Monitoring Requirements Before commencing immunosuppressant therapy. Record patient’s blood pressure, weight and height if clinically indicated. • Screening for lung disease should be undertaken at clinician discretion on a case-by-case basis. The extent of screening should be influenced more by a patient’s clinical features and risk factors for lung disease (e.g. underlying autoimmune disease or smoking history) rather than subsequent immunomodulating choice. Pre-existing lung disease should not be considered an absolute contraindication to any immunomodulating medication. • Consultant to consider ECG where appropriate especially when commencing medications associated with hypertension • Screen for viral hepatitis B&C and HIV in all patients • Investigate patient medical history including co-morbidities and previous immunomodulating medication use. For patients with inflammatory arthritis CRP/ESR may be done every 3 months (this is not done for dermatology patients). These tests are part of the assessment of the underlying rheumatic disease rather than a requirement for monitoring of immunomodulation therapy. The monitoring CRP/ESR may be coordinated between secondary and primary care on an individual basis. Individuals with severely reduced TPMT activity (homozygous) should not be prescribed AZATHIOPRINE as serious and fatal toxicity may occur within 6 weeks of starting the drug. For mild/moderate (heterozygous) deficiency serious adverse events may occur anytime and as late as 6 months after treatment commences. Serious Adverse Events can be exacerbated by minor infections or drug interactions (See Drug Interactions & contra-indications). Heterozygous individuals should be prescribed Azathioprine/6-Mercaptopurine with caution and reduced drug dosage. Consultant/specialist monitoring schedule Baseline and 2 weekly until on a stable dose for at least 6 weeks • FBC • ALT and/or AST and albumin • U&E including creatinine/calculated GFR Annually review the patient and advise the GP promptly on when to adjust the dose, stop treatment or consult with the specialist GP responsibility monitoring schedule* In patients following the 6 weeks of dose stability conduct monthly monitoring as above for three months followed by three monthly monitoring thereafter of: • FBC • ALT and/or AST and albumin • U&E including creatinine/ calculated GFR Dosage increase For dose increase, monitor 2 weekly until stable for 6 weeks. Dose and monitoring to be agreed with consultant • FBC • ALT and/or AST and albumin • U&E including creatinine/ calcula...
