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Standard Operating Procedure for
Supplying Oral Methotrexate
To fol ow the NPSA's guidance to ensure the safe and efficient supply pf
This SOP covers the supply (from receipt to dispensing) of oral methotrexate
(MTX). This SOP does not cover the dispensing of injectable MTX.
It is the responsibility of al staff who are certified and suitably qualified to
carry out the duties set out by this SOP.
Supplying Oral Methotrexate
Responsibility: Pharmacist [P], Technician [T], Assistant [A].
This SOP was created according to guidance set out by the NPSA.
1. Prescription receipt.
The patient should have received a pre- [P]treatment booklet prior to being
Ask the patient whether they have had it
before. If it it is their first time ask for their
monitoring booklet if they do not have one,
contact the prescriber.
2. Pharmaceutical assessment.
Check whether the dose has changed and other medicines. If it is their first time whether the patient knows this.
then check if they take any additional medicines apart from what is stated on their PMR.
3. Interventions and problem solving.
toxicity, check the BNF. If the patient is [T]
representative of the patient who does not
to contact the prescriber for a possible
have a monitoring book, try and contact the dose reduction.
4. Assembly and labelling.
MTX dosage is always a WEEKLY dose, not Always double check the prescription a daily dose.
when giving out MTX as an error could be potentially fatal.
5. Accuracy checking.
dose specifies how many tablets to take [T]
Make sure all prescriptions dispensed for
MTX are double checked by a suitably
6. Transfer to patient.
Tell the patient in a concise manner what the medicines are for and how to take them. If the patient is taking folic acid tell the
Make sure that the patient knows to look out they are taking folic acid.
of a sore throat or infection. If so they should consult their prescriber as soon as
Highlight any possible interactions that
may occur with OTC medicines/ herbal remedies.
This SOP is dynamic, and should be constantly updated when and where necessary. The
above box can be filled concerning new staff, adverse incidents or any new circumstance
which arise after the publication of this first version. If no errors, incidences or RPSGB
recommendations occur a review will be carried out every six months starting from the
creation date*. This review will update the SOP content and format with the goal to
enable reduction of error within the pharmacy.
I have signed to say that I have read and understood the instructions overleaf.
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