From the Guidelines
Dextromethorphan is not recommended for treating Posterior Reversible Encephalopathy Syndrome (PRES) associated with methotrexate therapy. The primary treatment for methotrexate-induced PRES involves discontinuation of methotrexate, correction of electrolytes if imbalanced, and supportive care, including symptomatic treatment with benzodiazepines [V, B] 1. For patients experiencing PRES while on methotrexate, immediate discontinuation of the medication is crucial, along with neurological monitoring and management of any seizures.
Key Considerations
- Discontinuation of methotrexate is essential in managing PRES associated with its use.
- Correction of electrolytes and blood pressure control are critical components of treatment.
- Supportive care, including the use of benzodiazepines for symptomatic relief, is recommended 1.
- Dextromethorphan, primarily used as a cough suppressant, has no established role in PRES management due to its mechanism of action not targeting the pathophysiology of endothelial dysfunction and blood-brain barrier disruption seen in PRES.
Management Approach
- Immediate discontinuation of methotrexate.
- Neurological monitoring.
- Management of seizures with appropriate anticonvulsants.
- Blood pressure control if elevated.
- Supportive care with benzodiazepines if necessary, as per the guidelines for symptomatic treatment 1.
From the Research
Dextromethorphan Treatment for PRES with Methotrexate
- There is no direct evidence in the provided studies to support the use of dextromethorphan for the treatment of Posterior Reversible Encephalopathy Syndrome (PRES) with methotrexate 2, 3, 4, 5, 6.
- The treatment approaches for PRES mainly focus on managing the underlying cause of the syndrome, such as controlling blood pressure and discontinuing the offending agent, in this case, methotrexate 2, 4, 5, 6.
- The management of PRES typically involves the use of parenteral anti-hypertensives, proper blood pressure monitoring, and supportive care to reduce cerebral edema and improve clinical symptoms 4.
- Dexamethasone and furosemide have been used in the management of PRES to reduce cerebral edema, but there is no mention of dextromethorphan in the provided studies 2.
- Further research is needed to explore the potential role of dextromethorphan in the treatment of PRES with methotrexate, as the current evidence does not support its use for this indication 3, 5.