RT Journal Article SR Electronic T1 Deaths following methotrexate overdoses by medical staff. JF The Journal of Rheumatology JO J Rheumatol FD The Journal of Rheumatology SP 2009 OP 2011 VO 32 IS 10 A1 Inga Sinicina A1 Barbara Mayr A1 Gita Mall A1 Wolfgang Keil YR 2005 UL http://www.jrheum.org/content/32/10/2009.abstract AB Methotrexate (MTX) is an effective disease modifying antirheumatic drug (DMARD) with a relatively safe profile, and it is widely used to treat neoplastic diseases and dermatologic and rheumatologic disorders. As indications for use of MTX increase, more accidental overdoses are noted to occur. Typical problems include deficiencies in labeling, instructions, or packaging, as well as erroneous use. We describe 5 fatal cases of repeated oral overdose of MTX prescribed by physicians in the treatment of rheumatoid arthritis to focus attention on the design of the underlying system and the organizational practices as sources of problems.