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Incorrect Dosage Turns Rheumatoid Arthritis Drug Into A Killer

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A drug used for treating rheumatoid arthritis has been linked to the hospitalization of over 90 Australians and has led to the death of at least seven, a new study reports.

Methotrexate is a synthetic substance that inhibits folic acid. It was originally designed to inhibit cancer growth but is now prescribed for immune conditions like rheumatoid arthritis. It is also used for treating psoriasis and inflammatory bowel disease.

It was a simple case of medication error: patients took methotrexate once a day instead of once a week, causing major overdose, according to Dr. Rose Cairns of the New South Wales Poisons Information Centre.

“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,” said Cairns, whose findings on the accidental daily dosing were discussed in the Medical Journal of Australia.

Cairns warned that numbers of dosing errors involving this drug, however, are even more increasing. Amid difficulties in capturing nationwide death rates, three datasets discovered that over 90 dosing error cases were reported from 2004 to 2015.

Twenty-two died from taking the medication, but only seven can be directly attributed to overdosing.

The same problem has been recorded in the United States, where the Food and Drug Administration logged 25 deaths over a four-year timeframe.

Accidental overdosing could lead to weeks of hospital stay and can stem from mistaking methotrexate for another drug due to factors like carer’s error to incorrect packaging as assembled by pharmacists. The elderly can be particularly prone to this risk because of failing vision or memory.

“It’s a small tablet, it looks like a lot of other medication that people are taking, and meant to be taking daily,” explained Cairns, adding that they're seeing errors from doctors and pharmacists as well.

The researchers recommended some changes that include reducing the drug pack size from 50 tablets to four, producing the tablet in a distinct color, and improving labeling. Folate, for instance, is usually co-prescribed with the drug, thus the two are easily confused. This can be overcome by packaging the products together, they said.

Accidental drug overdose remains a concern. Recently, toxicology test results on the death of pop superstar Prince showed that the singer’s demise was caused by the synthetic opioid drug Fentanyl, highlighting the opioid addiction currently hitting the country.

New findings demonstrated that many patients continue to take these powerful painkillers months after their joint replacement surgery.

Photo: Alan Levine | Flickr

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