Ketamine as a Sedative for Methotrexate-Induced Neurotoxicity with Added
NMDA Antagonism
Abstract
MTX is used in the treatment of several childhood cancers and has side
effects of varying severity [1]. Neurotoxicity can occur in up to
15% of patients receiving high-dose MTX [2, 3]. Elevated
homocysteine in CSF are documented in such cases. Dextromethorphan, an
NMDA receptor antagonist, suppresses homocysteine activity and is the
initial treatment. Ketamine, also an NMDA receptor antagonist, may be
considered as an optimal treatment choice in intubated patients
requiring sedation. We describe the use of ketamine in a pediatric
patient with methotrexate-induced neurotoxicity. Ketamine as treatment
of MTX-induced neurotoxicity has not been described in the literature.