Disease-Modifying Anti-Rheumatic Drugs (DMARDs)
Drug Safety Update
March 2022: Hydroxychloroquine, chloroquine: increased risk of cardiovascular events when used with macrolide antibiotics; reminder of psychiatric reactions
September 2020: Methotrexate once-weekly for autoimmune diseases: new measures to reduce risk of fatal overdose due to inadvertent daily instead of weekly dosing
April 2020: Coronavirus (COVID-19): latest guidance on medicines safety - Chloroquine and hydroxychloroquine
NICE Guidance
NG100: Rheumatoid arthritis in adults: management, updated October 2020
NG226: Osteoarthritis: care and management, updated October 2022
Local Guidance
Shared care guidelines for disease modifying antirheumatic drugs (DMARDs)
Other conventional DMARDs include:
Follow the links for information on the above drugs. All these drugs require regular monitoring consult the BNF for details.
Methotrexate
This is given as a ONCE weekly dose as a single dose on the same day of the week. Folic acid 5mg supplements are advisable. There is little evidence with regard to the use and dose. 5 - 10mg is frequently used, with a gap of 24-48 hours between methotrexate and folic acid doses. Methotrexate may also be given by injection for those patients where the oral route is problematic. To avoid dosing errors with weekly low dose methotrexate, see Kent and Medway position statement for prescribing oral methotrexate.
Whilst all medications below are listed as on formulary for Kent & Medway, there is no rheumatology service at Dartford and Gravesham NHS Trust. These drugs will be prescribed by the other centres.
| Pack |
|---|
| 60 tablet (6 x 10 tablets) |
Note: when used to treat active rheumatoid arthritis, severe Crohn's disease and severe psoriasis the dose is a WEEKLY dose. To avoid error it is recommended that:
- the patient is carefully advised of the dose, the frequency and the reasons for taking methotrexate and any other co-prescribed medication e.g. folic acid
- only one strength of methotrexate tablet is prescribed and dispensed (usually 2.5mg)
- the prescription and the dispensing label clearly show the dose and the frequency of administration
- the patient is warned to report immediately the onset of any feature of blood disorders, liver toxicity and respiratory effects
- See drug safety update Sept 2020 for further adviceKMICB - Methotrexate (shared care guidance)
There is currently no commissioned mechanism for cytotoxic waste disposal in Medway. As such, GP practices providing services to patients living within Medway will not be expected to undertake shared care for cytotoxic injectables such as subcutaneous methotrexate and these medicines will remain hospital-only (RED) in this locality.
| Pack |
|---|
| 100 tablet |
| 24 tablet |
| 28 tablet |
| Pack |
|---|
| 35 ml |
| Pack |
|---|
| 1 pre-filled disposable injection |
| Pack |
|---|
| 1 pre-filled disposable injection |
| Pack |
|---|
| 1 pre-filled disposable injection |
| Pack |
|---|
| 1 pre-filled disposable injection |
| Pack |
|---|
| 1 pre-filled disposable injection |
| Pack |
|---|
| 1 pre-filled disposable injection |
| Pack |
|---|
| 1 pre-filled disposable injection |
| Pack |
|---|
| 1 pre-filled disposable injection |
| Pack |
|---|
| 1 pre-filled disposable injection |
| Pack |
|---|
| 30 tablet |
| Pack |
|---|
| 30 tablet |
| Pack |
|---|
| 56 tablet |
| Pack |
|---|
| 56 tablet |
| Pack |
|---|
| 500 tablet |
| 100 tablet |
| 112 tablet |
| 50 tablet |
For specialist rheumatology, dermatology or microbiology use only
| Pack |
|---|
| 1 tablet |
- On Formulary Preferred
- On Formulary Second Line
- On Formulary Third Line
- Specialist Initiation
- Secondary Care Only
- Not Approved for Formulary