Accidental daily dosing of methotrexate meant to be taken weekly remains a cause of serious harm and death, through bone marrow suppression and mucositis. It typically happens at transitions: a new prescription, a hospital admission, a pharmacy dispensing loose tablets, or a relative helping with medicines.
Write the day of the week on the prescription, prescribe a single tablet strength, and give folic acid on a different day. Teach patients the warning signs of toxicity: mouth ulcers, sore throat, fever, bruising or breathlessness.
- Write the specific day of the week on every methotrexate prescription.
- Prescribe a single tablet strength to avoid confusion.
- Give folic acid on a different day from methotrexate.
- Teach patients to stop and seek help for mouth ulcers, fever, sore throat or unexplained bruising.
Why it matters
Daily dosing errors with weekly methotrexate are preventable and can be fatal.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for rheumatology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free