Medical Editor: John P. Cunha, DO, FACOEP
Neutrexin (trimetrexate glucuronate) for Injection is an inhibitor of the enzyme dihydrofolate reductase (DHFR) used along with leucovorin as an alternative therapy for the treatment of moderate-to-severe Pneumocystis carinii pneumonia (PCP) in immunocompromised patients, including patients with the acquired immune deficiency syndrome (AIDS), who are intolerant of, or are refractory to, trimethoprim-sulfamethoxazole therapy or for whom trimethoprim-sulfamethoxazole is contraindicated. The brand name Neutrexin is discontinued, but generic versions may be available. Common side effects of Neutrexin (trimetrexate glucuronate) include:
- rash and itching
- confusion, and
- low white blood cell count (neutropenia)
Neutrexin is administered at a dose of 45 mg/m2 once daily by intravenous infusion over 60 minutes. Leucovorin must be administered daily during treatment with Neutrexin and for 72 hours past the last dose of Neutrexin. Neutrexin may interact with erythromycin, rifampin, rifabutin, azole antifungals, and acetaminophen. Tell your doctor all medications and supplements you use. Neutrexin is not recommended for use during pregnancy. It may harm a fetus. It is unknown if this drug passes into breast milk. Because of the potential for serious adverse reactions in nursing infants, breastfeeding while using this drug is not recommended.
Our Neutrexin (trimetrexate glucuronate) for Injection Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
In the US -
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
Read the entire patient information overview for Neutrexin (Trimetrexate Glucuronate Inj)
Because many patients who participated in clinical trials of Neutrexin (trimetrexate glucuronate for injection) had complications of advanced HIV disease, it is difficult to distinguish adverse events caused by Neutrexin (trimetrexate glucuronate inj) from those resulting from underlying medical conditions.
Table 3 lists the adverse events that occurred in ≥ 1% of the patients who participated in the Comparative Study of Neutrexin (trimetrexate glucuronate inj) plus leucovorin versus TMP/SMX.
TABLE 3: NEUTREXIN (trimetrexate glucuronate inj) COMPARATIVE TRIAL Comparison of Adverse
Events Reported for ≥ 1% of Patients
|Adverse Events||Number and Percent (%) of Patients with Adverse Events|
(n = 109)
(n = 111)
|Non-Laboratory Adverse Events:|
|Fever||9 (8.3)||14 (12.6)|
|Rash/Pruritus||6 (5.5)||14 (12.6)|
|Nausea/Vomiting||5 (4.6)a||15 (13.5)a|
|Confusion||3 (2.8)||3 (2.7)|
|Fatigue||2 (1.8)||0 (0.0)|
|Neutropenia ( ≤ 1000/mm3)||33 (30.3)||37 (33.3)|
|Thrombocytopenia ( ≤ 75,000/mm3)||11 (10.1)||17 (15.3)|
|Anemia (Hgb < 8 g/dL)||8 (7.3)||10 (9.0)|
|Increased AST ( > 5 x ULNb)||15 (13.8)||10 (9.0)|
|Increased ALT ( > 5 x ULN)||12 (11.0)||13 (11.7)|
|Increased Alkaline Phosphatase ( > 5 x ULN)||5 (4.6)||3 (2.7)|
|Increased Bilirubin (2.5 x ULN)||2 (1.8)||1 (0.9)|
|Increased Serum Creatinine ( > 3 x ULN)||1 (0.9)||2 (1.8)|
|Hyponatremia||5 (4.6)||10 (9.0)|
|Hypocalcemia||2 (1.8)||0 (0.0)|
|No. of Patients With at Least one Adverse Eventc||58 (53.2)||60 (54.1)|
|a Statistically significant difference between
treatment groups (Chi-square: p=0.022)
b ULN = Upper limit of normal range
c Patients could have reported more than one adverse event; therefore, the sum of adverse events exceeds the number of patients
Table 4 lists the adverse events resulting in discontinuation of study therapy in the Neutrexin (trimetrexate glucuronate inj) Comparative Study with TMP/SMX. Twenty-nine percent of the patients on the TMP/SMX arm discontinued therapy due to adverse events compared to 10% of the patients treated with TMTX/LV (p < 0.001).
TABLE 4: NEUTREXIN (trimetrexate glucuronate inj) COMPARATIVE TRIAL Adverse Events Resulting
in Discontinuation of Therapy
|Adverse Events||Number and Percent (%) of Patients Discontinued for Adverse Eventsb|
(n = 109)
(n = 111)
|Non-Laboratory Adverse Events:|
|Neutropenia ( ≤ 1000/mm3)||4||(3.7)||6||(5.4)|
|Thrombocytopenia ( ≤ 75,000/mm3)||0||(0.0)||4||(3.6)|
|Anemia (Hgb < 8 g/dL)||0||(0.0)||4||(3.6)|
|Increased AST ( > 5 x ULNa)||3||(2.8)||9||(8.1)|
|Increased ALT ( > 5 x ULN)||1||(0.9)||4||(3.6)|
|Increased Alkaline Phosphatase ( > 5 x ULN)||0||(0.0)||1||(0.9)|
|No. of Patients Discontinuing Therapy Due to an Adverse Eventb||11||(10.1)d||32||(28.8)d|
| a ULN = Upper limit of normal range
b Patients could discontinue therapy due to more than one toxicity; therefore the sum exceeds number of patients who discontinued due to toxicity
c Patient discontinued TMTX/LV due to seizure, though causal relationship could not be established.
d Statistically significant difference between treatment groups (Chi-square: p < 0.001)
Hematologic toxicity was the principal dose-limiting side effect.
Read the entire FDA prescribing information for Neutrexin (Trimetrexate Glucuronate Inj)
© Neutrexin Patient Information is supplied by Cerner Multum, Inc. and Neutrexin Consumer information is supplied by First Databank, Inc., used under license and subject to their respective copyrights.