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Patients with significant nervous system dysregulation, adrenal depletion, impaired elimination, or high sensitivity may require stabilization before beginning detox

K.BaluchnejadmojaradT.RoghaniM.KhaksariM.NorouziP.AhooieM.et al (2014)

attributed the ultrastructural changes induced by MTX in rats to its precipitation and subsequent direct toxic effects on the renal tubules