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Pharmacokinetic interaction between methotrexate and chloral hydrate

Authors

  • Kim Dao MD,

    1. Division of Clinical Pharmacology, Biomedicine, Department of Laboratories, CHUV, Lausanne, Switzerland
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  • Anton Ivanyuk MD,

    1. Division of Clinical Pharmacology, Biomedicine, Department of Laboratories, CHUV, Lausanne, Switzerland
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  • Thierry Buclin MD,

    1. Division of Clinical Pharmacology, Biomedicine, Department of Laboratories, CHUV, Lausanne, Switzerland
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  • Maja Beck-Popovic MD,

    1. Department of Pediatrics, CHUV, Pediatric Hemato-Oncology Unit, Lausanne, Switzerland
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  • Manuel Diezi MD

    Corresponding author
    1. Division of Clinical Pharmacology, Biomedicine, Department of Laboratories, CHUV, Lausanne, Switzerland
    2. Department of Pediatrics, CHUV, Pediatric Hemato-Oncology Unit, Lausanne, Switzerland
    • Division of Clinical Pharmacology and Unit of Pediatric Haemato-Oncology, Centre Hospitalier Universitaire Vaudois, Hôpital de Beaumont, Avenue de Beaumont 29, Lausanne 1011, Switzerland.
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  • Conflict of interest: Nothing to report.

Abstract

We report the case of a drug interaction between methotrexate (MTX) and chloral hydrate (CH) observed in a child treated for acute leukemia. Significantly slower MTX clearance and increased MTX exposure occurred on the first three courses of a high-dose chemotherapy when co-administered with CH despite normal renal function, adequate hydration, and alkalinization. Mean MTX area under the curve associated with CH administration was 1,134 µmol hours/L, compared to 608 µmol hours/L after discontinuation of CH. This interaction possibly resulted from a competition between anionic CH metabolites and MTX for renal tubular excretion. Pediatr Blood Cancer 2013; 60: 518–520. © 2012 Wiley Periodicals, Inc.

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