Abstract: Deaths Following Methotrexate Overdoses by Medical Staff

Deaths Following Methotrexate Overdoses by Medical Staff

INGA SINICINA, BARBARA MAYR, GITA MALL, and WOLFGANG KEIL

ABSTRACT.

Methotrexate (MTX) is an effective disease modifying antirheumatic drug (DMARD) with a relatively safe profile, and it is widely used to treat neoplastic diseases and dermatologic and rheumatologic disorders. As indications for use of MTX increase, more accidental overdoses are noted to occur. Typical problems include deficiencies in labeling, instructions, or packaging, as well as erroneous use. We describe 5 fatal cases of repeated oral overdose of MTX prescribed by physicians in the treatment of rheumatoid arthritis to focus attention on the design of the underlying system and the organizational practices as sources of problems. (J Rheumatol 2005;32:2009-11)

Key Indexing Terms:

METHOTREXATE
OVERDOSE
PANCYTOPENIA

From the Institute of Legal Medicine, Ludwig-Maximilians-University Munich, Munich; German Airforce Institute of Airspace Medicine, Fuerstenfeldbruck; and the Institute of Legal Medicine, Johannes-Gutenberg-University Mainz, Mainz, Germany.

I. Sinicina, MD; W. Keil, MD, Professor, Institute of Legal Medicine, Ludwig-Maximilians-University; B. Mayr, MD, German Airforce Institute of Airspace Medicine; G. Mall, MD, Institute of Legal Medicine, Professor, Johannes-Gutenberg-University.

Address reprint requests to Dr. I. Sinicina, Institute of Legal Medicine, Ludwig-Maximilians-University Munich, Frauenlobstrasse 7A, D-80337 Munich, Germany. E-Mail: inga.sinicina@med.uni-muenchen.de

Accepted for publication May 30, 2005.