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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
    • Albumin
    • ALT or AST
    • Full blood count
    • Urinalysis
    • Urea and electrolytes
    • Serum creatinine (for creatinine clearance) or Estimated glomerular filtration rate

After started or dose changed

Required

  • Every 2 weeks for 6 weeks to 3 months, then monthly
    • Albumin
    • ALT or AST
    • Urinalysis
    • Full blood count
    • Serum creatinine (for creatinine clearance) or Estimated glomerular filtration rate

Ongoing once stable

Required

  • Monthly for 12 months; then every 3 months
    • Albumin
    • ALT or AST
    • Full blood count
    • Serum creatinine (for creatinine clearance) or Estimated glomerular filtration rateIncrease to every 2 weeks if renal impairment
    • Urinalysis

Indications other than rheumatoid arthritis

Consider whether reducing monitoring frequency is possible in stable patients. For example, longer interval may be possible in cystinuria and Wilson’s disease.

Abnormal results

Full blood count

Consider stopping and discussing with rheumatologist three successive falls in count for WBCs, neutrophils, platelets.

Respond to absolute values

Full blood count

Consider stopping and discussing if absolute values are:

  • WBC less than 3.5 x 109/L
  • Neutrophils less than 1.6 x 109/L
  • Platelets less than 150 × 109L

Stop permanently if recurrent leucopenia or thrombocytopenia.

Restart at reduced dose when counts return to reference range.

Proteinuria

If greater than 2, check mid-stream sample of urine:

  • If evidence of infection, treat appropriately
  • If sterile and persists, discuss with specialist.

Bruising or sore throat

Withhold until FBC available.

Care with elderly

Especially careful monitoring is necessary in the elderly since increased toxicity has been observed in this patient population regardless of renal function.

Abnormal results

Advice to patients

Advise patients to:

  • Report presence of rash or oral ulceration. If severe or oral ulceration present withhold and discuss with specialist.
  • Report sore throat, fever, infection, non-specific illness, unexpected bleeding and bruising, purpura.
  • Beware that if hypersensitive to penicillin may react rarely to penicillamine.
  • Alteration of taste may settle spontaneously.

Bibliography

Enquiries about this page

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