Occurrence and impact of unanticipated variation in intravenous methotrexate dosing

The Annals of Pharmacotherapy
Christopher S ParshuramAndreas Laupacis

Abstract

Studies using direct measurement suggest that the doses of up to 65% of drug infusions are outside industry standards. These preparation-associated errors occur despite routine safety procedures. As of April 5, 2006, the clinical impact of these errors had not been evaluated. To measure the occurrence and associated clinical outcomes of variations in intravenous methotrexate dosing. A prospective observational study was performed on 47 methotrexate infusions of 800 mg/m2 that were administered to 19 children with acute lymphoblastic leukemia. Serum methotrexate concentrations were measured at the end of the infusions, which were administered over 24 hours. The total methotrexate dose was determined by direct measurement of the concentration and the volume of each infusion. Dosing errors greater than or equal to 10% occurred in 11 (23%) infusions and ranged from -61% to 55% of the ideal dose. Repeated measures regression analysis found the measured total methotrexate dose was not significantly associated with the serum methotrexate concentration (p = 0.58) or with clinical toxicities. The methotrexate dose administered over the last hours of infusion (p = 0.006) and the serum creatinine level at diagnosis (p = 0.05) were the mos...Continue Reading

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Citations

Jan 2, 2008·CMAJ : Canadian Medical Association Journal = Journal De L'Association Medicale Canadienne·Christopher S ParshuramAndreas Laupacis
Sep 4, 2014·Journal of Oncology Pharmacy Practice : Official Publication of the International Society of Oncology Pharmacy Practitioners·Lindsey B PoppeStephen F Eckel
Aug 25, 2018·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·Patricia A RobertsLindsey B Amerine
Jan 8, 2013·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·Cyril StuckiPascal Bonnabry
Mar 1, 2018·European Journal of Hospital Pharmacy. Science and Practice·L P AinscoughM Roberts
Dec 24, 2021·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·Lindsey B AmerineCharles Gehring

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