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Methotrexate daily dosing error — GPhC CRA MCQ

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EasyGI TherapeuticsMethotrexate daily dosing errorGPhC CRA

A pharmacist receives a prescription for methotrexate 7.5 mg once weekly for a patient with Crohn's disease. The prescription reads 'methotrexate 2.5 mg tablets, take three tablets daily'. What is the most appropriate action?

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Correct answer: C — Contact the prescriber urgently as the prescription states daily dosing which could be fatal; methotrexate should be prescribed once weekly

Methotrexate prescribed daily instead of weekly is a well-recognised and potentially fatal prescribing error. The NPSA has issued a Patient Safety Alert highlighting that inadvertent daily dosing of methotrexate can cause fatal pancytopenia and multi-organ failure. The pharmacist must NOT dispense this prescription and must contact the prescriber urgently to clarify the intended once-weekly dosing. This is a never-dispense error.

Reference: NPSA Patient Safety Alert; BNF Methotrexate; NICE NG129