The Pharmaceutical Journal
Vol 271 No 7271 p562
18 October 2003

Society summary

Occasional guidance, developed in the Royal Pharmaceutical Society's Practice and Quality Directorate to help pharmacists improve their practice

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

• Dispensing methotrexate
• OTC requests and responding to symptoms, for methotrexate patients

Dispensing methotrexate

Where computer-labelling systems do not provide a routine warning on the dispensing label for methotrexate tablets, good practice is for pharmacists to include the following information on the label: “To be taken once a week on the same day each week.” Pharmacists should remind patients of the importance of attending for routine blood tests to monitor the effects of methotrexate on their blood count and on the function of their liver and kidneys.

See also Law and Ethics Bulletin ("Dispensing methotrexate")

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OTC requests and responding to symptoms, for methotrexate patients

Extra vigilance is needed when responding to symptoms or in response to requests for over-the-counter products for patients known to be taking methotrexate.

The pharmacist should deal with all such requests personally. Any patient on methotrexate who presents with symptoms described below must be referred to their doctor for urgent attention.

For patients taking methotrexate, these symptoms may require immediate medical attention:

• Chest pain, difficulty breathing or a persistent cough
• Infections, including fever, chills or sore throat
• Skin rashes
• Bleeding gums, black tarry stools or unexpected bleeding or bruising
• Yellowing of the skin or itching
• Sore mouth
• Feeling sick, vomiting or stomach pains
• Diarrhoea
• Vaginal inflammation or ulcers

See also Law and Ethics Bulletin ("Dispensing methotrexate")