The Pharmaceutical Journal
Vol 269 No 7228 p847
14 December 2002

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  PI insurance
  Locums
  Community pharmacy
  Pharmacy practice
  The Profession
  CPD
  Alternative medicine
  Methotrexate
  Modernisation
  Packaging
  The Society

Letters to the Editor

Methotrexate

10mg strength should be discontinued

From Mr B. J. Smith, MRPharmS

I read with interest the letter from M. F. Hannon (PJ, 30 November, p782) about methotrexate. Many hospitals have adopted the policy to stock only the lower 2.5mg strength tablets. This policy can cause problems in the community, which I will illustrate with a case from my pharmacy.

A patient was discharged from hospital on a dose of methotrexate 10mg once a week. The hospital pharmacy directed this as four 2.5mg tablets. The letter to the patient's general practitioner stated 10mg once a week. The repeat prescription called for methotrexate 10mg tablets "take as directed". The patient then took four 10mg tablets, not realising there are two strengths available.

The overdose continued until a community pharmacist intervened.

It would seem logical for manufacturers to discontinue the 10mg strength and to pack all cytotoxics in labelled blister packs.

Blister packs give a clear identification of product and strength. They also resolve the problem of hazard to pharmacy staff who "handle" loose cytotoxics.

Pharmacists should insist that directions be stated on prescriptions. "As directed" is unacceptable, particularly for methotrexate.

Barrie Smith
Professional Services Manager
Paydens Group of Pharmacies

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