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Methotrexate prescribing behaviours amongst NZ specialists (Derm, Rheum, Gastro)

1.What is your specialty?
2.How long have you been a specialist?
3.How often do you prescribe methotrexate?
4.What screening investigations do you perform prior to starting methotrexate therapy? (Select all applicable options)
5.What investigations do you request as part of monitoring? (select all applicable options)
6.How often do you request blood investigations to monitor patients starting on methotrexate? Example: once weekly for the first month, then every 2 weeks for the second and third month, then every 3 monthly thereafter
7.What would you regard as concerning for methotrexate related liver injury?
8.What would you consider to be a possible sign of methotrexate toxicity?
9.What is your methotrexate commencement regimen?
Example: 2.5mg test dose for week 1, then 10mg weekly for 2 weeks, then increase by 2.5mg every 2 weeks until 15mg weekly before next review.
10.What is the maximum dosage of methotrexate you usually prescribe?
11.When would you adjust your methotrexate dosage?
12.When would you prescribe subcutaneous methotrexate rather than oral methotrexate?
13.Do you supplement with folic acid?
14.If you do supplement with folic acid, what dose is this?
15.Do you prescribe folic acid to be taken on the same day as methotrexate?
16.What drug interactions would cause concern?
17.Have any of your patients experienced irreversible liver damage?
18.Have any of your patients died secondary to methotrexate use? If yes, please give the cause of death.
19.How long would you advise women to observe a washout period before falling pregnant?
20.Do you consider methotrexate to carry a paternity risk?
21.What alcohol consumption do you regard as safe on methotrexate?
22.Would a history of skin cancer alter your decision to prescribe methotrexate?
23.What are the main challenges you encounter when prescribing methotrexate?
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