Misadministration of Methotrexate

Letters to the Editor The Safety of Antirheumatic Drugs by Dr. med. Johanna Mucke, Prof. Dr. med. Dr. h. c. Hans-Uwe Simon, and Prof. Dr. med. Gerd Rüdiger Burmester in issue 6/2022

In the detailed article (1), we missed a reference in the methotrexate (MTX) section about the risk of incorrect administration, by the patients themselves as well as by medical professionals, of MTX over several days rather than once-weekly. It is not uncommon for these multi-day MTX overdoses to end fatally (2). This problem has also been pointed out several times by the Poisons Information Center in Erfurt (3). Unfortunately, past warnings (4) have not resulted in a decrease in these incidents. The Erfurt poison emergency hotline observed cases have nearly doubled, from 13 in 2012 to 22 cases in 2021 (with a total of 175 cases from 2012 to 2021, including 10 deaths). We would therefore like to appeal once again to the medical professionals to take special care in the use of MTX and to remind them of their obligation to provide patients with accurate information.

DOI: 10.3238/arztebl.m2022.0185

PD Dr. med. Michael Deters

Pharmacology and Toxicology Physician

Poisons Information Center Erfurt– c/o HELIOS Klinikum Erfurt GmbH, Germany

Dr. rer. nat Anne Stürzebecher

Specialist Pharmacist for Clinical Pharmacy

Conflict of interest statement

The authors declare that no conflict of interest exists.

References

1. Mucke J, Simon HU, Burmester GR: The safety of antirheumatic drugs. Dtsch Arztebl Int 2022; 119: 81–7

2. Hirsch S, Ahrenstorf G, Schmidt RE, Klintschar M: Methotrexat: Todesfälle durch falsche Dosis. Dtsch Arztebl 2020; 117: A-76

3. Stuerzebecher A, Frimlova G, Deters M, Hentschel H: Methotrexate exposures reported to the poisons information centre Erfurt, Germany. Clin Toxicol 2015; 53: 379.

4. BfARM: Informationsbrief zu Methotrexat: Korrekte indikationsabhängige Dosierung www.bfarm.de/SharedDocs/Risikoinformationen/Pharmakovigilanz/DE/RHB/2009/info-methotrexat.html (last accessed on 5 May 2022).