@entity3043 associated with low dose pulse methotrexate in the treatment of XXXX .

@entity1 @entity8 @entity4988 @entity56 @entity1500 @entity1011 @entity236 @entity3043 @entity309
Low dose pulse @entity1500 was associated with the development of @entity3043 in six @entity1 with @entity309 . Two @entity1 died. Factors implicated in the occurrence of this complication were @entity8 in five @entity1 , medication errors by two @entity1 , preexisting @entity236 from occult alcoholism in one @entity1 , and an apparent idiosyncratic reaction to the drug in another. Medication errors were associated with the use of five or more medications, and the unusual schedule of administration of low dose @entity1500 may also have been contributory. From a consideration of the clinical pharmacokinetics of @entity1500 , we suggest other factors that may predispose to the occurrence of @entity236 : the presence of @entity4988 , interactions between @entity1500 and other protein bound or weakly acidic drugs, and the repetitive dosing schedule of low dose @entity1500 . Based on our experience, @entity1 with @entity8 ( @entity1011 greater than or equal to 2.0 mg/dL) should not receive @entity1500 . Renal function should be monitored regularly during treatment with @entity1500 , and blood counts should be observed carefully if a new drug is added or substituted. A 5 mg test dose of @entity1500 before initiating weekly therapy may identify @entity1 with severe @entity56 to the drug. The potential risks of using @entity1500 in a @entity1 unwilling to accept blood products should be acknowledged and discussed with the @entity1 . Furthermore, we recommend the use of leucovorin if @entity3043 occurs, even if low or undetectable serum levels of @entity1500 are present.
