The treatment of several diseases within the field of medicine is increasingly reliant on drugs that, while clinically effective, need regular blood monitoring. This is due to the potentially serious side effects that these drugs can occasionally cause. It has been shown that the incidence of side effects can be reduced significantly if this monitoring is carried out in a well-organised way, close to the patient’s home. Approximately 6% of hospital admissions are due to adverse drug reactions (ADRs), and 3.7% are drug-related and preventable.

Half of these admissions are caused by three groups of drugs which are among the most commonly prescribed, namely warfarin and other anticoagulants, non-steroidal anti-inflammatory drugs (NSAIDs) and anti-platelets, and diuretics and other renal toxic drugs.

Since they are much less commonly prescribed, cytotoxic drugs, like methotrexate, leflunomide and azathioprine, do not cause emergency hospital admission on the same scale. However, their inherent toxicity means that they do regularly cause severe harm, including death (although this is rare), and have been the subject of regular National Patient Safety Agency (NPSA) alerts as a consequence.

Practices need to ensure that prescriptions for community cytotoxic drugs are appropriate and carefully monitored to minimise risk. Current data drawing on work in progress that indicates the prescribing and monitoring of community cytotoxic is suboptimal and potentially unsafe.