II. Indications
- Refractory Rheumatoid Arthritis
III. Mechanism
- Mycophenolic acid (MPA) derivative
- Reversibly inhibits inosine monophosphate dehydrogenase (IMPDH)
- Primarily effects T Cell and B Cell proliferation and Antibody production
IV. Dosing
- Dose: 500-1000 mg twice daily
V. Adverse effects
- Infection
- Malignancy (e.g. Skin Cancer, Lymphoma)
- Neutropenia
- Gastrointestinal Bleeding
- Nausea or Vomiting
VI. Monitoring
- PPD before starting therapy
-
Complete Blood Count
- Obtain baseline
- Obtain weekly for first month, twice monthly for next 2 months and then monthly