Methotrexate should be used with extreme caution in the presence of debility. If vomiting, diarrhea, or stomatitis occur, which may result in dehydration, Methotrexate should be discontinued until recovery occurs. Post-marketing experience suggests that the occurrence of bone marrow suppression, thrombocytopenia, and pneumonitis may increase with age. In chronic use situations, certain toxicities may be reduced by folate supplementation.
Elderly patients should be closely monitored for early signs of hepatic, bone marrow and renal toxicity. Serum Methotrexate levels may also be helpful. Since decline in renal function may be associated with increases in adverse events and serum creatinine measurements may over estimate renal function in the elderly, more accurate methods should be considered. In general, dose selection for an elderly patient should be cautious reflecting the greater frequency of decreased hepatic and renal function, decreased folate stores, concomitant disease or other drug therapy in this population. Clinical studies of Methotrexate did not include sufficient numbers of subjects age 65 and over to determine whether they respond differently from younger subjects.
