Guidance on the management of drugs requiring monitoring during COVID-19

Drug monitoring may include measuring levels of the drug itself in the body; reviewing blood, renal or liver function; or undertaking physical measurements such as blood pressure and weight.

Our guidance aims to help clinicians manage patients who are currently on a medicine that requires monitoring during the COVID-19 pandemic.  The objective is to both protect patients from unnecessary health care visits and help preserve capacity in primary care.  Overall, we recommend that drug monitoring during the COVID-19 pandemic is prioritised for patients that will gain most benefit, i.e.:

  • Those at risk of a serious adverse drug event that can be identified through monitoring
  • People taking a Narrow Therapeutic Index drug during a phase when intensive monitoring is still required (e.g. upon initiation)
  • Patients who have recently had an illness that may have impacted on how their drug works

Our advice is not intended as a definitive treatment strategy, although where we can we have tried to give specific advice on individual medicines.  Where we’ve been able, all our advice has been checked with relevant specialists.  However, this advice has been developed quickly, so if you spot anything that’s wrong report a concern to us.  In addition to our advice on individual medicines, we’ve also written advice on factors to consider when making monitoring decisions during COVID-19.

Our advice on individual medicines is below.

Azathioprine, leflunomide, mercatopurine, and methotrexate

Sulfasalazine

Hydroxychloroquine

Ciclosporin

Penicillamine

Warfarin

Lithium

Clozapine

The above pages are captured in the following word file and can be used for local adaptation: Guidance on the management of drugs requiring monitoring during COVID-19 (version 2 – published 15th April 2020)