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Methotrexate toxicity monitoring — GPhC CRA MCQ

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HardMusculoskeletal TherapeuticsMethotrexate toxicity monitoringGPhC CRA

A 64-year-old man taking methotrexate for psoriasis requests co-codamol and mentions mouth ulcers, unusual bruising and a new dry cough. His last blood test was 10 weeks ago and he has recently started co-trimoxazole from an out-of-hours service. What monitoring is required?

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Correct answer: A — urgent full blood count, renal and liver tests with same-day clinical review

Mouth ulcers and bruising suggest possible methotrexate toxicity or bone marrow suppression, and a new cough may indicate pulmonary toxicity or infection. Co-trimoxazole increases the risk of serious haematological toxicity with methotrexate. Urgent blood tests and clinical review are needed rather than routine monitoring. INR and HbA1c do not address the immediate safety concern.

Reference: BNF; NICE CKS: DMARDs