Methotrexate with Chloral Hydrate Interaction Details
Brand Names Associated with Methotrexate
- Amethopterin
- Methotrexate
- MTX
- Rheumatrex®
- Trexall®
Brand Names Associated with Chloral Hydrate
- Aquachloral®
- Chloral Hydrate
- Chloralum®
- Somnote®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 17, 2023
Interaction Effect
Increased methotrexate exposure
Interaction Summary
Both chloral hydrate and methotrexate are eliminated via renal tubular excretion. Increased methotrexate exposure may be linked to competition for renal tubular transporters between methotrexate and chloral hydrate metabolites. A 2-year-old girl with acute lymphoblastic leukemia who received chloral hydrate followed by high-dose methotrexate displayed increased methotrexate AUC levels compared with AUC levels of high-dose methotrexate without chloral hydrate pretreatment. Use chloral hydrate with caution when administered concurrently with methotrexate, and monitor closely for methotrexate adverse effects.
Severity
Major
Onset
Unspecified
Evidence
Probable
How To Manage Interaction
Coadministration of chloral hydrate and methotrexate may increase methotrexate exposure and increase the risk of methotrexate adverse effects. Use chloral hydrate with caution when used concurrently with methotrexate, and monitor closely for methotrexate adverse reactions.
Mechanism Of Interaction
Decreased methotrexate renal clearance due to competition for tubular secretion
Literature Reports
A) A 2-year-old girl with acute lymphoblastic leukemia displayed decreased methotrexate clearance and grade 2 mucositis when treated concomitantly with chloral hydrate and high-dose methotrexate (HD-MTX) for the first 3 courses of consolidation chemotherapy. The patient was treated with 6 courses of methotrexate 2 g/m(2) via 4-hour infusion every 3 weeks following a standard 4-week induction protocol of dexamethasone, vincristine, and asparaginase. Chloral hydrate was used as a sedative before the first 3 courses. Methotrexate clearance was abnormally slow during the first 3 courses of HD-MTX and the patient had corresponding methotrexate AUC values of 1163, 1087, and 1153 mcmol x hr/L for courses 1, 2, and 3, respectively. Methotrexate AUC values decreased after chloral hydrate discontinuation to 642, 567, and 616 mcmol x hr/L for courses 4, 5, and 6, respectively. Increased hydration during cycles 4, 5, and 6 partially accounted for increased methotrexate clearance in these cycles. As both chloral hydrate and methotrexate are eliminated via renal tubular excretion, increased methotrexate exposure may be linked to competition for renal tubular transporters between methotrexate and chloral hydrate metabolites .
Methotrexate Overview
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Methotrexate is used to treat severe psoriasis (a skin disease in which red, scaly patches form on some areas of the body) that cannot be controlled by other treatments. Methotrexate is also used along with rest, physical therapy, and sometimes other medications to treat severe active rheumatoid arthritis (RA; a condition in which the body attacks its own joints, causing pain, swelling, and loss of function) that cannot be controlled by certain other medications. Methotrexate is also used to treat certain types of cancer including cancers that begin in the tissues that form around a fertilized egg in the uterus, breast cancer, lung cancer, certain cancers of the head and neck, certain types of lymphoma, and leukemia (cancer that begins in the white blood cells). Methotrexate is in a class of medications called antimetabolites. Methotrexate treats cancer by slowing the growth of cancer cells. Methotrexate treats psoriasis by slowing the growth of skin cells to stop scales from forming. Methotrexate may treat rheumatoid arthritis by decreasing the activity of the immune system.
Chloral Hydrate Overview
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Chloral hydrate, a sedative, is used in the short-term treatment of insomnia (to help you fall asleep and stay asleep for a proper rest) and to relieve anxiety and induce sleep before surgery. It is also used after surgery for pain and to treat alcohol withdrawal.
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This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.