[Severe methotrexate toxicity in elderly: 7 years experience]

Area of Science:

• Rheumatology
• Geriatric Medicine
• Clinical Toxicology

Background:

• Methotrexate is a cornerstone rheumatology drug, valued for its efficacy.
• Elderly patients and those with cognitive impairment or low social support are at higher risk for methotrexate toxicity.
• Medication adherence and potential for errors increase with polypharmacy and cognitive decline.

Observation:

• An 87-year-old patient with multiple comorbidities and cognitive impairment experienced acute methotrexate toxicity.
• The patient had a history of cognitive impairment and limited social support, complicating medication management.
• This case underscores the vulnerability of certain elderly populations to adverse drug events.

Findings:

• Analysis of local hospital admissions over 7 years reveals patterns in methotrexate toxicity cases.
• Elderly patients represent a significant proportion of severe methotrexate toxicity cases.
• Factors such as polypharmacy, renal function, and adherence contribute to toxicity.

Implications:

• Clinical vigilance is crucial when prescribing methotrexate to elderly patients, especially those with cognitive issues.
• Enhanced monitoring and patient support systems may mitigate methotrexate toxicity risks in vulnerable populations.
• Understanding local trends in methotrexate toxicity can inform clinical practice guidelines and patient safety initiatives.