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Using this page · Individualise medicines monitoring

This medicines monitoring page has been written using publications and expert opinion. It is designed to save clinician time, but not replace professional responsibility. When using this page you should: ensure an individualised monitoring plan is developed in partnership with the patient and take account of any locally agreed advice and guidance.

Before starting

Required

  • Baseline
    • ALT or AST
    • Albumin
    • Blood pressure
    • Full blood count
    • Height
    • Liver function tests
    • Platelet count
    • Serum creatinine (for creatinine clearance) or Calculated glomerular filtration rate
    • Vaccination status
    • Weight
    • White blood cell differential

Vaccination status

Consider vaccination against pneumococcus and influenza prior to starting treatment.

Consider in patients at risk of infection

  • Baseline
    • Hepatitis B
    • Hepatitis C
    • HIV

Consider

  • Baseline
    • Lung disease screening

After started or dose changed

Required

  • Every 2 weeks until on stable dose for 6 weeks, then monthly for 3 months
    • Blood pressure
    • Full blood count
    • Liver function testsincluding AST or ALT and albumin
    • Platelet count
    • Serum creatinine (for creatinine clearance) or Calculated glomerular filtration rate
    • Weight
    • White blood cell differential

Increasing monitoring frequency

More frequent monitoring is appropriate in patients:

  • at higher risk of toxicity
  • where leflunomide is combined with methotrexate; for these patients, continue monthly monitoring until stable for 12 months, then consider reduced frequency monitoring on an individual basis

Ongoing once stable

Required

  • Every 2 - 3 months
    • Blood pressure
    • Full blood count
    • Liver function testsincluding ALT or AST and albumin
    • Platelet count
    • Serum creatinine (for creatinine clearance) or Calculated glomerular filtration rate
    • Weight
    • White blood cell differential

Increasing monitoring frequency

More frequent monitoring is appropriate in patients at higher risk of toxicity.

Abnormal results

Be aware of trends in results and respond accordingly.

Respond to absolute levels

Consider stopping treatment and contacting a specialist if any of the following develop:

Full blood count

  • Albumin less than 30g/L
  • WCC less than 3.5 x 109/L
  • Neutrophils less than 1.6 x 109/L
  • Eosinophilia more than 0.5 x 109/L
  • Platelets less than 140 x 109/L
  • Reticulocytes less than 80 x 109/L and haemoglobin less than 90g/L
  • Haemoglobin below 45g/L or dropped by over 30g/L from baseline
  • MCV greater than 105fL

Liver function

  • AST and/or ALT greater than 100units/mL

Renal function

  • Creatinine increase greater than 30% above baseline over 12 months
  • Calculated GFR less than 60ml/min/1.73m2 (repeat in 1 week, if still more than 30% from baseline, withhold and discuss with specialist team)

Notes

Advice to patients

Advise patients to seek urgent medical attention if they develop any of the following:

  • Skin or mucosal reaction; for example rash, pruritus, mouth or throat ulceration
  • Sore throat
  • Fever
  • Unexplained bruising or bleeding
  • Nausea, vomiting, diarrhoea or weight loss
  • Diffuse alopecia
  • Breathlessness, infection or cough
  • Peripheral neuropathy

Bibliography

Enquiries about this page

Contact us if you have any enquiries about the drug monitoring information on this page.