Pharmacy Mistakenly Administers Rheumatoid Arthritis Medication To Healthy Patient

This case involves a post-menopausal female patient who was prescribed the hormone supplement medroxyprogesterone to prevent overgrowth of her uterine lining. When the patient went to the pharmacy to pick up her medication, she was accidentally dispensed a high dosage of methotrexate, an immunosuppressive used to treat rheumatoid arthritis. This incorrect dosage led to various negative side effects, including frequent falling, weakness, nausea and diarrhea, and vomiting. The patient presented to the hospital with multiple medical findings consistent with methotrexate poisoning. Her renal function was severely impaired and she was transfused with packed red blood cells and platelets. This pharmacy error caused irreparable kidney damage to the patient and she subsequently required a kidney transplant.

Question(s) For Expert Witness

1. Do you have experience managing patients who've taken Methotrexate? If so, please explain.

2. Are you familiar with the adverse side effects of Methotrexate on mental, kidney, and other organ functions? Please explain.

Expert Witness Response E-018018

I have years of experience managing rheumatology patients on low dosage methotrexate. My academic career has been focused on the development of therapies for treating rheumatoid arthritis (RA). Most notably, I have been involved in the development program for the use of methotrexate, which has become the most widely prescribed drug for the treatment of RA. I am more than familiar with the adverse side effects associated with methotrexate, having published extensively on its use and written book chapters on both the use of methotrexate in RA and its toxicity at low doses. I would need to review the medical records in order to determine if care after the patient received methotrexate could have led to a better result, but the patient's prognosis would have been better had she not been incorrectly given methotrexate instead of the medroxyprogesterone that she was prescribed.