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The General Pharmaceutical Council has urged pharmacies to be vigilant when making a supply of methotrexate after patient safety concerns were raised with the regulator.

Writing to all registered pharmacists, pharmacy technicians and pharmacy owners yesterday (December 18), GPhC chief pharmacy officer Roz Gittins highlighted several concerning incidents that have occurred recently. 

In one instance, a patient was handed their prescribed methotrexate with a label mistakenly stating the drug should be taken once daily rather than once per week. 

In light of this, the GPhC urged pharmacy teams to consult a 2020 drug safety update from the MHRA and its advice to speak to methotrexate patients or their carers about the risk of overdose and the need to dose on a specific day of the week, as well as a 2023 update on the need to protect the skin from sun exposure while taking the drug. 

The regulator also highlighted recent concerns brought to its attention over drug interactions and contraindications not being "fully considered as part of a clinical check" before a supply was made. 

In one example, a Pharmacy First consultation led to an antibiotic supply being made to "a severely immunocompromised patient taking methotrexate which can increase the risk of toxicity/ myelosuppression," said the GPhC. 

"Another incident involved a patient who was routinely prescribed a long-term medicine and was provided with an antibiotic where an interaction was present," it said, adding that these interactions can cause serious harm to patients. 

"While pharmacy teams may not always have access to a patient’s complete medication history, they should take all reasonable steps to ensure a safe and appropriate supply," the GPhC commented. 

Other instances were reported in which fluoroquinolones were prescribed without being the recommended first-line option, with the GPhC advising that pharmacy teams "should remain vigilant when encountering fluoroquinolone prescriptions, ensure that their use is clinically justified, and provide clear counselling so that patients understand the potential risks and know to seek urgent medical advice if they experience symptoms suggestive of tendon, nerve, muscle or psychiatric adverse effects".

The regulator urged pharmacies to include in their risk assessment a consideration of how IT systems can be used to prevent unsafe supplies, and to report any adverse drug reactions via the MHRA's Yellow Card scheme.