Monitoring Requirements for DMARDs

Monitoring requirements for DMARDs
GENERIC	BRAND(s)	RECOMMENDED MONITORING	RECOMMENDED FREQUENCY
Azathioprine*	Imuran	FBC	Weekly (or more frequently if high dose or if patient has severe renal and/or hepatic impairment) for first 8 weeks then monthly, or at least every 3 months
		FBC and LFTs (in patients with hepatic impairment)	At regular intervals
Chloroquine	Nivaquine	Ophthalmological examination**	At baseline then every 3–6 months
		FBC	At regular intervals
Ciclosporin	Capimune Deximune Neoral	Serum creatinine and urea	Two baseline measurements then every 2 weeks for first 3 months, then every 4 weeks or more frequently if dose increased or if NSAID therapy added or increased
		Blood pressure	At regular intervals
		Serum lipids	At baseline then as appropriate
		LFTs (when coadministering with NSAIDs)	At regular intervals
		Investigate signs of raised intracranial pressure	When patients present with relevant signs of raised intracranial pressure
Hydroxychloroquine	Plaquenil	Ophthalmological examination**	At baseline then annually, or more frequently in patients >65 years, with renal impairment or visual acuity below 6/8 and in those receiving >6.5mg/kg lean bodyweight daily or >200g cumulative dose
		FBC	At regular intervals
		Skeletal muscle function and tendon reflexes	At regular intervals
		Plasma hydroxychloroquinine levels (in patients with severe renal or hepatic impairment)	As appropriate to aid dosage adjustment
Leflunomide	Arava	Simultaneous ALT (SGPT) and FBC	At baseline then every 2 weeks for first 6 months, then every 8 weeks. If treatment discontinued due to raised liver enzymes, continue to monitor liver enzymes until levels have normalised.
		Blood pressure	At baseline then at regular intervals
Methotrexate*	Metoject	FBC, renal and LFTs	At baseline then weekly until therapy stabilised, then every 2–3 months
		Chest x-ray	At baseline
		Monitor for symptoms of pneumonitis (dyspnoea, cough, fever)	At each follow-up visit
Penicillamine*	Distamine	FBC, urinalysis and renal function tests	At baseline then every 1–2 weeks for first 8 weeks, then monthly (and in the week following any dose increase)
Sodium aurothiomalate (Gold)	Myocrisin	FBC, urinary protein test, skin inspection	At baseline and before each subsequent injection
		Chest x-ray	Annually
Sulfasalazine*	Salazopyrin EN-Tabs	FBC	At baseline then monthly for at least first 3 months
		LFTs	At monthly intervals for first 3 months
		Renal function tests	At baseline then at regular intervals

* Generic preparation available

** Refer also to 'Hydroxychloroquine and Ocular Toxicity: Recommendations on Screening (October 2009)’ Royal College of Ophthalmologists

For full details of monitoring requirements please refer to the relevant Summaries of Product Characteristics

KEY:
LFTs - liver functon tests
FBC - full blood count

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KEYWORDS: Rheumatoid arthritis