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Monitoring for safety

Authoring team

Gold therapy is potentially toxic and therefore the drug must be carefully monitored.

FBC, U&Es, urine dipstick Every 2 weeks until stable; then before each injection

Before each injection:

  • FBC (watch Hb, MCV, Differential WCC & platelets for trends as well as absolute levels) - give injection only if previous result is available and satisfactory
  • urinalysis for proteinuria or haematuria

ESR is monitored monthly.

Stop drug, inform specialist if:

  • rash or mouth ulcers
  • WBC < 3.5 x10^9/l
  • platelets < 150 x 10^9/l
  • haematuria or proteinura on two or more occasions - inform specialist, order MSU and 24-hour urinary protein

If suspicious symptoms or signs:

  • urgent FBC if there are symptoms of infection(leucopenia)
  • urgent platelets if bruising, bleeding(thrombocytopenia)

Ideally results should be recorded in a patient-held booklet

Reference:

  1. Doctor magazine(December 2002). Disease-modifying anti-rheumatic drugs
  2. MeReC Bulletin 2007;17(5):1-8.

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