II. Indications: Rheumatoid Arthritis
- First line DMARD instead or Methotrexate
- Combination with Methotrexate
III. Mechanism
- Pyrimidine inhibitor
- T-Cell Activation and proliferation inhibitor
- Similar to Methotrexate in effects
- Onset of action in 1-2 months
IV. Efficacy
- Comparable to Methotrexate
- Used with Methotrexate for maximal effect
V. Adverse effects
VI. Monitoring
- Labs:
- Aspartate Transaminase (SGOT, AST)
- Complete Blood Count with Platelet Count
- History
- Ask about new onset cough
- Timing
- Check monthly for 6 months
- Check every 6-8 weeks
VII. Dose
- Loading dose: 100 mg PO qd for 3 days
- Maintenance: 10 mg PO qd (or 20 mg PO qod)
- Inadequate relief at lower dose: 20 mg PO qd
VIII. References
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