|TYPE/GENERIC (TRADE) NAME||RECOMMENDED DOSAGES||TOXIC EFFECTS||RECOMMENDED MONITORING|
|Gold compounds (Myochrysine)||IM: 10 mg followed by 25 mg 1 wk later, then 25-50 mg wkly until there is toxicity, major clinical improvement, or cumulative dose = 1 g. If effective, interval between doses is increased.||Pruritus, dermatitis, stomatitis, nephrotoxicity, blood dyscrasias, “nitritoid” reaction: flushing, weakness, nausea, dizziness 30 min after injection.||CBC, platelet count before every other injection.|
|Aurothioglucose (Solganal)||IM: 10 mg; 2nd and 3rd doses 25 mg, 4th and subsequent 50 mg. Interval between doses: 1 wk. If improvement, no toxicity, decrease dose to 25 mg or increase interval between doses.||Dermatitis, stomatitis, nephrotoxicity, blood dyscrasias.||CBC, platelet count every 2 wk.|
|Auranofin (Ridaura)||Oral: 3 mg bid or 6 mg qd. May increase to 3 mg tid after 6 months.||Loose stools, diarrhea (up to 50%), dermatitis.||Baseline CBC, platelet count, U/A, renal, liver function, at onset then CBC with platelet count, U/A 9 months.|
|Antimalarial Hydroxychloroquine (Plaquenil)||Oral: 400-600 mg qd with meals then 200-400 mg qd.||Retinopathy, dermatitis, muscle weakness, hypoactive DTRs, CNS.||Ophthalmologic examination every 3 months (visual acuity, slitlamp, funduscopic, visual field tests), neuromuscular examination.|
Penicillamine (Cuprimine, Depen)
|Oral: 125-250 mg qd, then increasing at
monthly intervals doses to max 750-1000 mg by 125-250 mg.
|Pruritus, rash/mouth ulcers, bone marrow depression, proteinuria, hematuria, hypogeusia, myesthenia, myositis, GI distress, pulmonary toxicity, teratogenic.||CBC every 2 weeks until dose stable, then every month.
U/A weekly until dose stable, then every month. HCG as needed.
|Methotrexate (Rheumatrex)||Oral: 7.5-15 mg weekly.||Pulmonary toxicity, ulcerative stomatitis, leukopenia, thrombocytopenia, GI distress, malaise, fatigue, chills, fever, CNS, elevated LFTs/liver disease, lymphoma, infection.||CBC with platelet count, LFTs weekly
x 6 wk then monthly LFTs, U/A
periodically, HCG as needed.
|Azathioprine (Imuran)||Oral: 50-100 mg qd, increase at 4-wk
intervals by 0.5 mg/kg/d up to 2.5 mg/kg/d.
|Leukopenia, thrombocytopenia, GI,
neoplastic if previous Rx with alkylating
|CBC with platelet count, wkly x 1 mo,
2x/mo. x 2 mo, then monthly, HCG
|Sulfasalazine (Azulfidine)||Oral: 500 mg daily then increase up to 3 g daily.||GI, skin rash, pruritus, blood dyscrasias,
|CBC, U/A q 2 wk x 3 mo, then
monthly x 9 mo, then every 6 mo.
|Alkylating agents Cyclophosphamide (Cytoxan)||Oral: 50-100 mg daily up to 2.5 mg/kg/d.||Leukopenia, thrombocytopenia, hematuria, GI, alopecia, rash, bladder cancer, non-Hodgkin’s lymphoma, infection.||CBC with platelet count, regularly.
HCG as needed.
|Chlorambucil (Leukeran)||Oral: 0.1-0.2 mg/kg/d.||Bone marrow suppression, GI, CNS,
|CBC with platelet count every wk.
WBCs 3-4 days after each CBC
during 1st 3-6 wk at therapy. HCG as
|Cyclosporine (Sandimmune)||Oral 2.5-5 mg/kg/d.||Nephrotoxicity, tremor, hirsutism,
hypertension, gum hyperplasia.
|Renal function, liver function.|
|Pyrimidine, synthesis inhibitors||Loading dose: 100 mg/d for 3 days.||Hepatotoxicity, carcinogenesis.||LFTs every month, drug levels after
discontinuation (after 1 month
therapy, remains in blood for 2 years
without use of cholestyramine).
|Leflunomide (Arava)||Maintenance therapy: 20 mg/d; if not
tolerated, 10 mg/d.
|Immunosuppression, long half-life.|