Methotrexate is a wonder drug. Sold under the brand names Trexall and Rasuvo, the prescription medication is used to treat various forms of cancer, rheumatoid arthritis, inflammatory bowel disease and psoriasis. It is one of the most common drugs used to treat rheumatoid arthritis, and is most often prescribed to senior citizens.

Poor labeling can be lethal

A recent study from Australia has identified a serious risk of death associated with incorrect dosing of methotrexate. The drug, administered in low doses for common conditions, is sold in blister packs of 50 pills with instructions to take one pill per week. Confusing instructions and multiple medication regimens led to some seniors taking one pill per day, leading to dangerous concentrations of the immunosuppressant in their blood within just three days.

According to the study, published in The Medical Journal of Australia, “Twenty-two deaths linked with methotrexate were identified… including seven cases in which erroneous daily dosing was documented. Methotrexate medication error was listed in ten cases… including two deaths. Australian PIC databases contained 92 cases, with a worrying increase seen during 2014–2015.”

A growing issue

The problem is a common one as our population ages; multiple medications with different dosing and timing requirements are leading to an increase in medication errors, sometimes with fatal results. The Sydney Morning Herald reported, “The researchers recommended current pack sizes be reduced to contain just one month’s supply of the drug, or four tablets. They also suggested packaging the drug with folic acid, which is taken daily and often co-prescribed, in a way that mimics the packaging of the oral contraceptive pill, with sugar tablets used in place of methotrexate six out of seven days a week. ‘This would make it nearly impossible to make these kinds of errors,’