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ISMP Safety Brief: Prevent Additional Patient Harm and Deaths From Accidental Daily Methotrexate Dosing

National Association of Boards of Pharmacy

For example, in one case, methotrexate 15 mg once weekly was prescribed for treatment of an autoimmune disorder in an elderly patient. The community pharmacy dispensed a three-month quantity of medication but provided instructions on the label to take 15 mg (six 2.5 mg tablets) once daily.