This story is making its way around pro-life news media because methotrexate can be used for early abortions. Read on to get a more accurate view of why methotrexate is found in retail pharmacies, the poor job that the media does in presenting medical stories, and an example of who the media uses as an expert for retail pharmacy practice.
A error occurred at a Safeway pharmacy in which methotrexate, a drug used for chemotherapy, treatment of severe inflammatory disorders such as rheumatoid arthritis, and abortions, was dispensed to a pregnant woman. It is important to understand that the usual patient who comes to a retail pharmacy for methotrexate is getting it for inflammatory conditions. The doses are normally a few to several 2.5mg tablets, (although larger sizes are now available), and the drug might come in a dose pack called Rheumatrex. It is usually taken once per week for those conditions.
This error occurred due to mixup in which Mareena Silva, of Ft. Lupton, CO, received a prescription intended for another patient, supposedly with the same last name and a similar first name.
Unanswered in most news coverage is whether Silva took a single dose of several tablets, which is frequently characteristic of orally administered methotrexate treatments, and is not characteristic of most oral antibiotic treatments. The usual dose for rheumatoid arthritis is quite a bit lower than the dose to kill a human embryo.
Yet to be found is whether Ms Silva was given methotrexate rescue treatment (leucovorin calcium,) which might conteract the assault by methotrexate upon folate metabolism to its active form, which is the basis of its toxicity to the human embryo or fetus, (and various rapidly dividing cells throughout the body).
Safeway is acknowledging their liability, and has offered to pay all medical expenses which result from this error.
Error prevention: At many retail pharmacies, scanning, name and birthdate checks are eliminating much of the possibility of these errors, but if the two Silva prescriptions were back to back and went into wrongly tagged bags before dispensing, nothing but extensive counseling with the bag opened and drug visible would have stopped this error. We know that many patients refuse such counseling, and that often there is not time to carry out extensive counseling on the use of medications at the pharmacy.
Expert commentary: This is a job for a person with retail pharmacy experience, as well as practical clinical knowledge. The media chosen point man of the day is one “distinguished service” professor from the University of Florida, Paul Doering M.S.. (ABC news has given his credentials incorrectly.) Doering is NOT quoted by ABC as suggestingTHE RESCUE TREATMENT for methotrexate. As expected is the media favorite recommendation of abortion, from ABC:
“Doering, who did his master’s thesis on the drug”, [way back in 1975] “said methotrexate is the “poster child for why certain medicines shouldn’t be used in pregnancy. It’s such a well-known and potent cause of birth defects.”
In some instances taking the drug during pregnancy warrants termination, according to Doering.
“There are downsides to that and risks,” he said. “But if it were my wife or daughter, I would recommend it.”
To exemplify the quality of drug information brought to you by media experts, here is a blast from Paul Doering’s past from 2006 Drug Topics magazine, which is particularly salient during the time that Planned Parenthood is being called to task for practices related to what Doering has been quoted as advocating.
“Pointing out that OTC Plan B will be sold only in pharmacies and in health clinics,Paul Doering M.S., Distinguished Service Professor of pharmacy practice, University of Florida College of Pharmacy, said, said, “This is one of the times the FDA has publicly acknowledged that there can be or needs to be a third class of drugs. It’s a de facto third class of drugs because you can’t get Plan B in a convenience store or a supermarket or vending machine.”
Doering is skeptical about whether women under 18 will be prevented from obtaining OTC Plan B. “There are no pill police out there to enforce things. It’s voluntary enforcement on the part of pharmacists. Someone may present false identification. If you don’t believe these things are hard to enforce, just read an article on underage drinking. The intent is good, but the so-called closed system is going to be more like a sieve with leaks.”
Doering said he’s not worried about leaks because he thinks Plan B should be available for 14- and 15-year-olds. “That’s the reality,” he said. “Keeping it behind the counter and ensuring someone is 18—I would take that as a wink and a nod. If someone has a need to get a hold of Plan B, she will.””
Pharmer is hoping that Ms. Silva is now being offered better pharmaceutical care than is available from such media chosen experts as Paul Doering, and that she and her unborn child are spared the consequences of this pharmacy error.
Patients should not be afraid to call up the pharmacy and question any prescription drug which doesn’t make sense, or has an unexplained change.
There are no infallible humans, and we’ve only gotten infallible proclamations three times in 2 millenia from the Popes.
4 thoughts on “Pharmacist Error, Methotrexate Dispensed to a Pregnant Woman”
As is so aptly pointed out in the article, methotrexate toxicity can be readily reversed if the rescue agent (Leucovorin) is taken shortly (12-24 hours) after ingestion of the methotrexate. The fact that there is a readily available antidote to methotrexate which should minimize risk to patient and child, should have been commented by the "noted" experts that were quick to advise on the situation. Unfortunately, hysteria and calamity sells and stories with better endings do not. It is hoped the hospital staff had the information to treat the patient appropriately.
Thanks for dropping in, Dr. Newton. Just seeing one more professional recognize the deficit in the media coverage of this incident lends more hope that this patient actually received rational medical attention when she visited the hospital.
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