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Disease-Modifying Anti-Rheumatic Drug (DMARD) dose, screening and monitoring requirements






Methotrexate FBC, U&Es, LFTs, CXR in last 6/12 increase by 2.5mg every 2 weeks FBC,U&Es, LFTs, 2 weekly until dose stable, then monthly
Leflunomide FBC, U&Es, LFTs, BP 10-20mg FBC, U&Es, LFTs, weekly for 6/52, then 2-4/52. Monitor BP
Sulfasalazine FBC, U&Es, LFTs 500mg od 1/52, bd 1/52, 500mg + 1g 1/52, 1g bd FBC, U&Es, LFTs monthly
Hydroxychloroquine FBC, U&Es, LFTs 200-400mg od Annual eye check
Azathioprine FBC, U&Es, LFTs, TPMT Start @ 1mg/kg/day, increase every 4-6/52 (target 2mg/kg/day) FBC & LFTs weekly for 6/52, then 2 weekly until dose stable, then monthly
Mycophenolate FBC, U&Es, LFTs, CXR in last 6/12 Start @500mg/day, increase by 500mg every week (max 3g/day) Weekly until dose stable, then fortnightly for 2/12, then monthly


DMARDS in acutely unwell patients

  • If in doubt, stop them and liaise with rheumatology
  • Should always be stopped in septic patient and:
    • Consider IV folinic acid for patients on methotrexate
    • Consider washout with cholestyramine or activated charcoal for patients on leflunomide


Click here to download free teaching notes on DMARD: DMARD monitoring

Perfect revision for medical students, finals, OSCEs and MRCP PACES