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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
  Bladder injury Administer all at once in the morning with a large amount of fluid
   Consideration of MESNA if intermittent dosing is given
  Transitional cell carcinoma of the bladder Urinalysis every 3–6 months
   Cytology every 6 months
   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
  Hepatic injury and fibrosis Monitor liver function tests every 4 weeks
   Liver biopsy based on guidelines established by the American College of Rheumatology
   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
  1. MESNA, sodium 2-mercaptoethanesulphonate.