Methotrexate Warnings

There is a central concern that methotrexate is a high risk drug with unusual dosing. To help mitigate the risks involved with this:

High Risk flag

The drug list displays high risk items in red font with a shaded red background. 'High Risk!' precedes the drug name:

You are similarly warned if you select penicillamine (125mg and 250mg), mercaptamine (50mg and 150 mg), mecaptopurine 50 mg tabs and 150 mg, co-proxamol sf susp 32.5mg + 325mg and co-proxamol tabs 32.5mg + 325mg, and dextropropoxyphene HCl with paracetamol tabs.

Note - When printing any of the above dangerous drugs, the signature area is shaded in order to draw attention to it.

When you select the item, an additional message associated with the selected drug for example, 'This is a NPSA High Risk process Caution! methotroxate tablets 10mg - Usually prescribed weekly. Patients require regular monitoring & blood tests. Proceed / Do not Proceed'. Select:

  • Proceed to continue, or

  • Do not Proceed to return to the screen prior to the secondary alert.

One Dose a Week

To comply with a recent MHRA Drug Safety Update (DSU), for one dose a week prescriptions you should now include a day of the week for the patient to take their medication on.

When you prescribe a methotrexate item, and select OK, the Methotrexate - Select Day of Week screen displays:

Either:

  • Select a day to append to the Dosage and select OK. The day selected is added to your dosage, for example 'ON WEDNESDAY':

  • Select Skip to bypass adding a day. The 'A day of the week for intake has not been specified for this drug. Do you wish to continue?' warning displays if you do not enter a day in the dosage, select Yes to continue or No to select a day:

If you prescribe Methotrexate with a dosage frequency that is not weekly, you are prompted with the following warning 'Warning! The current dosage does not match any of the recommended dosages. You are recommended to record clinical evidence to support this dosage regime.'

For Scotland and Northern Ireland, Vision 3 does not allow you to continue unless "Weekly" appears in Dosage. You are also warned if you change the text of a recommended dosage.

Note - 'AS DIR' is not a valid Methotrexate dosage.

Updating the Dosage

Dosages for Methotrexate can be selected from a dosage pick list on Therapy - Add.

You may override these dose options to prescribe greater multiples of 2.5mg, and if you do so, it is recommended that you record clinical evidence of any overridden dosages and a message 'Warning! The current dosage does not match any of the recommended dosages. You are recommended to record clinical evidence to support this dosage regime. Are you sure you wish to continue? Proceed / Do not proceed.' reminds you of this, select:

  • Proceed to continue, or

  • Do not Proceed to return to the screen prior to the Therapy - Add screen.

For patients that are taking more than 7.5 mg (3 x 2.5mg), or more than 20 mg (2 x 10mg), and there are no 10 mg tabs available, you are prompted to record clinical evidence to support overriding the maximum 3 x 2.5mg dosage or 2 x 10mg dosage.

Training Tip - We strongly recommend that you switch on drug doubling checks to avoid prescribing two forms of methotrexate simultaneously, see Consultation Manager Setup - Drug Check. This ensures that if a patient has been prescribed 2.5 mg tablets and within the specified time is prescribed the 10mg tablets, then a warning displays.
Note - To print this topic select Print in the top right corner and follow the on-screen prompts.