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甲氨喋呤可用于治疗白血病、头部和颈部肿瘤及乳房癌,但会出现肾中毒,严重者可能引起死亡;而且对肾中毒出现的时间也无法作出预测。本文作者指出,甲氨喋呤的排泄,除被动滤过外,还取决于其它因素,以肌酐清除率来预报该药消除率的临床价值有限,因此掌握病人体内的甲氨喋呤清除动力学参数具有一定的临床意义。目前采用的方法是:先对病人使用1～3g低剂量的甲氨喋吟,测定药物动力学参数,在以后给药时,以此剂量的清除率作为安全指标,根据机体的耐受性,谨慎地逐步加大给药量。作者采用这种方法后,即使剂量高于36g也未产生严重的蓄积作用。作者还指出,在静脉滴注该药前后,有必要采取大量补水和使尿液碱化等措施,同时还应提醒病人注
Methotrexate can be used to treat leukemias, head and neck cancers, and breast cancers, but nephrotoxicosis can occur and in severe cases death can result; and the timing of nephrotoxicity can not be predicted. The authors point out that excretion of methotrexate, in addition to passive filtration, depends on other factors and that the clinical value of creatinine clearance in predicting drug elimination is limited and therefore masters the patient’s methotrexate clearance kinetics The parameters have some clinical significance. The current method is: first use of patients with low doses of 1 ~ 3g methotrexate Yin, determination of pharmacokinetic parameters, after administration, the dose clearance rate as a safety indicator, according to the body’s tolerance, Cautiously and gradually increase the dose. With this method, the authors did not produce any significant accumulation even at doses above 36 g. The author also pointed out that in the intravenous infusion of the drug before and after, it is necessary to take a lot of water and alkalize the urine and other measures, but also should remind patients Note