Acetazolamide for alkalinisation of urine in patients receiving high-dose methotrexate

@article{Shamash2004AcetazolamideFA,
  title={Acetazolamide for alkalinisation of urine in patients receiving high-dose methotrexate},
  author={Jonathan Shamash and Helena Earl and Robert Souhami},
  journal={Cancer Chemotherapy and Pharmacology},
  year={2004},
  volume={28},
  pages={150-151}
}
SummaryAcetazolamide, 500 mg 6 hourly, has been used to alkalinise the urine in patients receiving high dose methotrexate. A urinary pH of >7.5 was achieved in every cycle (13 cycles in 10 patients). In 6 cycles a single supplementary dose of sodium bicarbonate was necessary. Plasma methotrexate levels fell satisfactorily at 24 and 48 h. Acetazolamide is a simple and effective method of achieving urinary alkalinisation with advantages over oral and intravenous bicarbonate. 
Outcomes Associated with Reducing the Urine Alkalinization Threshold in Patients Receiving High‐Dose Methotrexate
TLDR
Whether a reduction in the urine pH threshold from 8 to 7 in patients receiving high‐dose methotrexate (HDMTX) results in a shorter length of hospital stay, delayed MTX clearance, or higher rates of nephrotoxicity is investigated. Expand
A prospective study on urine alkalization with an oral regimen consisting of sodium bicarbonate and acetazolamide in patients receiving high-dose methotrexate
TLDR
This analysis supports the use of PO regimens to achieve urine alkalization necessary for safe administration of HDMTX during periods of IV sodium bicarbonate shortage. Expand
Evaluation of methotrexate clearance with an enteral urine alkalinization protocol for patients receiving high-dose methotrexate
TLDR
High-dose methotrexate is a cytotoxic agent used to treat several malignancies and urine alkalinization with sodium bicarbonate and hyperhydration are given to prevent drug resistance. Expand
Addition of low dose acetazolamide as an adjunct in patients undergoing high dose methotrexate is safe and beneficial
TLDR
High‐dose methotrexate is utilised in central nervous system lymphoma and acute lymphoblastic leukaemia due to its ability to penetrate the blood–brain barrier, and routine AZL was administered to appropriate patients from 2010 onwards. Expand
Safety and efficacy of a urine alkalinization protocol developed for high-dose methotrexate patients during intravenous bicarbonate shortage
TLDR
A urinary alkalinization protocol involving hyperhydration with intravenous fluids, oral bicarbonate, and intravenous or oral acetazolamide was utilized from 10 April to 30 May 2017 and compared outcomes between protocols. Expand
Oral sodium bicarbonate protocol for high-dose methotrexate urine alkalinization: A pediatric experience
TLDR
Intravenous hydration and urine alkalinization with sodium bicarbonate with NaHCO3 can mitigate nephrotoxicity associated with high-dependence on methotrexate. Expand
Safety and effectiveness of the combination acetazolamide and bicarbonates to induce alkaline diuresis in patients with rhabdomyolysis
TLDR
The combined use of acetazolamide and bicarbonates was effective and safe as it achieved alkaline urines on the first day and CPK levels were reduced to <5000 IU/L within 3 days, no patient needed chronic haemodialysis, and no electrolyte or metabolic abnormalities were observed. Expand
Assessing the impact of adding acetazolamide to oral or intravenous sodium bicarbonate as compared with intravenous bicarbonate monotherapy as urinary alkalinization in adults receiving high-dose methotrexate
TLDR
Addition of Acet to NaHCO3 reduces time to pH ≥ 7 and initiation of HD-MTX but does not appear to improve LOS, MTX toxicities, or time to MTX clearance. Expand
Evaluating off-label uses of acetazolamide.
TLDR
The potential benefits of acetazolamide include ventilator weaning for chronic obstructive pulmonary disease patients, avoidance of invasive procedures in patients with a CSF leak or elevated ICP, and prevention of high-dose methotrexate toxicity and contrast-induced nephropathy. Expand
Risk factors for high-dose methotrexate-induced nephrotoxicity
TLDR
It is suggested that low urine pH at day 1 is an independent risk factor for MTX-induced nephrotoxicity. Expand
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