REVIEW - Methods to enhance the safety of MTX prescribing

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J Clin Pharm Ther. 2007 Aug;32(4):327-31.

Methods to enhance the safety of methotrexate prescribing.

Goldsmith P, Roach A.

Department of Neurology, Addenbrooke's Hospital, Cambridge, and

DanioLads Ltd, Cambridge, UK. paul.goldsmith@...

Abstract

The treatment of chronic inflammatory conditions often involves a

difficult balance between the benefits of disease modification and the

risks attendant with the use of disease-modifying agents. Methotrexate

is a useful and commonly used disease-modifying agent but has a

particularly notable reputation for causing morbidity and mortality.

We explore ways in which the safety of methotrexate prescribing may be

improved. There has been considerable debate as to the whether some of

the side-effects can be mitigated by co-prescription of folate with

methotrexate. Whereas no definitive conclusion can yet be reached,

evidence suggests that the improvement in side-effect profile is

limited to fewer elevations of liver enzymes, but that this may be at

the expense of decreased methotrexate efficacy. The question remains

as to whether the improved tolerability more than compensates for the

decreased efficacy or whether folic acid should be used in a more

circumspect way. However, a very specific danger arises from the fact

that methotrexate is prescribed once weekly for inflammatory

conditions, leading to errors at both the prescription and patient

level. We highlight simple ways of improving safety to decrease such

errors.

PMID: 17635334

http://www.ncbi.nlm.nih.gov/pubmed/17635334

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