All,

As you all may know, the toxicity of methotrexate administered daily is much higher than weekly administration even when the total weekly dose is the same. When verifying orders for oral methotrexate, please be sure to verify the following:

Oral Methotrexate for NON-ONCOLOGIC Use 

1. Check the order frequency - should be WEEKLY; a daily frequency should ONLY be used for oncologic indications
2. Check the total weekly dose: Usual dose: 7.5 - 30 mg PO WEEKLY
3. Check the home medication history to confirm dosing, including external RX history

Remember to always use a questioning attitude when verifying these orders - especially with high-risk medications like methotrexate! I have attached a more detailed document for you to review about dosing. If you are unsure about verifying a methotrexate continuation, please reject it and enter a "Home Med Clarification" intervention for TOC. Thank you for your continued effort to help us reduce medication errors and improve patient safety!