aminosalicylates –balsalazide, mesalamine

Apriso™

Asacol® HD

Colazal®

Giazo™

Canasa®

Delzicol™

Rowasa®

Lialda™

Pentasa®

Prior to Initiating Therapy

• Complete initial/baseline bloodwork such as complete blood counts, renal function, liver function

While on Therapy

• Complete yearly Renal (kidney) function test often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)
• Complete yearly urinalysis

aminosalicylates – sulfasalazine

Azulfidine®

Azulfidine® EN-tabs

Prior to Initiating Therapy

• Complete initial/baseline bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)]

While on Therapy

• Complete routine bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)] every 3-6 months
• Complete yearly urinalysis
• Take daily folic acid supplements (1mg /day and up 2 mg/day if pregnant)

NOTE: More frequent lab monitoring may be necessary during first few months of therapy

biologics – TNF-α (adalimumab, infliximab, certolizumab pegol, golimumab)

Humira®

Cyltezo™

Amjevita®

Hyrimoz™

Cimzia®

Simponi®

Remicade®

Renflexis®

Avsola

Inflectra™

IXIFI™

Prior to Initiating Therapy

• Complete Tuberculosis (TB) screening prior to initiating medication (e.g., QuantiFERON-TB Gold or PPD. If high risk or indeterminate results from QuantiFERON-TB Gold or PPD: Chest X-ray)
• Check Hepatitis B Immunity Status (preferably before starting therapy but can be done after starting therapy) and re/vaccinate if not immune
• Avoid live vaccines within 4 weeks of starting therapy and during therapy
• Complete initial/baseline bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)]

While on Therapy

• Complete annual TB risk assessment and screening if meeting criteria for high risk
• Avoid live vaccines
• Complete routine bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)] every 3-6 months
• Consider requesting a lab order to measure drug concentrations to ensure there is a therapeutic amount in your system, especially when you are symptomatic. (This can be considered shorty after starting therapy)

biologics – α4 integrin (natalizumab)

Tysabri®

Prior to Initiating Therapy

• Enroll in TOUCH program
• Complete initial/baseline bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)]

While on Therapy

• Complete routine bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)] every 3-6 months

biologics – IL-12/23 (ustekinumab)

IL-23 (risankizumαb)

Stelara®

Skyrizi®

Prior to Initiating Therapy

• Complete Tuberculosis (TB) screening prior to initiating medication (e.g., QuantiFERON-TB Gold or PPD. If high risk or indeterminate results from QuantiFERON-TB Gold or PPD: Chest X-ray)
• Avoid live vaccines within 4 weeks of starting therapy
• Complete initial/baseline bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)]

While on Therapy

• Complete annual TB risk assessment and screening if meeting criteria for high risk
• Avoid live vaccines
• Complete routine bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)] every 3-6 months. For Skyrizi, liver function monitoring is recommended within the first 3 months of initiating therapy.
• Consider requesting a lab order to measure drug concentrations to ensure there is a therapeutic amount in your system, especially when you are symptomatic

biologics – α4β7 integrin (vedolizumab)

Entyvio®

Prior to Initiating Therapy

• Optional: Patients at high risk for tuberculosis (TB) may be screened for TB, at discretion of the provider
• Complete initial/baseline bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)]
• Avoid live vaccines within 4 weeks of starting therapy

While on Therapy

• Avoid live vaccines
• Complete routine bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)] every 3-6 months
• Consider requesting a lab order to measure drug concentrations to ensure there is a therapeutic amount in your system, especially when you are symptomatic

corticosteroids – budesonide

Entocort® EC

Uceris™

• Daily Calcium of (1200-1500 mg) and Vitamin D supplements (1000-4000 IU daily or 50,000 Units weekly) is recommended
• Consider an ophthalmology exam to monitor for ocular side effects
• Inform your GI provider of all courses of steroids so a bone density exam* may be recommended, as necessary

Generally, a bone density exam may be considered if you have used oral corticosteroids lasting > 3 months, or if you have used oral corticosteroids lasting 1 year within the past 2 years.

