New alert gives advice on the prescription and management of oral methotrexate.

Methotrexate is an immunosuppressant drug commonly used to reduce joint damage caused by rheumatoid arthritis. When taken correctly it is a safe and effective treatment for this condition and has been in use for 25 years. However when taken incorrectly it has the potential to cause severe toxicity resulting in patient harm and even death.

There is a significant risk of errors occurring around dosage as oral methotrexate should be administered just once each week.  Patients may become confused over which day their medication should be taken or may take it daily instead of weekly.  In one case a patient misread the directions on a prescription bottle and took 10mg every “morning” instead of every “Monday”.  Confusion may also occur over changes in dosage when different strength tablets are prescribed.

This alert recommends that protocol and processes for the managing patients receiving oral methotrexate are standardised. For example the day of the week should be written in full and the same tablet strength used for each clinical situation.

Patient information should be reviewed to ensure they understand how their medication should be taken and its possible side effects. Clinicians should double check prescription details and check a patient’s blood count and liver function before issuing a repeat prescription.

Implementing these simple measures will help ensure patient safety and reduce the risk of further deaths in New Zealand.

Click here to read the alert in full.