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METHOTREXATE How Supplied/Storage and Handling (Methotrexate Vial)

HOW SUPPLIED

Parenteral:

Methotrexate Injection, USP, Isotonic Liquid, Contains Preservative. Each 25 mg/mL, 2 mL vial contains methotrexate sodium equivalent to 50 mg methotrexate.

Unit of SaleConcentration
NDC 61703-350-38
Carton containing 5 Vials
50 mg/2 mL
(25 mg/mL)

Store at controlled room temperature, 20° to 25°C (68° to 77°F) [see USP Controlled Room Temperature]; excursions permitted to 15° to 30°C (59° to 86°F). PROTECT FROM LIGHT.

‡LEUCOVORIN RESCUE SCHEDULES FOLLOWING TREATMENT WITH HIGHER DOSES OF METHOTREXATE

Clinical Situation

Laboratory Findings

Leucovorin Dosage and Duration

Normal Methotrexate Elimination

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

Serum methotrexate level remaining above 0.2 micromolar at 72 hours, and more than 0.05 micromolar at 96 hours after administration.

Continue 15 mg PO, IM, or IV q six hours, until methotrexate level is less than 0.05 micromolar.

Delayed Early Methotrexate Elimination and/or Evidence of Acute Renal Injury

Serum methotrexate level of 50 micromolar or more at 24 hours, or 5 micromolar or more at 48 hours after administration, OR; a 100% or greater increase in serum creatinine level at 24 hours after methotrexate administration, (e.g., an increase from 0.5 mg/dL to a level of 1 mg/dL or more).

150 mg IV q three hours, until methotrexate level is less than 1 micromolar; then 15 mg IV q three hours until methotrexate level is less than 0.05 micromolar.

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