ADAP drugs: trimetrexate (Neutrexin)

trimetrexate (Neutrexin)

Drug description

Trimetrexate has been approved by the U.S. Food and Drug Administration for the treatment of moderate-to-severe PCP pneumonia in people with compromised immune systems. Pneumocystis carinii pneumonia, commonly referred to as PCP, can affect the lungs as well as other parts of the body, including the skin and internal organs. People who are at the greatest risk of contracting this type of pneumonia are those who have less than 200 T4 cells. Symptoms of PCP include shortness of breath, dry cough, and fever. Trimetrexate is an alternative for people that can't take other approved treatments like TMP/SMX. It can also be used if the PCP pneumonia doesn't get better with the standard treatments. Due to very serious and potentially life-threatening side-effects of this drug, leucovorin must be co-administered for at least 72 hours after the last dose.

Side effects
Leukopenia, low numbers of white blood cells called leukocytes, and thrombocytopenia, low platelets, and reversible changes in kidney and liver function tests are often seen. So far, no infections have resulted from the leukopenia. Leukopenia and thrombocytopenia respond promptly to lowering the dose by 50%. Liver function tests usually return towards normal as therapy is continued. Inflammation of the mouth, anemia, and skin rashes occur occasionally; diarrhea, arthralgia, fever, bleeding, anorexia, nausea, and vomiting have been reported less frequently.

Dosage
Trimetrexate is usually given at a dose of 45 mg/m2 once daily by intravenous infusion over 60-90 minutes. Leucovorin must be given daily during trimetrexate treatment and for 72 hours afterward. Leucovorin may be given intravenously at a dose of 20 mg/m2 over 5-10 minutes every 6 hours or orally as 4 doses of 20 mg/m2 spaced evenly throughout the day.

How long it may take to work
The recommended course of therapy is 21 days of trimetrexate and 24 days of leucovorin.

Managing side effects and drug interactions
Your doctor will need to conduct blood tests at least twice a week to monitor for any of the side effects listed above. Severe effects on blood cells or kidney and liver function tests may require that trimetrexate treatment be stopped. In cases of moderate side effects treatment can be withheld for a short period and then restarted. Report any inflammation in your mouth to your doctor. Fevers may be controlled by medications that your doctor can prescribe you. Drugs that may interact and need careful monitoring when given along with trimetrexate are acetaminophen (Tylenol), erythromycin, rifampin, rifabutin, ketoconazole, fluconazole, clotrimazole, miconazole and cimetidine (Tagamet).

This information is specific to the use of this medication for HIV-related conditions. For additional information about this drug for other conditions, refer to: www.nursespdr.com/ and www.healthanswers.com/Library/library_fset.asp

The drug descriptions on these pages are intended for informational purposes only. The Network does not promote or endorse the use of any specific treatment for any health-related condition. The medications described here can only be dispensed by a licensed health care professional. The information may have changed since these pages were updated, though every effort is made to keep these pages current. Please contact The Network at (800) 734-7104 to make sure you have the most up-to-date information

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