Methotrexate still safe when taken as directed
by Naomi Creek for CreakyJoints Australia
20 June 2016


**Editor’s Note: This post was written by/for the Australia CJ community. While the information is applicable to those outside of Australia, programs such as a free Home Medicines Review are not available in other countries such as the United State of America**


When a negative news story about a commonly used drug hits the press, it makes patients worried and doctors frustrated.

“Worrying rise in accidental overdose of prescription drug methotrexate” Read more

Dr Irwin Lim, Rheumatologist from BJC Health said “I just hope this type of report does not scare patients from using a medication that certainly has a role in treating disease effectively”.

Methotrexate, a drug originally developed for treating cancer and now commonly used in treating immune disorders such as Rheumatoid Arthritis, Psoriatic Arthritis and Psoriasis seems to be having to defend itself once again.

The article from the Sydney Morning Herald on 7th June 2016 states that “…eight people died after taking the oral medication daily instead of weekly”

The article’s heading projects an alarming statistic, however it needs to be made clear that these incidences happened over the last 16 years and were specific to people aged 66-87. Age-related issues such as poor memory, confusion and bad eye-sight were likely the cause of the overdoses. These are serious problems that need addressing, but statistically – death from taking Methotrexate is very rare.

So how can patients feel confident when taking Methotrexate? Dr. Lim said “Rheumatologists need to educate their patients carefully about the dosing. Patients need to understand and then need to take a certain responsibility after an adequate amount of education. Pharmacists also need to dispense correctly”.

Patients from the Young Women’s Arthritis Support Group responded to the news article by saying:

“My specialist was constantly telling me this tablet is to be taken once a week, not every day. He made sure I was very clear on instructions.” Jenna Wilson

“I can’t remember if I took it this week, so I decided not to take it again, incase.” Gabby Di Berardino Romeo

“Webster packs made up by the pharmacy will prevent this issue from happening”. Terry Padgett

“Everyone on prescription medication is entitled to have a free Home Medicines Review by a pharmacist. This can go a long way towards preventing accidental misuse of medication”. Rosemary Ainley

To assist with correct dosing, researchers have recommended current pack sizes be reduced to contain just 4 tablets. With many patients taking 2 x 10mg tablets weekly, this would see each packet only lasting two weeks. Another suggestion is to combine Methotrexate with folic acid (usually co-prescribed and taken daily) into one sheet to mimic the contraceptive pill. This could work effectively but would need to be clearly labelled and have various doses available.

As with any drug, patients must weigh up the benefits versus the negatives when taking medications. There will always be potential risks but there will often be rewards. Methotrexate has been a highly successful drug used for decades to treat many conditions and is seen as a drug that changed the rheumatology landscape. Melbourne Rheumatologist, Associate Professor Stephen Hall said “30 years ago we had patients coming to clinic in wheelchairs. No more. Methotrexate stopped all of that and it remains one of the most useful drugs available to use for rheumatoid arthritis.”