Acute accidental methotrexate poisoning: Fatal consequences – An Indian experience

Methotrexate (MTX) is a versatile drug used in various fields, including oncology and rheumatology, acting by inhibitory effects on DNA synthesis and cellular replication. While low-dose MTX is a first-line treatment for rheumatoid arthritis and psoriasis, overdose or incorrect dosing can lead to severe toxicity. We present three cases of accidental MTX poisoning, highlighting the diverse clinical manifestations and challenges in management. Patients presented with fever, weakness, mucocutaneous lesions, and pancytopenia, necessitating intensive care and supportive treatment. These cases underscore the importance of proper dosing, patient education, and pharmacist vigilance to prevent medication errors. Heightened awareness among clinicians is crucial to promptly recognize and manage MTX toxicity, ensuring the safe and effective use of this valuable therapeutic agent. Further research is needed to optimize dosing strategies and enhance safety measures for MTX administration.