IA Intrathecal Methotrexate Sodium

Choriocarcinoma and similar trophoblastic diseases. Dose individualized. PO, IM:

15-30 mg/day for 5 days. May be repeated 3-5 times with 1-week rest period between courses.

Acute lymphatic (lymphoblastic) leukemia.

Initial: 3.3 mg/m2 (with 60 mg/m2 prednisone daily); maintenance: PO, IM, 30 mg/m2 2 times/week or IV, 2.5 mg/kg q 14 days.

Meningeal leukemia. Intrathecal: 12 mg/m2 q 2-5 days until cell count returns to normal.

Lymphomas. PO: 10-25 mg/day for 4-8 days for several courses of treatment with 7- to 10-day rest periods between courses.

Mycosis fungoides. PO: 2.5-10 mg/day for several weeks or months; alternatively, IM: 50 mg once weekly or 25 mg twice weekly.

Lymphosarcoma. 0.625-2.5 mg/kg/day in combination with other drugs.

Osteosarcoma. Used in combination with other drugs, including doxorubicin, cisplatin, bleomycin, cyclophosphamide, and dactinomycin. Usual IV starting dose for methotrexate: 12 g/m2; dose may be increased to 15 g/m2 to achieve a peak serum level of 10-3 mol/L at the end of the methot-rexate infusion.


Adults, usual: PO, IM, IV, 10-25 mg/week, continued until beneficial response observed. Weekly dose should not exceed 50 mg. Alternate regimens: PO, 2.5 mg q 12 hr for three doses or q 8 hr for four doses each week (not to exceed 30 mg/week); or PO, 2.5 mg daily for 5 days followed by 2 days of rest (dose should not exceed 6.25 mg/day). Once beneficial effects are noted, reduce dose to lowest possible level with longest rest periods between doses.

Rheumatoid arthritis.

Initial: Single PO doses of 7.5 mg/week or divided PO doses of 2.5 mg at 12-hr intervals for three doses given once a week; then, adjust dosage to achieve optimum response, not to exceed a total weekly dose of 20 mg. Once response has been reached, the dose should be reduced to the lowest possible effective dose.

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