Cookie policy: This site uses cookies (small files stored on your computer) to simplify and improve your experience of this website. Cookies are small text files stored on the device you are using to access this website. For more information please take a look at our terms and conditions. Some parts of the site may not work properly if you choose not to accept cookies.

Join

Subscribe or Register

Existing user? Login

PJ Online | PJ Letters: Medicines in use

Home > PJ (current issue) > Letters | Search

Return to PJ Online Home Page

The Pharmaceutical Journal
Vol 269 No 7226 p782
30 November 2002

This page
Reprint
Photocopy

   

PDF* 75K

Letters

  Smoking cessation
  Community pharmacy
  Mental health
  Remuneration
  Patient information
  Drug tariff
  Medicines in use
  Cannabis
  Food safety
  Alzheimer's disease
  The Society
  Onlooker


Letters to the Editor

  * PDF files on PJ Online require Acrobat Reader 4 or later.

Medicines in use

Be vigilant about methotrexate toxicity

From Mr M. F. Hannon, MRPharmS

I read with interest the letter regarding the confusion between folic acid and methotrexate tablets (PJ, 16 November, p712). Within our hospital we have had similar anxieties about this type of confusion occurring in one of our dermatology outpatients clinics and we have had two near misses of which we are aware. Our analysis suggested that although the colours and shape of the two agents are similar, we need to pay much more attention to the strength of the methotrexate tablets prescribed (dispensed) and their dosing frequency.

Therefore, about 15 years ago, we took action to stock only one strength of oral methotrexate (2.5mg tablets) in the hospital pharmacy. This decision was driven by a consultant dermatologist and myself and we organised it such that all our dermatology outpatients on oral methotrexate would, for reasons of safety and continuity, always get their drug from the hospital pharmacy. The consultant argued forcefully that with the drive by the Government to encourage generic prescribing and dispensing, changes in tablet presentation, colour, etc, happen so frequently that patients often "miss" the obvious warning signs when something is dispensed wrongly. He reasoned that for a drug such as methotrexate where the therapeutic index is so low, we needed to ensure that the patient was trained adequately and that the supply and the identity of the drug could be guaranteed. Therefore we purchased only branded, identifiable methotrexate tablets 2.5mg and patients in the clinic knew what to expect. This initiative soon spread to patients in other clinics and so far we have had no problems.

One of my colleagues in another trust asked me whether our patients and pharmacy staff eventually become "desensitised" to the risks of oral methotrexate. I hope that this never happens but given the growth in the use of oral methotrexate in other specialties (immunology, oncology, rheumatology), it is possible that methotrexate could become "just another drug". Patients, for instance, expect to take their tablets every day and weekly dosing is relatively infrequent in pharmacy practice so complacency can creep in. However, anyone who read the recent report on the fatality with methotrexate (see www.cambs-ha.nhs.uk/publications/pdf/methotrexate-toxicity.pdf) can be left in no doubt as to its potential toxicity.

The pharmaceutical industry could, with better packaging, do much more to help eliminate the hazard. But given the range of doses that we dispense in our hospital (from 2.5mg up to 22.5mg once weekly), it could prove to be difficult to get a standard pack. Until there are further controls on oral methotrexate (see Pharmacy in Practice, September 2002, p277), perhaps the only safeguard for patients and pharmacists is more information and better education. As pharmacists we must remain acutely aware of the risk posed by this drug if it is taken daily instead of weekly.

M. F. Hannon
Principal Pharmacist
Royal Victoria Infirmary
Newcastle Hospitals NHS Trust

Send your letter to The Editor

Previous Topic (Drug tariff)
Next Topic (Cannabis)

Back to Top

Home | Journals | News | Notice-board | Search | Jobs  Classifieds | Site Map | Contact us

©The Pharmaceutical Journal

Citation: The Pharmaceutical Journal URI: 20008264

Rate this article 

Click to rate

  • 1 star out of 5
  • 2 stars out of 5
  • 3 stars out of 5
  • 4 stars out of 5
  • 5 stars out of 5

0 out of 5 stars

Have your say

For commenting, please login or register as a user and agree to our Community Guidelines. You will be re-directed back to this page where you will have the ability to comment.

Recommended from Pharmaceutical Press

  • BNF and BNF for Children

    BNF and BNF for Children

    Now available as a 1 year print subscription to both the BNF and BNFC, ensuring you have the latest medicines information as it publishes and at a greatly reduced price.

    £138.50Buy now
  • BNF and BNF for Children

    BNF and BNF for Children

    Now available as a 2 year print subscription to both the BNF and BNFC, ensuring you have the latest medicines information as it publishes and at a greatly reduced price.

    £262.50Buy now
  • Patient Care in Community Practice

    Patient Care in Community Practice

    Patient Care in Community Practice is a unique, practical guide for healthcare professionals or carers. Covers a range of non-medicinal products suitable for use at home.

    £22.00Buy now
  • Clinical Pharmacokinetics

    Clinical Pharmacokinetics

    A practical guide to the use of pharmacokinetic principles in clinical practice. Includes case studies with questions and answers.

    £33.00Buy now
  • Pharmaceutical Toxicology

    Pharmaceutical Toxicology

    Explains the methodology and requirements of pre-clinical safety assessments of new medicines. Includes registration requirements and pharmacovigilance.

    £40.00Buy now

Search an extensive range of the world’s most trusted resources

Powered by MedicinesComplete
  • Print
  • Share
  • Comment
  • Rate
  • Save
  • Print Friendly Version of this pagePrint Get a PDF version of this webpagePDF

Jobs you might like

Newsletter Sign-up

Want to keep up with the latest news, comment and CPD articles in pharmacy and science? Subscribe to our free alerts.