The Pharmaceutical Journal
Vol 271 No 7271 p562
18 October 2003

Society summary

An occasional feature, prepared in the Royal Pharmaceutical Society’s Professional Standards Directorate, to highlight problems and inquiries currently being handled

Law and Ethics Bulletin, 2001 to present
See also Good Practice Points, 2003 to present

Dispensing of methotrexate

Pharmacists are reminded that particular vigilance is needed when dispensing prescriptions for methotrexate tablets.

The two strengths (2.5mg and 10mg) of methotrexate tablets have similar packaging. Pharmacists are advised to check and recheck that the correct strength has been selected. Dispensing the incorrect strength could have serious consequences for the health of the patient.

Pharmacists must check that the dosage on the prescription is correct. Most prescriptions will be a once weekly dose. Any deviation from this must be clarified with the prescriber. Additional checks may be required with the manufacturer for unusual indications. A dose written “as directed” must also be clarified with the prescriber. In all circumstances the patient must be counselled to ensure understanding of the dose requirements.

Pharmacists should be alert to the symptoms of methotrexate toxicity, particularly when patients known to be taking methotrexate request over-the-counter medicines. Patients who may be exhibiting signs of toxicity should be immediately referred to their general practitioner.

See also Good Practice Points
   Dispensing methotrexate
   OTC requests and responding to symptoms, for methotrexate patients