Closely monitor complete blood counts (CBCs), including platelet counts, before each Methotrexate dose and regularly throughout treatment. Target monitoring frequency depends on the patient’s overall health and response to treatment, but weekly checks are often necessary, especially in the initial phase.
Renal Function Monitoring
Assess renal function via serum creatinine and blood urea nitrogen (BUN) levels before initiating Methotrexate and at regular intervals during therapy. Hydration is vital to prevent nephrotoxicity; encourage patients to drink plenty of fluids. Adjust the dosage based on renal function, consulting appropriate guidelines.
Liver Function Tests
Regularly monitor liver function tests (LFTs), including alanine aminotransferase (ALT) and aspartate aminotransferase (AST), to detect potential hepatotoxicity. Dosage adjustments or treatment cessation may be required depending on the severity of liver enzyme elevations.
Monitoring for Toxicity
Actively monitor for signs of mucositis (mouth sores), nausea, vomiting, diarrhea, and fatigue. These are common side effects that can be managed with supportive care. Promptly address any significant adverse events.
Methotrexate Levels
Consider therapeutic drug monitoring (TDM) of Methotrexate levels, particularly in high-dose regimens, to optimize efficacy and minimize toxicity. This allows for tailored dosage adjustments based on individual patient pharmacokinetics.
Patient Education
Educate patients about potential side effects and the importance of regular follow-up appointments. Emphasize the need to report any unusual symptoms immediately. Provide clear instructions on medication administration and supportive care measures.
Documentation
Maintain meticulous records of all lab results, clinical observations, and dosage adjustments. This detailed documentation is crucial for effective management and facilitates informed decision-making.
