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http://www.swscn.org.uk/wp/wp-content/uploads/2019/04/HDMTXCNSProphylaxis.pdf#:~:text=Serum%20methotrexate%20levels%20should%20be%20taken%2048%20hours,increased%20if%20serum%20creatinine%20increases%20%3E50%25%20from%20baseline.
https://pubmed.ncbi.nlm.nih.gov/316368/
The predicted incidence of moderate-severe overall toxicity in the high-risk group (48-hour MTX level greater than 1.00 x 10(-6) mol/l., prior infusions greater than 10, age greater than or equal to 15 years) was 33.2% compared to only 2.4% in the "low-risk" group (48-hour MTX level less than or equal to 1.00 x 10(-6) mol/l., prior infusions less than or equal to 10, age less than 15 years).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5153332/
Within 48 hours of glucarpidase administration, only a chromatographic (high-performance liquid chromatography) method can reliably measure methotrexate concentrations because the DAMPA produced by enzymatic breakdown of methotrexate cross-reacts with methotrexate in the standard immunoassay and artificially elevates the level . The long half-life …
https://www.drugs.com/ppa/methotrexate.html
Normal methotrexate elimination (serum methotrexate level ~10 micromolar at 24 hours after administration, 1 micromolar at 48 hours, and <0.2 micromolar at 72 hours): Leucovorin calcium 15 mg (oral, IM, or IV) every 6 hours for 60 hours (10 doses) beginning 24 hours after the start of methotrexate infusion.
https://globalrph.com/oncology/methotrexate/
Serum methotrexate level approximately 10 micromolar at 24 hours after administration, 1 micromolar at 48 hours, and less than 0.2 micromolar at 72 hours. 15 mg PO, IM, or IV q 6 hours for 60 hours (10 doses starting at 24 hours after start of methotrexate infusion). Delayed Late Methotrexate Elimination
https://www.nwcscnsenate.nhs.uk/index.php/download_file/view/4561/1947/
• If 48hr methotrexate level < 0.1mmol/l ‘rescue’ has been completed, folinic acid and fluids may be discontinued • If MTX level at 48 hrs is between 0.1 & 20mmol/l, continue folinic acid 15mg/m2 every 6 hrs • If methotrexate level is > 20mmol/l – need to discuss with Consultant, as need to
https://www.uhs.nhs.uk/Media/SUHTExtranet/Services/Chemotherapy-SOPs/Lymphoma/InP-methotrexate.pdf
• Methotrexate levels taken every 24 hours beginning 48 hours after the start of the infusion until the level is below 0.1micromol/L • Urinary pH every two hours as a minimum until the methotrexate level is below 0.1micromol/L • Strict fluid balance chart to be maintained throughout methotrexate administration
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