SMH report of preventable Methotrexate Overdosing

SMH report of preventable Methotrexate Overdosing

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Oh no. Bad press for Methotrexate.

“Worrying rise in accidental overdose of prescription drug methotrexate” was the headline in the Sydney Morning Herald newspaper (read this here).


Since 2000, 7-8 people died due to Methotrexate overdosing, when the medication was taken EVERY DAY instead of ONCE WEEKLY.

Incorrect dosing is clearly life threatening.

And yes, people may confuse their weekly dose with their daily medications. Especially if the patients already suffer with confusion from any cause.

So we have to be careful. 

Rheumatologists need to educate their patients carefully about the dosing.

Patients need to understand and then need to take a certain responsibility after an adequate amount of education.

Pharmacists need to dispense correctly. 

All these steps should help prevent accidental overdose.

One suggestion from the newspaper article and from the source journal (published in the Medical Journal of Australia here) is for pack sizes to be reduced to 4 tablets! That would increase patient inconvenience greatly especially when a standard dose is around 2 tablets (of the 10mg tablet size) a week. Other suggestions such as clearer labelling on the packaging to remind about the weekly dosing make sense.

I am not saying that attempts to reduce dosing mistakes are not needed.

It’s just that my heart sinks when this sort of story plays out. A drug which is so commonly used, and which suffers from an unfair amount of misinformation, does not really need more bad press. 

The numbers reported need to be placed in context. If we use a figure quoted in the paper, around 260,000 Methotrexate scrips were dispensed in a year. The number of deaths reported from overdose were over a 14-15 year period, which while tragic, remains very small. This is a rare event.

I just hope this type of report does not scare patients from using a medication that certainly has a role in treating disease effectively.

Used appropriately, low dose Methotrexate is safe.

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