{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T01:22:34Z","timestamp":1781659354879,"version":"3.54.5"},"reference-count":15,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2020,9,2]],"date-time":"2020-09-02T00:00:00Z","timestamp":1599004800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Oncol Pharm Pract"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Pharmacokinetic interaction of high-dose methotrexate (MTX) and other concomitantly administered renally secreted medicinal products may lead to insufficient methotrexate serum level decrease and significant MTX toxicity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case report<\/jats:title>\n                    <jats:p>We report the case of an 18-year-old male patient treated with high-dose MTX for an osteosarcoma and with high-dose piperacillin-tazobactam at the same time. MTX serum levels were severely elevated 24\u2009hours after the MTX infusion and did not decrease in accordance with the specific calcium folinate rescue protocol. The patient experienced renal failure accompanied by neurological symptoms, most consistent with MTX-related renal and CNS toxicity. Management and outcome: After discontinuation of piperacillin-tazobactam, intensified calcium folinate rescue therapy, and IV hydration, the MTX serum levels decreased appropriately, and toxicity symptoms resolved.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Severe MTX-related toxicity, caused by drug-drug interaction, suggests that the concomitant use of high-dose MTX and high-dose piperacillin-tazobactam should be avoided generally.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1078155220953878","type":"journal-article","created":{"date-parts":[[2020,9,3]],"date-time":"2020-09-03T01:06:37Z","timestamp":1599095197000},"page":"1000-1004","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":8,"title":["Significant interaction between high-dose methotrexate and high-dose piperacillin-tazobactam causing reversible neurotoxicity and renal failure in an osteosarcoma patient"],"prefix":"10.1177","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7576-3665","authenticated-orcid":false,"given":"Irene","family":"Kr\u00e4mer","sequence":"first","affiliation":[{"name":"Department of Pharmacy, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jelena","family":"Rosentreter","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marius","family":"Fried","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III (Hematology Oncology), University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"K\u00fchn","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III (Hematology Oncology), University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2020,9,2]]},"reference":[{"key":"bibr1-1078155220953878","unstructured":"Medac GmbH. Methotrexate 100 mg\/mL solution for injection summary of product characteristics, www.medicines.org.uk\/emc\/product\/8504\/smpc\/print (2018, accessed 7 January 2020)."},{"key":"bibr2-1078155220953878","unstructured":"European and American Osteosarcoma Study Group. EURAMOS-1 Version 4.0 ISRCTN67613327 EudraCT no. 2004-000242-20: A randomized trial of the European and American Osteosarcoma Study Group to optimize treatment strategies for resectable osteosarcoma based on histological response to pre-operative chemotherapy, https:\/\/www.skion.nl\/workspace\/uploads\/euramos_appendix_a_v1-0.pdf, 2015."},{"key":"bibr3-1078155220953878","unstructured":"Hospira UK Ltd. Calcium Folinate 10 mg\/ml injection summary of product characteristics, https:\/\/www.medicines.org.uk\/emc\/product\/1572\/smpc\/print (2018, accessed 7 January 2020)."},{"key":"bibr4-1078155220953878","doi-asserted-by":"publisher","DOI":"10.1001\/archderm.119.6.449"},{"key":"bibr5-1078155220953878","doi-asserted-by":"publisher","DOI":"10.1097\/00043426-199221000-00014"},{"key":"bibr6-1078155220953878","doi-asserted-by":"publisher","DOI":"10.1097\/00007691-199310000-00004"},{"key":"bibr7-1078155220953878","doi-asserted-by":"publisher","DOI":"10.1177\/106002809703101022"},{"key":"bibr8-1078155220953878","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkl196"},{"key":"bibr9-1078155220953878","doi-asserted-by":"publisher","DOI":"10.1097\/00007691-200208000-00018"},{"key":"bibr10-1078155220953878","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2016.34.15_suppl.e21643"},{"key":"bibr11-1078155220953878","doi-asserted-by":"publisher","DOI":"10.1007\/BF00256687"},{"key":"bibr12-1078155220953878","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdw325"},{"key":"bibr13-1078155220953878","doi-asserted-by":"publisher","DOI":"10.1007\/BF02897260"},{"key":"bibr14-1078155220953878","doi-asserted-by":"publisher","DOI":"10.1159\/000069773"},{"key":"bibr15-1078155220953878","first-page":"90","author":"Krause J","year":"2020","journal-title":"Krankenhauspharmazie"}],"container-title":["Journal of Oncology Pharmacy Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1078155220953878","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1078155220953878","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1078155220953878","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T02:23:41Z","timestamp":1777688621000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1078155220953878"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,2]]},"references-count":15,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2021,6]]}},"alternative-id":["10.1177\/1078155220953878"],"URL":"https:\/\/doi.org\/10.1177\/1078155220953878","relation":{},"ISSN":["1078-1552","1477-092X"],"issn-type":[{"value":"1078-1552","type":"print"},{"value":"1477-092X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9,2]]}}}