RESEARCH - Central nervous system toxicity associated with weekly low-dose MTX

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Arthritis Rheum. 1989 Jun;32(6):770-5.

Central nervous system toxicity associated with weekly low-dose

methotrexate treatment.

Wernick R, DL.

Providence Medical Center, Portland, OR 97213.

Central nervous system (CNS) toxicity from low-dose methotrexate (MTX)

has been reported rarely, and reported symptoms consist primarily of

dizziness and headache. We reviewed the records of 25 consecutive

patients treated with low-dose MTX, and found 5 who had spontaneously

reported unpleasant cranial sensations, mood alteration, or memory

impairment. Rechallenge with MTX on 5 occasions in 3 patients led to

recurrent CNS symptoms in all cases. CNS toxicity was the sole reason

for discontinuation of MTX in 2 patients. These 5 patients differed

from the 20 without CNS toxicity in age (mean 68 versus 50) and

baseline serum creatinine level (1.3 mg/dl versus 0.9 mg/dl), but not

in weekly dosage of MTX (12 mg versus 16 mg). These results suggest

that CNS toxicity is more common than previously reported,

particularly in older patients with mild renal insufficiency.

PMID: 2735964

http://www.ncbi.nlm.nih.gov/pubmed/2735964

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