Alone or in combination w/ corticosteroids & procedures as immunosuppressant antimetabolite; in patients w/ severe RA. In combination w/ corticosteroids & other immunosuppressive agents & procedures to enhance organ transplant survival eg, renal, cardiac & hepatic transplants. Reduces corticosteroids requirements of renal transplant recipients.
Adult & childn Transplantation 3-5 mg/kg daily, 1-3 days before or at the time of surgery. Maintenance dose: 1-3 mg/kg daily. RA Initially 1 mg/kg once daily or bid. May be increased w/ dose increments of 0.5 mg/kg daily up to a max of 2.5 mg/kg daily beginning at 6-8 wk & thereafter by steps at 4-wk intervals.
Perform serologic testing to determine previous exposure to varicella zoster virus prior to treatment. History of varicella zoster virus. Signs of infection, unexplained bruising, bleeding or other expression of bone marrow depression. Increased risk of developing myelotoxicity & neoplasia. Risk of over-immunosuppression. Reduce dose if haematological or liver toxicity occurs. Avoid developing chickenpox or herpes zoster in patient w/ history of varicella zoster virus. Monitor CBC including thrombocytes at least once a wk for 1st 8 wk of treatment. Perform frequent monitoring w/ higher doses or severe &/or liver dysfunction. Repeat CBC monitoring mthly or at least w/ intervals of no >3 mth. Perform CBC & LFTs regularly in patient w/ liver function disorder. Consider passive immunization w/ varicella-zoster Ig. Co-administration w/ olsalazine, mesalamine or sulfasalazine. Renal &/or hepatic insufficiency. Patient should use adequate contraceptive measures during treatment. Not to be used in pregnant women w/ RA. Not recommended during lactation. Elderly.
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