Methotrexate Safety Checklist! Methotrexate is a powerful DMARD, but safe prescribing requires a strict protocol. Before you write your next prescription, are you following these essential steps? 1. Pre-Treatment Screening (Baseline): Rule out any active infections. Get baseline CBC, LFT, and RFT. 2. Initiating Therapy: Always start with a low test dose (e.g., 5mg) for the first week. Re-evaluate the patient after one week for any immediate side effects before escalating the dose. 3. Monitoring

A Critical Prescribing Lesson: Methotrexate Toxicity! The Scenario: You've correctly prescribed weekly Methotrexate. But the patient misunderstands and takes it daily, presenting to your ER with signs of toxicity. This is a medical emergency. What's the protocol? 1. The Antidote: Administer Leucovorin (Folinic Acid) Rescue immediately. It's the drug of choice. Dosing: The Leucovorin dose should be equal to or greater than the last dose of MTX taken. It's typically given IV, 6-hourly. 2. The Supp