GUIDELINES Monitoring guidelines Baseline Examination Careful history and physical examination Identification of high risk patients ID: 1007169
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1. METHOTREXATE MONITORING GUIDELINES
2. Monitoring guidelinesBaseline Examination Careful history and physical examination.Identification of high risk patients.Recording concomitant drugs that may interact with MTX.
3. LaboratoryCBCLFTSerologic test for hepatitis B and CRFTHIV testing
4. Follow up Laboratory CBC and LFT 5-6 days after test dose.Every 1-2 weeks for 2-4 weeks.1-2 weeks after dose excalations.Every 3-4 months long term.Renal function once or twice yearly.
5. Recommendation for hepatic monitoring/liver biopsy based on riskLow Risk PatientsNo baseline liver biopsyMonitor liver functionFor minor elevations in liver enzymes(less than 2 times normal) repeat in 2-4 weeks.
6. Moderate elevation in liver enzymes (2-3 times normal: repeat in 2-4 weeks, dose reduction if necessary.For persistent elevation in AST in 5-9 studies over 12 months or for decline in albumin with good nutrition: perform liver biopsy.
7. Consider liver biopsy after cumulative dose of 3.5-4.0 g or switch to alternating agent.HIGH RISK PATIENTSConsider an alternative agentConsider liver biopsy after 2-6 months of use.Repeat liver biopsy at cumulative dose 1.0-1.5 g