Disease modifying agents  (Anti-rheumatic agents)

adalimumab  (Humira ®):

A recombinant, anti-tumor necrosis factor (TNF)-alpha monoclonal antibody. Dosing: rheumatoid arthritis: 40 mg SQ every other week. The drug can be given concomitantly with methotrexate. Whether adalimumab will offer a significant advantage over infliximab or etanercept remains to be determined.

anakinra  (Kineret ®)

A recombinant, nonglycosylated form of the human interleukin-1 receptor antagonist (IL-1Ra). Rheumatoid arthritis: 100 mg/day SQ daily. Higher doses did not result in a higher response. The dose should be administered at approximately the same time every day.

auranofin  (Ridaura ®)

Oral gold compound. Normal dose (rheumatoid arthritis): 3 mg orally twice daily or 6 mg once daily. Maximum dose: 3 mg three times daily.

azathioprine  (Imuran ®)

An immunosuppressive agent. (Rheumatoid arthritis): Initial dose: 1 mg/kg (50-100mg) orally once daily or divided twice daily. In the absence of serious toxicity and if response is unsatisfactory, the dose can be increased, beginning at 6 to 8 weeks and thereafter at 4 week intervals, in increments of 0.5 milligrams/kilogram/day up to a maximum dose of 2.5 milligrams/kilogram/day. Patients who do not improve after 12 weeks of therapy can be considered refractory.

etanercept  (Enbrel ® )

Tumor necrosis factor receptor fused to the Fc fragment of human immunoglobulin G1. Indicated for the reduction of signs and symptoms of moderate to severe, active rheumatoid arthritis in patients who have had an inadequate response to one or more disease-modifying antirheumatic drugs. Can be used in combination with methotrexate for those patients not responding to methotrexate monotherapy. Usual dose: 25 mg SQ twice weekly.

hydroxychloroquine  (Plaquenil ®)

Antimalarial agent that possesses anti-inflammatory activity. (Rheumatoid arthritis) Initial dose: 400 to 600 mg orally once daily with food or milk. qd--then taper dose (usually after 4 to 12 weeks) to 200-400mg orally once daily. If there is no improvement after 6 months, discontinue drug.

infliximab  (Remicade ® )

Rheumatoid Arthritis. The recommended dose of Remicade is 3 mg/kg given as an intravenous infusion followed with additional similar doses at 2 and 6 weeks after the first infusion then every 8 weeks thereafter. Should be given in combination with methotrexate. For patients who have an incomplete response, consideration may be given to adjusting the dose up to 10 mg/kg or treating as often as every 4 weeks.

leflunomide  (Arava ®)

Immunomodulatory agent. Dosing (active rheumatoid arthritis): (Loading regimen) 100 mg orally once daily for three days, then start maintenance dose of 10 to 20 mg orally once daily.

methotrexate  (Rheumatrex ®)

Antineoplastic agent - can be used for immunosuppressive therapy in severe rheumatoid arthritis, psoriasis, and systemic lupus erythematosus. Rheumatoid arthritis: Starting dose: 7.5 milligrams orally once a week. This dosage may be administered as a single dose or as a divided dose of 2.5 mg every 12 hours for 3 doses once a week. Once a response has been achieved, reduce the dosage if possible to the lowest effective dose. Maximum recommended dose: 20 mg/week. Consider folate supplementation.

sulfasalazine  (Azulfidine ®)

Indicated in the treatment of rheumatoid arthritis in patients who have responded inadequately to salicylates or other non-steroidal anti-inflammatory drugs. Recommended daily dose: 500 mg orally once or twice daily after meals up to 2 grams divided twice daily.

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Listed dosages are for - Adult patients ONLY. PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph.  GlobalRPh Inc.