Inflammatory Arthritis & Connective Tissue Disease for Adult Services, over 16

Only use where a 300mg daily dose is necessary 

NICE NG100 Management of Rheumatoid Arthritis in adults

There are several drug interactions for Hydroxychloroquine including: Digoxin - increases plasma digoxin levels. Halofantrine - prolongs the QT interval and should not be administered with other drugs that have the potential to induce cardiac arrhythmias, including hydroxychloroquine. Ciclosporin - levels were reported to increase when ciclosporin and hydroxychloroquine were co-administered. Drugs affecting the convulsive threshold (other anti-malarials) -may increase the risk of convulsions. Also, the activity of anti-epileptic drugs might be impaired if co-administered with hydroxychloroquine. Tamoxifen is not recommended for concomitant use with hydroxychloroquine due to renal toxicity. NICE NG100
Management of Rheumatoid Arthritis in adults
Jul-18

Inflammatory Arthritis & Connective Tissue Disease for Adult Services, over 16

Rationale: 1,2 a b

Refer to the Shared Care Protocol for the Management of Inflammatory Arthritis, Connective Tissue Disease & Systemic Vasculitis for Adult services (over 16) 

NICE NG100 Management of Rheumatoid Arthritis in adults

75 mg and 100mg Grey listed please prescribe 25mg & 50mg Tablets

A total daily dose be included on all scripts, prescribers are discouraged from writing half tablets e.g. give 25mg and 50mg for total dose of 75mg , not one and a half 50mg 

Inflammatory Arthritis & Connective Tissue Disease for Adult Services, over 16, Transplantation, Immunosuppression, Non rheumatology indications

Inflammatory Arthritis & Connective Tissue Disease for Adult Services

Rationale 1,2,3

"Ciclosporin is a critical-dose drug with a narrow therapeutic index

Care should be taken to stabilise the patient on a single brand of ciclosporin, and to ensure that the same brand of ciclosporin is always prescribed and dispensed to the patient

When switching of a patient stabilised to one brand of ciclosporin is unavoidable, the patient should be closely monitored for side effects, drug blood concentrations, and transplant function.

MHRA Drug Safety Update Volume 3 Issue 5 December 2009"

Inflammatory Arthritis & Connective Tissue Disease for Adult Services, over 16

Refer to Shared Care Protocol for the Management of Inflammatory Arthritis, Connective Tissue Disease & Systemic Vasculitis for Adult services (over 16) 

Rationale 1,2,5

NICE NG100

Inflammatory Arthritis & Connective Tissue Disease for Adult Services, over 16

Rational:1,2,5

Prescribe 2.5mg tablets only

Refer to Shared Care Protocol for the Management of Inflammatory Arthritis, Connective Tissue Disease & Systemic Vasculitis for Adult services (over 16)

NICE NG100

Inflammatory Arthritis & Connective Tissue Disease for Adult Services, over 16.

Refer to Shared Care Protocol for the Management of Inflammatory Arthritis, Connective Tissue Disease & Systemic Vasculitis for Adult services (over 16)

Mycophenolic acid has a cytostatic effect on B- and T-lymphocytes, therefore an increased severity of COVID-19 may occur. Dose reduction or discontinuation should be considered for patients in cases of clinically significant COVID-19.

NICE NG100 Rheumatoid arthritis in adults: management

Drug Safety Update Mycophenolate mofetil, mycophenolic acid: new pregnancy-prevention advice for women and men
Drug Safety Update Mycophenolate mofetil (CellCept) and mycophenolic acid: risk of hypogammaglobulinaemia and risk of bronchiectasis

Mycophenolate salts and brands are not interchangeable. Prescribe as brand. Changes of brand or salt must be supervised by a consultant.
Dose reduction or discontinuation of mycophenolate mofetil should be considered in patients who develop pure red cell aplasia. Changes to treatment should be done only under specialist supervision to minimise the risk of graft rejection MHRA Drug Safety Update Volume 2 Issue 12 July 2009

Inflammatory Arthritis & Connective Tissue Disease for Adult Services, over 16

Rationale 1,2,5

Refer to Shared Care Protocol for the Management of Inflammatory Arthritis, Connective Tissue Disease & Systemic Vasculitis for Adult services (over 16)

NICE NG100 Management of Rheumatoid Arthritis in adults

Prescribe as generic sulfasalazine and NOT Salazopyrin EN 

Inflammatory Arthritis & Connective Tissue Disease for Adult Services, over 16

Rationale:1,2,5

Refer to Shared Care Protocol for the Management of Inflammatory Arthritis, Connective Tissue Disease & Systemic Vasculitis for Adult services (over 16)

NICE NG100 Management of Rheumatoid Arthritis in adults