Methotrexate intoxication: the Pharmaceutical Care process reveals a critical error

Abstract

The reasons for the intoxication were not discovered accidently but by the routine use of the Pharmaceutical Care process SOAP by the community pharmacist. We describe three main errors that might have been avoided and provide solutions for physicians, pharmacists, manufacturers and patients, to reduce such risks. Our case highlights the dangers of teleconsultation, the crucial role of Pharmaceutical Care provided by community pharmacists and the continued need to supply advice to patients being prescribed low-dose MTX. The fact that a patient has had a previous and successful experience with a similar treatment should not deter health professionals from verifying a patient's understanding via questions and feedback.

Importance of Pharmacotherapy Follow-Up on Health: A Literature Review

“…Assim, esse SFT apresentou-se como ferramenta importante na detecção, prevenção e resolução de PRM também no tratamento da hepatite C (ROSA et al, 2010). Arnet et al (2012) reportou um caso onde um importante erro foi descoberto pela comunidade farmacêutica durante a implementação da atenção farmacêutica, utilizando com método o SOAP NOTE. O estudo revelou uma intoxicação devido ao uso indevido de metotrexato poucos dias após o seu uso.…”

“…Essa descoberta não foi acidental. O SOAP NOTE se mostrou fundamental na descoberta de PRM (ARNET et al, 2012 (KASSAM et al, 2001).…”

Adherence to National Recommendations for Safe Methotrexate Dispensing in Community Pharmacies

“…In low doses, MTX is generally safe; however, serious side effects and toxicity can occur due to overdosing, including hepatotoxicity and ulceration of gastrointestinal and mouth mucosa. 8 In the Netherlands, MTX is registered for the indications RA, plaque psoriasis, and several carcinomas (e.g., trophoblastic tumours, non-Hodgkin's lymphoma, and head and neck tumours). The dosage schedules for treatment of these diseases MTX dispensing based on pharmacy dispensing records was assessed.…”

“…9,10 Serious events, including fatal incidents with MTX, have been reported in several countries. 8,9,[11][12][13] Improving patient safety is a priority health policy across the world. Previous research shows that medication errors are a common cause of harm to patients.…”

Safe use of oral cytotoxic medicines

“…Serious toxicities and fatal outcomes have occurred as a result of incorrect prescribing and dispensing as well as patient misinterpretation of dosing instructions. [1][2][3][4][5][6] responsibilities of the healthcare team…”