Methotrexate for psoriasis dosing must be obeyed.

[Fred]

If you are using Methotrexate to treat psoriasis you must read this. I'm known to be anti methotrexate for treating psoriasis but some of our members do well on it, and before anyone shoots me down this is not a personal view.

Quote:

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Objective:
Accidental daily dosing of methotrexate can result in life-threatening toxicity. We investigated methotrexate dosing errors reported to the National Coronial Information System (NCIS), the Therapeutic Goods Administration Database of Adverse Event Notifications (TGA DAEN) and Australian Poisons Information Centres (PICs).

Design and setting:
A retrospective review of coronial cases in the NCIS (2000–2014), and of reports to the TGA DAEN (2004–2014) and Australian PICs (2004–2015). Cases were included if dosing errors were accidental, with evidence of daily dosing on at least 3 consecutive days.

Main outcome measures:
Events per year, dose, consecutive days of methotrexate administration, reasons for the error, clinical features.

Results:
Twenty-two deaths linked with methotrexate were identified in the NCIS, including seven cases in which erroneous daily dosing was documented. Methotrexate medication error was listed in ten cases in the DAEN, including two deaths. Australian PIC databases contained 92 cases, with a worrying increase seen during 2014–2015. Reasons for the errors included patient misunderstanding and incorrect packaging of dosette packs by pharmacists. The recorded clinical effects of daily dosage were consistent with those previously reported for methotrexate toxicity.

Conclusion:
Dosing errors with methotrexate can be lethal and continue to occur despite a number of safety initiatives in the past decade. Further strategies to reduce these preventable harms need to be implemented and evaluated. Recent suggestions include further changes in packet size, mandatory weekly dosing labelling on packaging, improving education, and including alerts in prescribing and dispensing software.

Source: mja.com.au

*Early view funding unknown.

If you are using Methotrexate for treating psoriasis be sure to follow the guidelines.

[D Foster]

That's the reason that I think that injections of MTX is much better as you can't overdose and it gets rid of the side effects brought on by stomach related problems, I cannot understand why the self injection of MTX is not used more.
It is a very widely used drug and is used for many health issues a lot of them at much higher doses than we use for P in fact it is a bit higher for PsA ,I was on 25mg which is quite a high dose for our use I think.

[Fred]

That's the reason that I think that injections of MTX is much better as you can't overdose and it gets rid of the side effects brought on by stomach related problems, I cannot understand why the self injection of MTX is not used more.
It is a very widely used drug and is used for many health issues a lot of them at much higher doses than we use for P in fact it is a bit higher for PsA ,I was on 25mg  which is quite a high dose for our use I think.

I still got nausea and loss of appetite with the injections.

And I still think it should be banned for the treatment of psoriasis.

[Turnedlight]

I think the dosing method of mtx is weird, I was taking 8 of those tiny little tablets a week. You get them in a bottle so you could easily get confused as to how many you took or whether you took them at all.

Maybe they should do one pill with the correct dose, blister packed with 'week one' etc on.

[Fred]

Maybe they should do one pill with the correct dose, blister packed with 'week one' etc on.

That's to easy for them TL.

But then again I suppose as it's such a cheap drug it would put the cost up as there are different dosing regimes.

[jiml]

Maybe they should do one pill with the correct dose, blister packed with 'week one' etc on.

That's to easy for them TL.  

But then again I suppose as it's such a cheap drug it would put the cost up as there are different dosing regimes.

I asked why each tablet was such a low dose as there were larger 25mg tablets available and was told that would cause problems and make it easier to overdose by taking 6 of the 25mg rather than 6 of the 5mg

I know it's daft but that's why they wouldn't give me the larger tablets so I had to take 10 a week not an easy thing when you are loathing them

[D Foster]

Maybe they should do one pill with the correct dose, blister packed with 'week one' etc on.

That's to easy for them TL.  

But then again I suppose as it's such a cheap drug it would put the cost up as there are different dosing regimes.

I asked why each tablet was such a low dose as there were larger 25mg tablets available and was told that would cause problems and make it easier to overdose by taking 6 of the 25mg rather than 6 of the 5mg

I know it's daft but that's why they wouldn't give me the larger tablets so I had to take 10 a week not an easy thing when you are loathing them

Bloody hell Jim I thought that I was on a high dose at 25mg , I didn't realise that they used 50mg a week for P no wonder you loathed them. I eventually got the nausea and sickness with the injections Fred and that's why I came of it but I still say that it's a good alternative.

[Fred]

I eventually got the nausea and sickness with the injections Fred and that's why I came of it but I still say that it's a good alternative.

They told me the injections wouldn't cause the problems and that was the only reason I tried it again. They still didn't seem to believe me when I said I got the same feelings as the pills and worse as I also got mood swings with it too.

But I respectfully disagree Dave, it is not a good alternative there are other treatments that are more tolerable that work as well if not better and they won't ruin ones life or poison your body.

[jiml]

Maybe they should do one pill with the correct dose, blister packed with 'week one' etc on.

That's to easy for them TL.  

But then again I suppose as it's such a cheap drug it would put the cost up as there are different dosing regimes.

I asked why each tablet was such a low dose as there were larger 25mg tablets available and was told that would cause problems and make it easier to overdose by taking 6 of the 25mg rather than 6 of the 5mg

I know it's daft but that's why they wouldn't give me the larger tablets so I had to take 10 a week not an easy thing when you are loathing them

Bloody hell Jim I thought that I was on a high dose at 25mg , I didn't realise that they used 50mg a week for P no wonder you loathed them. I eventually got the nausea and sickness with the injections Fred and that's why I came of it but I still say that it's a good alternative.

Yes Dave I found it got increasingly hard, persuading myself to take them and force them between my teeth...
And then I struggled swallowing them and keeping them down...I got a mental block because I knew how bad I would feel the next few days ... But gladly no more no matter what .......

[jiml]

Maybe they should do one pill with the correct dose, blister packed with 'week one' etc on.

That's to easy for them TL.  

But then again I suppose as it's such a cheap drug it would put the cost up as there are different dosing regimes.

I asked why each tablet was such a low dose as there were larger 25mg tablets available and was told that would cause problems and make it easier to overdose by taking 6 of the 25mg rather than 6 of the 5mg

I know it's daft but that's why they wouldn't give me the larger tablets so I had to take 10 a week not an easy thing when you are loathing them

Bloody hell Jim I thought that I was on a high dose at 25mg , I didn't realise that they used 50mg a week for P no wonder you loathed them. I eventually got the nausea and sickness with the injections Fred and that's why I came of it but I still say that it's a good alternative.

You made me think there Dave 10 X 2.5 mg tablets the same as you were on 25 mg ....I had to get my fingers out to count though