strategies to manage administration and delayed elimination of MTX.

Methods: A review of published literature and guidelines was performed to evaluate nursing considerations for patients receiving HDMTX.

Findings: Using existing and novel tools, nurses can closely monitor patients and provide supportive care to mitigate HDMTX toxicity. Early identification of delayed MTX elimination and subsequent treatment with glucarpidase, if appropriate, has been associated with shorter length of hospital stay and decreased incidence of grade 4 toxicities and mortality.

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