Methotrexate and dextromethorphan
DXM has multiple proposed mechanisms of action. NMDA receptors are found throughout the central nervous system, and, in contrast to the other NMDA-receptor antagonists, DM has widespread binding sites in the central nervous system. There was no difference in the number of side effects. Thus the observed DM effects could be due to both its antagonistic activity on NMDA receptors and agonistic activity on the sigma receptors present in the glial cells. The use of dextromethorphan in most of our patients resulted in symptomatic improvement. Finally, because DXM is metabolized by the CYP2D6 liver enzzymes, addition of any medication that inhibits this enzyme may increase DXM blood levels that could potentially lead to side effects and this risk is likely to be higher with high doses of DXM. Anita SiuRichard A. Hcy is directly toxic to vascular endothelium and it and its metabolites are excitatory agonists of the N -methyl-D-aspartate NMDA receptor. In the management of chronic pain, oral DXM at doses of 30—90 mg appears to have an advantage over other NMDA antagonists in reducing the sensation of pain and sparing the requirement of conjointly administered opioids, and has proven to have no or a low rate of untoward side effects.
Pediatr Hematol Oncol. Jul-Aug;19(5) Dextromethorphan is effective in the treatment of subacute methotrexate neurotoxicity.
Accurate Education – Dextromethorphan (DXM)
Drachtman RA( 1). Review of dextromethorphan administration in 18 patients with subacute methotrexate central nervous system toxicity. Afshar M(1), Birnbaum.
We have given dextromethorphan to a small group of patients who developed severe neurologic side effects after methotrexate. All had a.
Kamen Published in Pediatric hematology and oncology Methotrexate-induced neurotoxicity MTX-Ntox is a frequent complication of methotrexate MTX therapy for patients with both malignant and inflammatory diseases.
The rate of side effects was minimal if a high dose is divided into smaller portions. Two cases in adult cancer patients, who recovered with pathophysiologically based therapy Shodeinde A.
Dextromethorphan is effective in the treatment of subacute methotrexate neurotoxicity. The pioneering study of Kawamata et al.
Five patients with severe subacute MTX-Ntox (most with dysarthria and/or hemiplegia) were treated with mg/kg oral dextromethorphan (DM).
Dextromethorphan is effective in the treatment of subacute methotrexate neurotoxicity.
Dextromethorphan and the “Blahs”: Neurotoxicity is quite common with high-dose MTX chemotherapy (10% seizures) and more frequent than most realize with.
Link to citation list in Scopus. It also appears to reduce opioid tolerance and work synergistically with opioids so that they work more effectively for pain See neurobiology of dextromethorphan, below. DXM is rapidly absorbed in the gastrointestinal tract; its peak blood levels are reached at approximately 2 to 2.
NMDA receptors are found throughout the central nervous system, and, in contrast to the other NMDA-receptor antagonists, DM has widespread binding sites in the central nervous system. In one study, dextromethorphan 60 mg 4 times a day provided a beneficial effect in reducing the severity of opioid withdrawal symptoms, notably over days of treatment.