Methotrexate poisoning

Three case studies of accidental methotrexate ingestion in paediatric patients are presented. Two patients had toxic methotrexate levels. Treatment included the administration of charcoal, intravenous hydration, alkalinisation of urine and the administration of the specific antidote folinic acid. All patients made an uneventful recovery. Parenteral folinic acid therapy should be commenced without delay in all cases of suspected methotrexate poisoning in equimolar concentration to the suspected dose of methotrexate. It is recommended that methotrexate tablet packaging be altered to reduce the likelihood of paediatric access.