Table 5 Cytotoxic medications frequently used in the treatment of Wegener's granulomatosis: strategies to monitor for and prevent toxicity
From: Wegener's granulomatosis: current and upcoming therapies
Medication | Toxicity | Strategy for monitoring or prevention |
Cyclophosphamide | Bone marrow suppression | Complete blood counts every 1–2 weeks to maintain the total leukocyte count above 3000/mm3 |
| Â | Bladder injury | Administer all at once in the morning with a large amount of fluid |
| Â | Â | Consideration of MESNA if intermittent dosing is given |
|  | Transitional cell carcinoma of the bladder | Urinalysis every 3–6 months |
| Â | Â | Cytology every 6 months |
| Â | Â | Cystoscopy in patients with nonglomerular hematuria or abnormal cytology |
|  |  | If bladder injury present, cystoscopy every 1–2 years |
Methotrexate | Bone marrow suppression | Complete blood counts weekly while adjusting dose, and every 4 weeks thereafter |
|  |  | Consider use of 5–10 mg calcium leucovorin weekly 24 hours after methotrexate, or 1 mg folic acid daily |
| Â | Hepatic injury and fibrosis | Monitor liver function tests every 4 weeks |
| Â | Â | Liver biopsy based on guidelines established by the American College of Rheumatology |
| Â | Â | Alcohol consumption prohibited |
|  | Mucositis | Consider use of 5–10 mg calcium leucovorin weekly 24 hours after methotrexate, or 1 mg folic acid daily |
Azathioprine | Bone marrow suppression | Complete blood counts weekly for the first 2 weeks and every 4 weeks thereafter |
|  | Transaminase elevation | Monitor liver function tests every 2 weeks for the first month, every 1–3 months thereafter |