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Methotrexate daily dosing error — GPhC CRA MCQ

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HardAdverse Drug Reactions and Drug SafetyMethotrexate daily dosing errorGPhC CRA

A 70-year-old woman takes methotrexate weekly for rheumatoid arthritis. She reports new mouth ulcers, bruising and breathlessness. Her latest repeat request shows methotrexate was labelled once daily in error last month. What is the most appropriate action?

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Correct answer: A — Refer urgently for suspected methotrexate toxicity and report the dispensing incident.

Daily administration of weekly methotrexate can cause life-threatening toxicity. Mouth ulcers, bruising and breathlessness are warning signs requiring urgent assessment for bone marrow suppression and pneumonitis. The incident also requires appropriate reporting and governance follow-up.

Reference: BNF; MHRA Drug Safety Update; GPhC Standards