HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Bookstaver, P. B. Articles by Fant, J. Search for Related Content PubMed PubMed Citation Articles by Bookstaver, P. B. Articles by Fant, J.

P. BRANDON BOOKSTAVER, PHARMD., BCPS, is Clinical Assistant Professor; LEANNNORRIS, PHARMD., BCPS, is Clinical Assistant Professor; and CELESTERUDISILL, PHARM.D., is Clinical Assistant Professor, South Carolina College of Pharmacy, University of South Carolina, Columbia. TAMMY DEWITT, PHARMD., is Pharmacist, University of Virginia Health System, Charlottesville. At the time of writing, she was Post Graduate Year One Resident, Palmetto Health Richland, Columbia. SHAHID AZIZ, m.d., is Physician Resident, Palmetto Health Richland. JAMES FANT, M.D., is Associate Professor, Clinical Internal Medicine, and Director, Division of Rheumatology, School of Medicine, University of South Carolina.

Address correspondence to Dr. Bookstaver at the South Carolina College of Pharmacy, University of South Carolina Campus, 715 Sumter Street, Columbia, SC 29208 (bookstaver{at}sccp.sc.edu).

Purpose. A case of toxicity encountered with low-dose methotrexate therapy is discussed. Summary. A 59-year-old African American woman receiving long-term therapy for psoriasis came to the hospital with painful ulcers, difficulty swallowing, cutaneous lesions, and acute renal failure. Her medical history included type 2 diabetes mellitus, hypertension, coronary artery disease, morbid obesity, and psoriasis. On admission, the patient looked ill and had a low-grade fever; maculopapular skin lesions; and bullae and vesicles in her mouth and on her hands, legs, groin, and buttocks. With the exception of carvedilol, all home medications, including methotrexate, were discontinued. A complete medication history revealed that the patient had been taking methotrexate 2.5 mg daily, instead of 2.5 mg three times weekly as prescribed. This error translated into an estimated cumulative dose of 360 mg, nearly twice the prescribed amount. There were no clinically significant drug–drug interactions noted among her prescribed medications; however, the patient did report increased ibuprofen use secondary to the painful ulcerations in the previous few months. Leucovorin 15 mg i.v. every six hours was initiated along with additional supportive care. Skin and mucosal lesions, as well as her pain, had dramatically improved on day 5 of hospitalization. The patient was discharged after a six-day hospitalization and was provided with leucovorin 15 mg orally ever day for seven additional days until rheumatology follow-up. The patient was instructed to avoid any future methotrexate therapy. Conclusion. A patient who erroneously took oral methotrexate daily rather than thrice weekly for psoriasis developed multiple manifestations of methotrexate toxicity. Index terms: Antineoplastic agents; Carvedilol; Dosage; Errors, medication; Methotrexate; Psoriasis; Toxicity