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Methotrexate weekly dosing — GPhC CRA MCQ

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HardMusculoskeletal TherapeuticsMethotrexate weekly dosingGPhC CRA

A 54-year-old woman with rheumatoid arthritis brings a prescription for methotrexate 10mg to be taken daily. Her previous hospital letter states methotrexate 10mg once weekly on Mondays with folic acid 5mg weekly on Fridays. She has mouth ulcers and her FBC last month was normal. What is the most appropriate action?

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Correct answer: E — Do not supply as written and contact the prescriber urgently

Methotrexate for rheumatoid arthritis is usually taken once weekly, and daily prescribing can cause fatal toxicity. The discrepancy, plus mouth ulcers, requires urgent clarification before supply. The pharmacist should not silently alter the prescribed directions without prescriber agreement. Clear weekly labelling and patient counselling are essential once clarified.

Reference: BNF Methotrexate; NPSA/MHRA methotrexate safety guidance