Before starting
Required
- Baseline
- Serum creatinine (for creatinine clearance) or Estimated glomerular filtration rate
- Urea and electrolytes
Consider
- Baseline
- Full blood count
- Liver function tests
Continued until stable
Required
- At 3 months; then annually. More frequently in renal impairment
- Serum creatinine (for creatinine clearance) or Estimated glomerular filtration rate
- Urea and electrolytes
Consider
- At 3 months; then annually
- Full blood count
- Liver function tests
Some manufacturers recommend more frequent monitoring, such as 14 days after starting, then every 4 weeks for 2 to 3 months, then 3 monthly thereafter.
Ongoing once stable
Required
- Annually, more frequently in renal impairment
- Serum creatinine (for creatinine clearance) or Estimated glomerular filtration rate
- Urea and electrolytes
Consider
- Annually (depending on risk factors)
- Full blood count
- Liver function tests
Some manufacturers recommend monitoring 3 monthly.
Abnormal results
Monitor trends
Be aware of trends in results in addition to absolute values. An upward trend in liver transaminases could be sign of toxicity, even if the absolute results are within the normal range.
Respond to absolute values
Renal function
Stop if deteriorates
Liver function
If AST or ALT are greater than twice the upper limit of the reference range, stop and discuss with specialist.
Notes
Advice to patients
Advise patients to report any of the following:
- unexplained bleeding
- bruising
- rash
- sore throat
- fever
- malaise
Beware of blood dyscrasia or toxicity
Perform full blood count and stop treatment immediately if a blood dyscrasia or toxicity is suspected.
Bibliography
- Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press [cited 10/02/2025]
- Tillotts Pharma UK Limited. Summary of Product Characteristics – Octasa 400 mg modified-release tablets. Last revised 01/2021 [cited 10/02/2025]
- Lamb CA, Kennedy NA, Raine T et al. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut 2019, updated 2021; 68:s1-s107 [cited 10/02/2025]
- David S, Hamilton J. Drug-induced liver injury. US Gastroenterol Hepatol Rev. 2010 Jan 1; 6: 73–80 [cited 10/02/2025]
Update history
- Full update and review complete. Clarity added to which tests are required and those to be considered. Requirement to perform a urine dipstick has been removed.
- Published