Oral Methotrexate: Preventing Inadvertent Daily Administration
Bibliographic record
Abstract
Methotrexate, a folic acid antagonist, is classified as a cytotoxic antimetabolite. It has been used for many years in the treatment of various types of cancer and is also used to treat autoimmune disorders such as rheumatoid arthritis and psoriasis. In the treatment of autoimmune conditions, methotrexate is typically given once weekly, but numerous errors involving methotrexate that has been inadvertently prescribed, dispensed, administered, or taken once daily have been reported worldwide. Because of the immunosuppressive properties that make this drug so valuable in the treatment of autoimmune disorders, daily dosing can lead to serious patient harm. Daily administration, even if doses are low, can cause severe adverse effects involving the bone marrow, liver, and other organ systems. Recently, a cluster of cases were reported to ISMP Canada in which methotrexate was taken or administered daily rather than weekly, resulting in serious adverse effects or death. This article includes (with permission) excerpts from a recent issue of the ISMP Canada Safety Bulletin describing inadvertent daily administration of methotrexate, along with case summaries from other publications. This article aims to raise awareness of the consequences of daily instead of weekly dosing of methotrexate, to highlight some of the contributing factors that have led to the improper use of methotrexate, and to suggest strategies to enhance the safety of methotrexate use.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".