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Your child must stay well hydrated after getting high-dose methotrexate. They will get IV fluids by a portable pump for at least 3 days afterward. The amount of fluid given is based on your child’s size and how well their body tolerates each course of methotrexate. The amount of fluid given may change with future courses of methotrexate.
Call your provider or clinical pharmacist if your child has:
Your child may need extra IV fluids to replace fluids lost from diarrhea or vomiting.
Leukemia patients will begin mercaptopurine the same day that high-dose methotrexate is given. Mercaptopurine is often called 6-MP. Mercaptopurine is a type of chemotherapy. It works by slowing or stopping cells from growing. It is used along with other medicines.
Mercaptopurine is taken by mouth every day for 14 days.
After your child gets high-dose methotrexate, lab staff will check their methotrexate blood levels once every 24 hours for 3 days. Your care team will tell you when to return for these tests.
After each blood test, you must remain at the hospital until your child is seen by a clinical pharmacist. This staff member will tell you:
Leucovorin is a medicine that helps reduce the side effects of high-dose methotrexate. Your child will always take leucovorin after high-dose methotrexate.
Leucovorin works best when a constant amount is in the body. So, your child must take this medicine at scheduled times. Do not miss any leucovorin doses. If your child does miss a dose, call the clinical pharmacist or doctor right away to find out how to make up the dose.
Your child may get leucovorin by mouth or by IV. Store the IV form of leucovorin in the refrigerator, out of the reach of children.
Your child should have 1 dose of leucovorin by IV or by mouth every 6 hours for a total of 6 doses. Your care team will tell you when to take each dose.
The dose, scheduled times, and length of leucovorin treatment are based on your child’s methotrexate blood level. If the blood level is high, your care team may change the leucovorin therapy. They will also tell you when your child should have another methotrexate blood test.
If you have questions about your child’s medicines or methotrexate blood levels, talk to your child’s doctor, clinical pharmacist, or nurse. Always follow the instructions given by your care team.
Reviewed: August 2022