Methotrexate was first used in 1947 as a chemotherapeutic drug in the treatment of acute lymphoblastic leukemia (ALL). Methotrexate has been extensively explored as an anticancer drug since that time. High dose methotrexate is a term used for doses above 1000mg/m2. The objective of this study is to determine efficacy of Furosemide in methotrexate clearance in patients treated with high dose methotrexate.

It was a prospective cohort study carried out at the Oncology department of a tertiary care hospital, Pakistan for a period of one year. Total 80 patients were enrolled and all received daily hydration of at least 5L along with urine alkalization with sodium-bicarbonate and calcium rescue as per protocol. All patients were given Furosemide 40 mg three times a day. Methotrexate levels were monitored every 24 hours to follow its clearance. Data analysis was done by using IBM SPSS version 24.

The mean (SD) hospital stay in the current study was 4 (±1) days. Frequency of delayed methotrexate clearance was observed in 16 (20%) patients. The mean (SD) time of methotrexate clearance was 4 (±1) days. Renal injury was observed in 8 (10%) subjects, electrolyte imbalance in 12 (15%) subjects, and transaminitis in 11 (13.75%) subjects while mucositis was observed in 8 (10%) subjects.

Our study concludes that furosemide is effective in methotrexate clearance in patients treated with high dose methotrexate. The use of furosemide reduces the cost and hospital stay. As furosemide is cheaper and easily available so it can be used easily in the methotrexate clearance.