Letters to the Editor
- Aust Prescr 2000;23:93-6
- 1 May 2000
- DOI: 10.18773/austprescr.2000.108
The Editorial Executive Committee welcomes letters, which should be less than 250 words. Before a decision to publish is made, letters which refer to a published article may be sent to the author for a response. Any letter may be sent to an expert for comment. When letters are published, they are usually accompanied in the same issue by their responses or comments. The Committee screens out discourteous, inaccurate or libellous statements. The letters are sub-edited before publication. Authors are required to declare any conflicts of interest. The Committee's decision on publication is final.
Editor, – I refer to the interesting article 'Perils and pitfalls of methotrexate prescription' (Aust Prescr 2000;23:44-5) in which Dr Kanagarajah highlights the significant compliance problems that a prescriber should be aware of when using this therapy in elderly patients. Indeed, the increasing use of methotrexate is likely to centre on older patients, who may have concurrent multi-organ system impairments. Renal function is impaired in many of these patients, even though the serum creatinine remains in the normal range. A similar situation exists in other organ systems where reduced reserve function remains silent and subclinical until challenged and exposed by disease or medication.
Underlying deficits in haematological, nutritional (including folate) and immunological reserve may become overt when challenged with a potent immunomodulator such as methotrexate. A sinister danger is that, through the mechanism of convergence, where multiple system factors impact on key physical functions, an older person may not present with adverse effects usually ascribed to that drug, but rather with ailing function. The use of ever more powerful medications, aiming for symptom reduction in an ageing patient population, requires increasing levels of clinical awareness and prudence.
Senior Staff Specialist
Department of Geriatric Medicine
Prince of Wales Hospital