A decade of Australian methotrexate dosing errors

Monisha Gupta, Marius Rademaker, John R Sullivan and Peter Foley
Med J Aust 2016; 205 (10): . || doi: 10.5694/mja16.00708
Published online: 21 November 2016

In their article, Cairns and colleagues1 raised a pertinent issue regarding the incorrect dosing and administration of low dose methotrexate, which may result in potentially serious adverse outcomes. In 2014, the Australasian Psoriasis Collaboration recommended a specified day dosing regimen for methotrexate and folic acid, with the instructions written on the script: methotrexate on Mondays and folate on Fridays.2 Even if the patient mistook one for the other, they would still take the medication once a week even if it was on the wrong day. This does not prevent the incorrect tablet size (2.5 mg or 10 mg) from being dispensed, but it should reduce the risk of taking methotrexate more than once a week. Moreover, the Australasian Psoriasis Collaboration also recommended a greater use of weekly subcutaneous methotrexate as a way of reducing adverse gastrointestinal effects, improving compliance and reducing medication error.

  • Monisha Gupta1
  • Marius Rademaker2
  • John R Sullivan1,2
  • Peter Foley3,4,5

  • 1 Liverpool Hospital, Sydney, NSW
  • 2 Waikato Hospital, Hamilton, New Zealand
  • 3 University of Melbourne, Melbourne, VIC
  • 4 St Vincent's Hospital Melbourne, Melbourne, VIC
  • 5 Skin and Cancer Foundation, Melbourne, VIC



We thank the Australasian Psoriasis Collaboration, Megan Andrews, Katherine Armour, Jacob George, Diana Rubel and Kurt Gebauer.

Competing interests:

No relevant disclosures.


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