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Methotrexate toxicity red flags — GPhC CRA MCQ

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HardMusculoskeletal TherapeuticsMethotrexate toxicity red flagsGPhC CRA

A 29-year-old woman taking methotrexate 15mg once weekly for rheumatoid arthritis asks for co-codamol. Her repeat medicines include folic acid 5mg once weekly on Tuesday; methotrexate is taken on Friday. She has mouth ulcers and a sore throat. What is the most appropriate action?

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Correct answer: D — Advise urgent same-day medical review and withhold methotrexate until assessed

Mouth ulcers and sore throat in a patient taking methotrexate may indicate bone marrow suppression or significant toxicity. This requires urgent clinical assessment and usually withholding methotrexate pending review and blood tests. Simply treating symptoms risks missing a serious adverse effect. NSAIDs may increase methotrexate toxicity risk and are not the appropriate response to red flags.

Reference: BNF; NICE CKS DMARDs