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Medication error with methotrexate.

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A medication error involving methotrexate led to shortness of breath in an elderly patient. Prompt treatment with folinic acid resolved the toxicity, highlighting the need for careful medication review.

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Area of Science:

  • Internal Medicine
  • Clinical Pharmacy

Background:

  • An elderly female patient with a history of COPD, hypertension, and polymyalgia rheumatica presented with worsening dyspnea.
  • A medication error involving methotrexate was identified during the patient's medical history review.

Observation:

  • The patient inadvertently took 2.5 mg of methotrexate daily for three weeks instead of the prescribed 15 mg weekly dose.
  • Initial presentation included stable vital signs, 94% oxygen saturation, and a slightly elevated D-dimer.

Findings:

  • Methotrexate toxicity was suspected due to the medication error and clinical presentation.
  • Intravenous folinic acid administration was initiated as an antidote treatment.

Implications:

  • This case highlights the critical role of accurate medication reconciliation and patient communication in preventing adverse drug events.
  • Effective collaboration between healthcare providers and clinical pharmacists is essential for identifying and managing medication errors in emergency settings.