page86
Dose
. By intramuscular injection,
severe Crohn’s disease
[unlicensed indication],
ADULT
over 18 years, induction
of remission, 25 mg once weekly; maintenance, 15 mg
once weekly
. By mouth,
maintenance of remission of severe
Crohn’s disease [unlicensed indication],
ADULT
over 18
years, 10–25 mg once weekly
Important
Note that the above dose is a weekly dose.
To avoid
error with low-dose methotrexate, it is recommended
that:
.
the patient is carefully advised of the dose and frequency
and the reason for
taking methotrexate and any other
prescribed medicine (e.g.
folic acid);
.
only one strength of methotrexate tablet (usually 2.5 mg) is
prescribed and dispensed;
.
the prescription and the dispensing label
clearly show the
dose and frequency of methotrexate administration;
.
the patient
is warned to report immediately the onset of
any feature of
blood disorders (e.g.
sore throat,
bruising,
and mouth ulcers),
liver
toxicity (e.g.
nausea,
vomiting,
abdominal
discomfort,
and dark urine),
and respiratory
effects (e.g.
shortness of breath).
Preparations
Section 10.1.3
Cytokine modulators
Infliximab and adalimumab are
monoclonal
anti-
bodies
which inhibit
the pro-inflammatory cytokine,
tumour
necrosis
factor
alpha.
They should be used
under
specialist
supervision.
Adequate
resuscitation
facilities must be available when infliximab is used.
ADALIMUMAB
Indications
see under Inflammatory Bowel Disease,
p.
60;
ankylosing spondylitis,
psoriatic arthritis,
rheu-
matoid arthritis, juvenile idiopathic arthritis,
(section
10.1.3);
psoriasis (section 13.5.3)
Cautions
section 10.1.3
Contra-indications
section 10.1.3
Pregnancy
section 10.1.3
Breast-feeding
section 10.1.3
Side-effects
section 10.1.3
Dose
. By subcutaneous injection,
severe active Crohn’s
disease,
ADULT
over 18 years,
initially 80 mg,
then
40 mg 2 weeks after initial dose
or
accelerated regi-
men, initially 160 mg in 4 divided doses over 1–2 days,
then 80 mg 2 weeks after initial dose;
maintenance,
40 mg on alternate weeks,
increased if necessary to
40 mg weekly; review treatment if no response within
12 weeks of initial dose
Preparations
Section 10.1.3
INFLIXIMAB
Indications
see under Inflammatory Bowel Disease,
p.
59;
ankylosing spondylitis,
rheumatoid arthritis
(section 10.1.3);
psoriasis (section 13.5.3)
Cautions
see section 10.1.3;
also history of dysplasia
or colon carcinoma
Hypersensitivity reactions
Risk of
delayed hypersensi-
tivity if drug-free interval exceeds 16 weeks
Contra-indications
see section 10.1.3
Pregnancy
section 10.1.3
Breast-feeding
section 10.1.3
Side-effects
see section 10.1.3; also hepatosplenic T-
cell lymphoma
Dose
. By intravenous infusion,
severe active Crohn’s dis-
ease,
ADULT
over 18 years,
initially 5 mg/kg,
then
5 mg/kg 2 weeks after initial dose;
then if the condi-
tion has responded,
maintenance 5 mg/kg 6 weeks
after initial dose,
then 5 mg/kg every 8 weeks;
CHILD
6–18 years, initially 5 mg/kg,
then 5 mg/kg 2 weeks
and 6 weeks after initial dose,
then 5 mg/kg every 8
weeks; interval between maintenance doses adjusted
according to response;
discontinue if no response
within 10 weeks of initial dose
Fistulating Crohn’s disease,
ADULT
over 18 years,
initially 5 mg/kg,
then 5 mg/kg 2 weeks and 6 weeks
after initial dose,
then if condition has responded,
consult product literature for guidance on further
doses;
CHILD
under 18 years, see
BNF for Children
Severe active ulcerative colitis,
ADULT
over 18 years,
initially 5 mg/kg,
then 5 mg/kg 2 weeks and 6 weeks
after initial dose,
then 5 mg/kg every 8 weeks; dis-
continue if no response 14 weeks after initial dose
Preparations
Section 10.1.3
1.5.4
Food allergy
Allergy with classical
symptoms of vomiting,
colic and
diarrhoea caused by specific foods such as shellfish
should be managed by strict avoidance.
The condition
should be distinguished from symptoms of
occasional
food intolerance in those with irritable bowel syndrome.
Sodium cromoglicate may be helpful as an adjunct to
dietary avoidance.
SODIUM CROMOGLICATE
(Sodium cromoglycate)
Indications
food allergy (in conjunction with dietary
restriction);
asthma (section 3.3.1);
allergic con-
junctivitis (section 11.4.2);
allergic rhinitis (section
12.2.1)
Pregnancy
not known to be harmful
Breast-feeding
unlikely to be present in milk
Side-effects
occasional nausea, rashes, and joint pain
Dose
. 200 mg 4 times daily before meals; may be increased if
necessary after 2–3 weeks to a max. of 40 mg/kg daily
and then reduced according to response;
CHILD
2–14
years 100 mg 4 times daily before meals;
may be
increased if necessary after 2–3 weeks to a max.
of
40 mg/kg daily and then reduced according to
response
Counselling
Capsules
may be swallowed whole or
the
contents dissolved in hot water and diluted with cold water
before taking
Nalcrom
c
(Sanofi-Aventis) A
Capsules
,
sodium cromoglicate 100 mg.
Net price
100-cap pack = £59.75.
Label:
22,
counselling,
see
dose above
66
1.5.4 Food allergy
BNF 61
1
Gastro-intestinal system