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Methotrexate Central Nervous System Toxicity Identified in a Pharmacogenomics Pharmacist Consult Patient

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OBJECTIVE: To report a possible pharmacogenomics (PGx)-related, cognitive dysfunction, adverse drug reaction from methotrexate (MTX) that may be multifactorial in origin. SUMMARY: The patient subject is a 76-year-old Caucasian female of Russian ancestry suffering from rheumatoid arthritis and treated with MTX who presented to the diagnostic and consultative physician service in a medical clinic with advancing cognitive dysfunction, manifesting as memory loss, dizziness, and confusion. Components of this possible adverse drug reaction (ADR) may include ancestry, pharmacogenomics (PGx) characteristics of the patient, and a change in route of administration, among others. The case demonstrates how patients referred to a pharmacist consult service for a suspected ADR with possible PGx implications may uncover other contributory factors to the ADR. CONCLUSION: PGx testing may increase clinical pharmacist referrals to identify a PGx etiology to an ADR. However, they may also identify other non-PGx contributory factors to an ADR.
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Keywords: ADVERSE DRUG REACTION; DISEASE-MODIFYING ANTIRHEUMATIC DRUG; MEDICATION THERAPY MANAGEMENT; METHOTREXATE; PHARMACOGENOMICS; RHEUMATOID ARTHRITIS

Document Type: Miscellaneous

Publication date: October 1, 2019

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  • The Senior Care Pharmacist® is the official peer-reviewed journal of the American Society of Consultant Pharmacists. It is dedicated exclusively to the medication needs of the elderly in all settings, including adult day care, ambulatory care, assisted living, community, hospice, and nursing facilities. This award-winning journal is a member benefit of ASCP. Individuals who are not members and wish to receive The Senior Care Pharmacist® will want to consider joining ASCP.
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