Measures to reduce inadvertent daily methotrexate dosing
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Measures to reduce inadvertent daily methotrexate dosing A recent Drug Safety Update from the Medicines and Healthcare products Regulatory Agency (MHRA) reminded healthcare professionals that inadvertent methotrexate overdoses in patients with autoimmune conditions may occur if doses are taken more than once a week. Between January 2006 and July 2020, the agency received 11 reports of serious adverse events associated with inadvertent daily dosing, with 4 reports since January 2016. Methotrexate overdose can result in haematopoietic disorders and gastrointestinal reactions, fatal in some cases. Medication errors leading to using higher than intended doses can occur at several steps along the treatment pathway: medication prescribing and dispensing; transfer of care; and patient communication. A European review looking at root causes resulted in several recommendations. For all methotrexate products, the product information and both outer and inner packaging will display a warning about the dosing schedule and the consequences of dosing errors. Methotrexate availability in a bottle or tube will be phased out over a 4-year period. Prescribers should be fully aware of the benefits and risks of treatment, and ensure the patient can understand and comply with weekly dosing, noting the chosen day on the prescription. The overall polypharmacy burden should be considered, and the potentially fatal risk of accidental overdosing should be communicated to the patient. Dispensers should write the chosen dosing day in the space provided on the outer package, where applicable, and also on the patient card, which the patient is advised to carry with them in case of contact with unfamiliar healthcare professionals. Information on the patient card will help patients identify overdose signs and symptoms. Patients should seek urgent medical attention if they may have taken too much methotrexate. Any suspected adverse reactions or medication errors should be reported to the MHRA. Medicines and Healthcare products Regulatory Agency. Methotrexate once-weekly for autoimmune diseases: new measures to reduce risk of fatal overdose due to inadvertent daily instead of weekly dosing. Drug Safety Update : 7-9, No. 2, Sep 2020. Available from: URL: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/ 803506574 attachment_data/file/920770/Sept-2020-DSU-PDF.pdf
0114-9954/20/1825-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved
Reactions 10 Oct 2020 No. 1825
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