Alcohol, drug and medication related deaths

Disputed (AI summary) West Midlands Ambulance Service disputes the practicality and clinical effectiveness of the JRCALC cardiac arrest Naloxone guideline, stating they cannot customise the JRCALC app. Their Medical Director has raised these points with JRCALC and awaits clarification from an ongoing review. JRCALC's committee has approved the removal of naloxone use during cardiac arrest and is standardising drug monographs. These changes will be reviewed by the national ambulance service medical directors group (NASMeD) for subsequent introduction into clinical practice guidelines.

Disputed (AI summary) • The respondent stated that the dose regime in the "Shared Care Guideline for Oral Methotrexate in Rheumatological Conditions in Adults" is consistent with the Summary of Product Characteristics for Methotrexate. • The respondent noted that the protocol specifies the use of 2.5 mg tablets, which is a recognised national safety measure. • The Shared Care Protocol (SCP) includes a section that explains how methotrexate doses should be managed once a hospital specialist has started treatment. • The protocol states that methotrexate should be prescribed at 7.5–25 mg once weekly according to hospital instructions, with an initial dose of 5–15 mg once weekly, titrated upwards by 2.5–5 mg every 2–6 weeks according to response, with a typical maintenance dose up to 20 mg per week, and in some circumstances up to 25 mg per week. • The protocol also specifies that only 2.5 mg tablets should be prescribed, which is a recognised national safety measure intended to minimise the risk of dosing errors with methotrexate.