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was used.23 Even if a particle of saliva
from a patient taking LDM were to
land on the skin of another person the
recent Australian skin exposure study
demonstrates that this poses no risk.
Advice to patients
As rheumatologists, we hear from our
patients that they have been advised by
'well-meaning' friends and family, and by
some misinformed health professionals
that LDM is a dangerous oncology
'cancer' or chemotherapy drug with
drastic side effects and life threatening
complications (see Box 1). As with
any medication, there are risks and
benefits. When deciding to prescribe
LDM, these are taken into account, and
the risk-benefit equation is discussed
with the individual patient. When that
patient subsequently hears different
information outlining a set of apparently
more sinister risks, albeit from well
meaning advisors, the patient's
chance of optimal care is potentially
compromised. This situation benefits
no one. While some patients will return
to discuss this with the prescriber, too
many will, through ill-informed fear,
elect to leave their disease untreated.
The evidence that methotrexate, when
used in low dose for autoimmune
and other inflammatory diseases,
is a cytotoxic agent and hence in
need of oncology type precautions
is non-existent. Patients on LDM
should not be treated with the same
precautions as patients receiving
high dose methotrexate. The risks and
benefits of LDM are different to high
dose methotrexate and any advice
given to patients taking LDM needs to
As patients easily access multiple
information sources on the internet,
some reliable and some dangerous,
it is critical that all members of the
multidisciplinary healthcare team
convey the same scientifically correct
message. LDM should not be considered
chemotherapy. The risks and benefits of
LDM should be portrayed appropriately
so that each patient can make an
informed decision about therapy in
conjunction with their prescriber. It is
hoped this article goes some way to
promoting that ideal.
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• "A friend recently told me that she
was told not to mix MTX with any
other tablets - for example in a
• "I have had nursing staff gown
up, wear mask and goggles and
put a sign on the door referencing
the use of cytotoxic drugs when
administering my methotrexate
injection as an inpatient."
• "Patients told they can't share a
bathroom with the partners, can't
kiss their grandchildren, and on
one occasion, been told that home
care nurses couldn't visit while
they were taking MTX."
• "I was told by my daughter in law,
that if she had a baby I cannot
be near infants because I am on
methotrexate? Her mother is a
• "I heard another odd thing
recently by a pharmacist who
was doing a talk to physios about
arthritis which I was also doing a
talk at. She said anyone who takes
MTX should double flush the toilet
after going on the day or so after
they take the tablets, due to the
toxic nature of the tablets."
• Need to avoid contact with
• Patient told she could no longer
take her Celebrex, the anti-
inflammatory medication together
Box 1. Inappropriate precautions & advice
given to patients on low dose methotrexate
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