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Active Transport of Methotrexate from Cerebrospinal Fluid in Humans¹

Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland 20205 [U. B., I. T. M., D. G. P., and D. L. G.], Children's Orthopedic Hospital and Medical Center, University of Washington, and Fred Hutchinson Cancer Research Center, Seattle, Wash. 98105 [W. A. B.]

The cerebrospinal fluid (CSF) efflux kinetics of methotrexate (MTX) were studied in three patients with indwelling Ommaya reservoirs. A small dose of MTX was injected intraventricularly several hr after the start of a high-dose continuous i.v. infusion of MTX. In all patients, the CSF antifolate concentration returned to the preinjection level before the end of the i.v. infusion. This result indicated that the efflux of MTX from CSF in humans is independent of plasma drug concentrations. Efflux kinetics were further characterized in one patient. Serially obtained CSF samples after intraventricular injections demonstrated a biphasic disappearance curve with - and ß-phase half-disappearance times of 1.7 and 6.6 hr, respectively. Prolongation of the ß-phase half-time was associated with oral acetazolamide medication and with increased intracranial pressure, indicating that inhibition of CSF production slows MTX clearance. CSF MTX concentration, however, declined more rapidly than that of simultaneously administered diethylenetriaminepentaacetic acid, an extracellular marker substance excreted by bulk flow, indicating that bulk flow excretion alone is insufficient to account for MTX efflux from human CSF. Evidence that there is an active transport component was provided by probenecid pretreatment which also prolonged the CSF MTX half-life. These findings suggest that both passive and active mechanisms govern MTX efflux from the CSF in humans and that they can be inhibited by acetazolamide and probenecid, respectively.

¹ Portions of these results were presented in preliminary form at the meeting of the American Society of Clinical Oncology, Inc., New Orleans, May 1979 (3).

² To whom requests for reprints should be addressed, at Pediatric Oncology Branch, National Cancer Institute, Building 10, Room 3B-11, Bethesda, Md. 20205.

³ Scholar of the Leukemia Society of America. Present address: Children's Orthopedic Hospital and Medical Center, University of Washington, and Fred Hutchinson Cancer Research Center, Seattle, Wash. 98105.

Received 1/ 2/80. Accepted 4/ 3/80.

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