Trimetrexate Side Effects

Applies to trimetrexate: intravenous powder for solution.

Precautions

If your symptoms do not improve within a few days, or if they become worse, check with your doctor.

It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly and to check for unwanted effects.

Trimetrexate can lower the number of white blood cells in your blood temporarily, increasing your chance of getting an infection. It can also lower the number of platelets, which are necessary for proper blood clotting. If this occurs, there are certain precautions you can take, especially when your blood count is low, to reduce the risk of infection or bleeding:

• If you can, avoid people with infections. Check with your doctor immediately if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.
• Check with your doctor immediately if you notice any unusual bleeding or bruising; black, tarry stools; blood in urine or stools; or pinpoint red spots on your skin.
• Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.
• Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail or toenail cutters.

Check with your doctor right away if you experience symptoms of an allergic reaction such as cough, difficulty swallowing, dizziness, fainting or loss of consciousness, fast heartbeat, fast or irregular breathing, hives, itching, puffiness or swelling of the eyelids or around the eyes, face, lips or tongue, shortness of breath, skin rash, swelling of eyes or eyelids, tightness in chest, trouble in breathing, unusual tiredness or weakness, and/or wheezing .

Serious side effects of trimetrexate

Along with its needed effects, trimetrexate may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking trimetrexate:

Other side effects of trimetrexate

Some side effects of trimetrexate may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

For healthcare professionals

Applies to trimetrexate: intravenous powder for injection.

General adverse events

Because many patients in clinical trials had advanced HIV disease, it was difficult to distinguish between trimetrexate-associated side effects and underlying medical conditions. In a clinical trial, 10% of patients in the trimetrexate-leucovorin group discontinued treatment due to side effects, as compared to 29% in the sulfamethoxazole-trimethoprim group.^[Ref]

Hematologic

Hematologic toxicity has been the primary dose-limiting adverse effect. In a clinical trial (n=109) trimetrexate commonly caused myelosuppression, resulting in neutropenia (<= 1000/mm3) in 30%, thrombocytopenia (<=75,000/mm3) in 10%, and anemia (Hgb<8 g/dL) in 7% of patients also treated with leucovorin. Therapy was discontinued in 3.7% of patients due to hematologic toxicity.^[Ref]

Renal

Renal toxicity consisting of elevations in serum creatinine greater than 3 times upper normal limits has occurred in 0.9% of clinical trial patients treated with trimetrexate and leucovorin.^[Ref]

Gastrointestinal

Gastrointestinal side effects associated with trimetrexate have included nausea and vomiting in 5% or more of patients also treated with leucovorin. Mucositis and diarrhea also occur relatively often.^[Ref]

Hepatic

Hepatic side effects have included transient elevations in liver function tests in up to 14% (n=109) of trial patients who also received leucovorin with increases greater than 5 times upper normal limits in AST (13.8%), ALT (11%), alkaline phosphatase (4.6%), and 2.5 times upper normal limit increases in bilirubin (1.8%). Discontinuation of therapy was necessary in approximately 3% of cases.^[Ref]

Hypersensitivity

Hypersensitivity reactions to trimetrexate have occurred and are generally limited to skin rash and pruritus. However, severe reactions consisting of bronchospasm, hypotension, rigors, and fever have occurred rarely.^[Ref]

Respiratory

Respiratory side effects have included dyspnea and rare cases of pneumonitis.^[Ref]

Metabolic

Metabolic abnormalities have included hyponatremia (4.6%) and hypocalcemia (1.8%).^[Ref]

Dermatologic

Dermatologic side effects have included alopecia in a few patients treated with trimetrexate.^[Ref]

Nervous system

Nervous system side effects have included confusion (2.8%) and fatigue (1.8%).^[Ref]

See also:

Further information

Trimetrexate side effects can vary depending on the individual. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Note: Medication side effects may be underreported. If you are experiencing side effects that are not listed, submit a report to the FDA by following this guide.

Medical Disclaimer