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Classification
Antineoplastics
Indications
Gestational choriocarcinoma, chorioadenoma destruens & hydatidiform mole. In all, as prophylaxis of mentingeal leukemia & as maintenance therapy in combination. Alone or in combination-breast cancer, epidermoid cancers of the head & neck; advanced mycosis fungoides & lung CA; advanced stage of non-Hodgkin's lymphoma; in high doses followed by leucovorin rescue & in combination - may prolong relapse-free surgical resection or amputation of primary tumor. Psoriasis. RA.
Dosage
Choriocarcinoma & similar trophoblastic diseases 15-30 mg orally daily for 5 days. Repeat course 3-5 times, w/ rest periods of >1 wk between courses. Leukaemia Induction: 3.3 mg/m2 together w/ 60 mg/m2 prednisone daily for 4-6 wk. Maintenance: Orally 2 tames wkly w/ total wkly dose of 30 mg/m2 every 2 wk. Meningeal leukaemia Childn >3 yr 12 mg, 2yr 10 mg, 1 yr 8 mg, <1 yr 6 mg. Burkitt's tumour, stages I-II 10-25 mg orally for 4-8 days, repeat for several courses. Lymphosarcoma, stage III 0.625-2.5 mg/kg daily. Mycosis fungoides 2.5-10 mg orally for wk or mth. Psoriasis Wkly single oral dose schedule: 2.5 mg 12 hrly for 3 dose or 8 hrly for 4 doses each wk. Max:30 mg/wk. Daily oral dose schedule : 2.5 mg daily for 5 days followed by 2 days of rest. Max: 6.25 mg/day.
Contraindications
Pregnancy & lactation. Patients w/ psoriasis or RA w/ alcoholism, alcoholic liver disease or other chronic liver diease; Immunodeficiency syndromes, preexisting blood dyscrasias.
Precautions
Peptic ulcer disease, ulcerative colitis, malignancy & preexisting hematopoietic impairment. Granulocytopenia, fever, preexisting liver damage, impaired hepatic function, infection or immunologic states, craniospinal irradiation. Renal impairment. Debility, in extreme youth & old age.
Adverse Reactions
Ulcerative stomatitis, leukopenia, nausea, abdominal distress, frequently reported malaise, undue fatigue, chills & fever, dizziness & decreased resistance to infection
Interactions
NSAIDs, salicylates, phenylbutazone, phenytoin, sulphonamides, probenecid, nephrotoxic chemotherapeutic agents. Tetracycline, broad-spectrum antibiotics. Penicillins, retinoids, theophylline, folic acid.
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