What two organs are closely monitored when a patient is receiving high dose methotrexate?

• A. Heart and kidneys
• B. Lungs and kidneys
• C. Heart and liver
• D. Liver and kidneys

Answer: (D)

High-dose methotrexate is a treatment where safety hinges on how the drug is cleared and how it can affect organs at risk. The kidneys and the liver are the two closely watched organs. Methotrexate is cleared primarily by the kidneys, so the risk of nephrotoxicity is a major concern with high doses. That’s why aggressive hydration and urine alkalinization are used to keep the drug in solution and improve renal clearance, and why renal function tests are monitored closely during and after infusion. The liver also warrants close attention because methotrexate is metabolized there, and high-dose therapy can cause hepatotoxicity over time. Regular liver function tests help detect early toxicity and guide timing or dose adjustments, including rescue strategies like administering folinic acid. By tracking both kidney and liver function, clinicians can balance achieving effective drug exposure with minimizing toxicity. Other organs, such as the heart or lungs, are not the primary monitoring focus for this regimen.