Any pharmaceutical drug can be dangerous if improperly prescribed, but in some regions methotrexate is becoming a killer for this very reason.
Killer Drugs Down Under!
It sounds like a tabloid headline or a fearmongering evening news report — but it has apparently been true for some rheumatoid arthritis (RA) patients residing in Australia.
More than 90 Australian patients over the course of 10 years have been hospitalized due to incorrect dosing of the RA drug, methotrexate. Out of these patients, at least seven have died, according to a recent study.
In the study, researchers said the overdoses were due to “patient misunderstanding,” as well as “incorrect packaging” that instructed patients — most of whom were taking methotrexate for RA or psoriatic arthritis (PsA) — to take methotrexate once per day, instead of the normal once per week.
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The overdosing was proclaimed accidental in the study chronicled in the Medical Journal of Australia and further reported on by the New South Wales Poisons Information Centre.
Overall, 22 patients were said to have died from taking methotrexate over the 10-year period. Researchers directly attributed seven of those deaths to “erroneous daily dosing.”
The fate of the other 70 patients who were hospitalized wasn’t detailed.
The author of the methotrexate study, Dr. Rose Cairns, a senior poisons specialist at the poison center, said in a statement to the media that, “Higher or more frequent doses than prescribed can result in ulceration of the lining of the gastrointestinal tract, liver toxicity, bone marrow suppression, septicemia, and death.”
She noted in the same press statement that while she saw mistakes being made by doctors and pharmacists, some of the accidental methotrexate overdoses were because of patient error or noncompliance, perhaps due to brain fog, cognitive impairment, or failing vision.
“It’s a small tablet. It looks like a lot of other medications that people are taking and meant to be taking daily,” she said.
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Methotrexate is not typically a “killer drug,” but it can certainly be a dangerous drug to misuse.
In some countries it is labeled as a chemotherapy drug. Most commonly in the United States it is classified as a disease-modifying anti-rheumatic drug (DMARD) when used for RA and other rheumatic diseases. It’s labeled as an anticancer medication when used to treat various forms of cancer.
Methotrexate is given at a substantially higher dosage in cancer patients than it is for those with RA and similar conditions.
Many rheumatologists and medical professionals treating RA patients with methotrexate in the United States are reluctant to call it a chemotherapy drug, although some other forms of chemo are actually given for RA on a fairly regular basis.
But these same doctors are rarely hesitant to warn patients about the severity of the drug and its potential side effects.
The side effects of methotrexate can include nausea, vomiting, increased risk of infection, and hair loss. It can increase risk for lymphoma, sepsis, and liver problems.
If it’s taken more than recommended, the drug can be seriously harmful to patients, as seen in the Australian study.
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While opioid overdoses are often cited in the press, chronic pain and autoimmune patients now face new concerns as the incidence of accidental methotrexate overdoses continues to rise.
But as Dr. Gary Smith of Pennsylvania says, “The risk of overdosing on any medication is rare if it is taken correctly and as prescribed.”
That’s a good piece of advice for patients to follow, as long as doctors and pharmacies are writing and filling the proper doses.
In the Australia case, some weren’t.
Experts say patients should be careful to do their homework when it comes to starting new treatments. They should become familiarized with correct dosing procedures and terminology surrounding the drug.
“If anything raises a red flag or seems questionable when it comes to your medical treatment, follow your gut instinct and seek a second opinion,” advises health coach and patient advocate Judy Bell of New York. “It’s better safe than sorry when it comes to meds.”
Methotrexate may have resulted in some deaths, but the Arthritis Foundation still touts its relative safety and efficacy.
The nonprofit group reminds patients and doctors that the drug can be toxic, but that taking folic acid and having regular bloodwork done to monitor things is the key in managing methotrexate use safely.