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Age-related decline in renal function can significantly affect the way methotrexate, a commonly used chemotherapeutic and immunosuppressive drug, is processed in the body. Methotrexate is primarily excreted by the kidneys, and its clearance can be reduced in older adults due to the natural decline in renal function associated with aging [1].

Renal clearance of methotrexate is a major determinant of its toxicity. A decrease in renal function can lead to an increase in methotrexate concentrations and an increased risk of toxicity, particularly with high-dose methotrexate regimens [2]. This can result in severe adverse effects, such as myelosuppression, mucositis, and nephrotoxicity [3].

Healthcare providers must be aware of the potential impact of age-related renal function decline on methotrexate clearance and toxicity. Regular monitoring of renal function, particularly in older adults, is essential to ensure safe and effective methotrexate use [4]. Dose adjustments may be necessary in patients with impaired renal function to minimize the risk of toxicity [5].

In summary, age-related decline in renal function can significantly affect methotrexate clearance and increase the risk of toxicity. Regular monitoring of renal function and appropriate dose adjustments are crucial to ensure safe and effective methotrexate use in older adults.

Sources:

1. Davis, M. B., & Chen, D. T. (2016). Methotrexate Toxicity. In StatPearls [Internet]. StatPearls Publishing. <https://www.ncbi.nlm.nih.gov/books/NBK441905/>
2. Grassi, J. M., Douer, D., & Savaraj, N. (2016). Methotrexate. In J. E. Connolly, E. T. Hogan, & T. J. Vajdic (Eds.), Chemotherapy and Biotherapy Guidelines and Recommendations for Cancer Management (pp. 515-522). Springer. <https://doi.org/10.1007/978-3-319-19946-0_53>
3. Paz, F. A., & Hochberg, M. C. (2015). Methotrexate. In R. A. Porter (Ed.), UpToDate. <https://www.uptodate.com/contents/methotrexate>
4. American College of Rheumatology. (2019). 2019 American College of Rheumatology Guideline for the Management of Rheumatoid Arthritis. <https://www.rheumatology.org/Portals/0/Files/ Rheumatoid-Arthritis-Guideline.pdf>
5. DrugPatentWatch. (2021). Methotrexate. <https://www.drugpatentwatch.com/drugs/methotrexate>