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Publication Type: Medication Safety Bulletin
Single or Multiple Incident: Multiple
Date: 11/1/2019 12:00:00 AM
Country: Hong Kong

This safety bulletin discusses the medication safety incidents which can occur with the use of oral methotrexate. Methotrexate is a folate antimetabolite used in the treatment of neoplastic diseases and non-oncological conditions such as psoriasis, rheumatoid arthritis, and other conditions. When used to treat disorders such as psoriasis and rheumatoid arthritis, low doses are administered weekly by the oral route. However, for some cancer types, a more frequent or higher dose is used. At high doses, oral methotrexate is known to be associated with serious and sometimes fatal blood dyscrasias, but similar adverse outcomes have been associated with the use of low-dose oral methotrexate when given daily. Prescribing, transcribing, dispensing, and administration errors (including self-administration by patients) have led to daily instead of weekly dosing of oral methotrexate for non-oncological indications. The goal of best practice involving methotrexate is to prevent errors involving inadvertent daily dosing instead of weekly dosing of oral methotrexate for non-oncologic conditions in the ambulatory and inpatient setting. Highlights of the best practices related to valproate are provided in the recommendations section of this alert.

Additional Details

Medication/Gas/Fluid:
methotrexate, folate antimetabolite
Medication/IV List:
chemotherapeutic agents, parenteral and oral, methotrexate, oral, non-oncologic use


Oral methotrexate - Best Practice to prevent inadvertent daily dosing for non-oncologic conditions