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Trimetrexate Disease Interactions

There are 3 disease interactions with trimetrexate:

Major

Trimetrexate (Includes Trimetrexate) ↔ Bone Marrow Suppression

Severe Potential Hazard, High plausibility

Applies to: Bone Marrow Depression/Low Blood Counts

The use of trimetrexate is associated with severe and potentially life-threatening bone marrow suppression. Concomitant use with leucovorin significantly diminishes but does not eliminate this risk. Therapy with trimetrexate should be administered cautiously in patients with preexisting blood dyscrasias and in patients receiving other myelotoxic drugs. Close clinical monitoring of hematopoietic function is recommended during therapy, and patients should be instructed to immediately report any signs or symptoms suggestive of hematologic toxicity such as fever, sore throat, local infection, bleeding, pallor, dizziness, or jaundice. The dosages of trimetrexate and leucovorin should be adjusted for hematologic toxicity in accordance with the product package labeling.

References

  1. "Product Information. Neutrexin (trimetrexate)." US Bioscience, West Conshohocken, PA.
Major

Trimetrexate (Includes Trimetrexate) ↔ Renal/Liver Disease

Severe Potential Hazard, High plausibility

Applies to: Liver Disease, Renal Dysfunction

Trimetrexate undergoes both renal and hepatic elimination. Therapy with trimetrexate should be administered cautiously in patients with renal and/or hepatic impairment, since they may be at increased risk for potentially life-threatening hematologic and gastrointestinal toxicities associated with the drug. In addition, trimetrexate may be nephro- and hepatotoxic. Elevations in serum creatinine and liver function tests occur in approximately 1% and up to 14%, respectively, of patients treated with trimetrexate and leucovorin. The manufacturer recommends blood tests at least twice a week during therapy to assess hematologic, renal, and hepatic function. Interruption of therapy is advised if serum creatinine level exceeds 2.5 mg/dL or if serum transaminase or alkaline phosphatase levels increase to > 5 times the upper limits of normal and these elevations are thought to be secondary to trimetrexate.

References

  1. Fanucchi MP, Walsh TD, Fleisher M, Lokos G, Williams L, Cassidy C, Vidal P, Chou TC, Niedzwiecki D, Young CW "Phase I and clinical pharmacology study of trimetrexate administered weekly for three weeks." Cancer Res 47 (1987): 3303-8
  2. "Product Information. Neutrexin (trimetrexate)." US Bioscience, West Conshohocken, PA.
  3. Reece PA, Morris RG, Bishop JF, Olver IN, Raghavan D "Pharmacokinetics of trimetrexate administered by five-day continuous infusion to patients with advanced cancer." Cancer Res 47 (1987): 2996-9
View all 4 references
Moderate

Antibiotics (Includes Trimetrexate) ↔ Colitis

Moderate Potential Hazard, Low plausibility

Applies to: Colitis/Enteritis (Noninfectious)

Pseudomembranous colitis has been reported with most antibacterial agents and may range in severity from mild to life-threatening, with an onset of up to two months following cessation of therapy. Antibiotic therapy can alter the normal flora of the colon and permit overgrowth of Clostridium difficile, whose toxin is believed to be a primary cause of antibiotic- associated colitis. The colitis is usually characterized by severe, persistent diarrhea and severe abdominal cramps, and may be associated with the passage of blood and mucus. The most common culprits are clindamycin, lincomycin, the aminopenicillins (amoxicillin, ampicillin), and the cephalosporins. Therapy with broad-spectrum antibiotics and other agents with significant antibacterial activity should be administered cautiously in patients with a history of gastrointestinal diseases, particularly colitis. There is some evidence that pseudomembranous colitis, if it occurs, may run a more severe course in these patients and that it may be associated with flares in their underlying disease activity. The offending antibiotic(s) should be discontinued if significant diarrhea occurs during therapy. Stool cultures for Clostridium difficile and stool assay for C. difficile toxin may be helpful diagnostically. A large bowel endoscopy may be considered to establish a definitive diagnosis in cases of severe diarrhea.

References

  1. Moriarty HJ, Scobie BA "Pseudomembranous colitis in a patient on rifampicin and ethambutol." N Z Med J 04/23/80 (1980): 294-5
  2. Thomas E, Mehta JB "Pseudomembranous colitis due to oxacillin therapy." South Med J 77 (1984): 532-3
  3. Harmon T, Burkhart G, Applebaum H "Perforated pseudomembranous colitis in the breast-fed infant." J Pediatr Surg 27 (1992): 744-6
View all 47 references

trimetrexate drug Interactions

There are 139 drug interactions with trimetrexate

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.

Do not stop taking any medications without consulting your healthcare provider.

Disclaimer: Every effort has been made to ensure that the information provided by Multum is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. Multum's information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill, knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective, or appropriate for any given patient. Multum Information Services, Inc. does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. Copyright 2000-2016 Multum Information Services, Inc. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse, or pharmacist.

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