A decade of Australian methotrexate dosing errors

Betty SH Chan and Nicholas A Buckley
Med J Aust 2016; 205 (10): . || doi: 10.5694/mja16.00755
Published online: 21 November 2016

Cairns and colleagues1 noted in their article that eight deaths were identified as medication errors due to daily methotrexate dosing. In addition, 92 cases of methotrexate dosing errors were reported to the four Poisons Information Centres in Australia with a concerning rise in 2014–15. The authors found that low dose daily administration for 3–7 days could cause toxicity and even death.1 The toxicity of methotrexate is likely to be more dependent on the duration of exposure rather than on serum concentration.2 In a retrospective series of 28 patients, pancytopenia (79%) was found to be the most common manifestation of low dose chronic methotrexate toxicity.3 In contrast, in our study, we observed no effects with acute single dose exposures.4

  • Betty SH Chan1
  • Nicholas A Buckley2

  • 1 Prince of Wales Hospital and Community Health Services, Sydney, NSW
  • 2 University of Sydney, Sydney, NSW



We thank the staff at the New South Wales Poisons Information Centre for recruiting patients with methotrexate poisoning.


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