Women 65 or older should receive a bone density for preventative screening every 2 years regardless of steroid exposure.

corticosteroids – prednisone

A-Methapred®
Depo-Medrol®
Medrol Dosepak®
Solu-Medrol®
Deltasone®
Oraped®
Prelone®
Pediapred®

• Daily Calcium of (1200-1500 mg) and Vitamin D supplements (1000-4000 IU daily or 50,000 Units weekly) is recommended
• Consider an ophthalmology exam to monitor for ocular side effects
• Inform your GI provider of all courses of steroids so a bone density exam* may be recommended, as necessary

Generally, a bone density exam may be considered if you have used oral corticosteroids lasting > 3 months, or if you have used oral corticosteroids lasting 1 year within the past 2 years.

Women 65 or older should receive a bone density for preventative screening every 2 years regardless of steroid exposure.

immunosuppressant – cyclosporine

Neoral®

Sandimmune®

Gengraf®

Prior to Initiating Therapy

• Review all medications, including herbal supplements, with provider
• Complete initial/baseline bloodwork such as complete blood count, renal function, liver function, potassium levels [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)], cholesterol, and magnesium levels

While on Therapy

• Avoid grapefruit juice
• Complete routine monitoring of drug concentrations and bloodwork such as complete blood count, renal function, liver function, potassium levels [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)], cholesterol and magnesium levels every 3-6 months
• Ensure consistency of taking medication, either always with food or always without food

NOTE: Bloodwork should be monitored more often in the first 3 months of therapy and should be discussed with your provider

immunosuppressant – methotrexate

Rheumatrex®

MTX®

Mexate®

Trexall®

Prior to Initiating Therapy

• Complete initial/baseline bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)]

While on Therapy

• Complete routine bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)] every 3-6 months
• Take daily folic acid supplements (1 mg/day)

NOTE: Bloodwork should be monitored more often in the first 3 months of therapy and should be discussed with your provider

immunosuppressant – tacrolimus

Prograf®

Astagraf XL®

Envarsus® XR

Hecoria®

Prior to Initiating Therapy

• Review all medications, including herbal supplements, with provider
• Complete initial/baseline bloodwork such as complete blood count, renal function, liver function, potassium levels [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)], cholesterol, and magnesium levels

While on Therapy

• Avoid grapefruit juice
• Ensure consistency of taking medication, either always with food or always without food
• Complete routine monitoring of drug concentrations and bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)], cholesterol, and magnesium levels every 3-6 months

NOTE: Bloodwork should be monitored more often in the first 3 months of therapy and should be discussed with your provider

immunosuppressant – thiopurine, azathioprine, 6-Mercaptopurine (6-MP)

Imuran®

Azasan®

Purinethol®

Purixan

Prior to Initiating Therapy

• Complete Thiopurine methyltransferase (TPMT) enzyme blood test to ensure a safe start to the medication. Results can impact starting dose.
• Complete initial/baseline bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)]

While on Therapy

• Complete routine bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)] every 3-6 months
• Consider requesting a lab order to measure drug concentrations to ensure there is a therapeutic amount in your system (Thiopurine Metabolites)

NOTE: White blood cell counts should be monitored more often in the first 3 months of therapy

small molecules – JAK-inhibitor (tofacitinib, upadacitinib)

Xeljanz®

Rinvoq®

Prior to Initiating Therapy

• Complete Tuberculosis (TB) screening prior to initiating medication (e.g., QuantiFERON-TB Gold or PPD. If high risk or indeterminate results from QuantiFERON-TB Gold or PPD: Chest X-ray)
• Avoid live vaccines within 4 weeks of starting therapy and during therapy
• Complete initial/baseline bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)]
• Consider the Inactive Herpes Zoster vaccine (Shingrix) especially if you are above the age of 50. Please discuss with your GI provider and primary care provider.

While on Therapy

• Complete a Fasting Lipid Profile, recommended 4-8 weeks after starting therapy
• Complete annual TB risk assessment and screening if you meet criteria for high risk
• Complete routine bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)] every 3-6 months

NOTE: Bloodwork should be monitored more often in the first 3 months of therapy and should be discussed with your provider

small molecules – S1P Receptor Molecules (ozanimod)

Zeposia®

Prior to Initiating Therapy

• Complete an Electrocardiogram (EKG) to screen for preexisting conduction abnormalities
• Complete blood pressure monitoring
• Review all your medications with your provider to ensure they don’t impact your heart rate
• Visit an ophthalmologist if you have diabetes or if you are diagnosed with inflammation or swelling inside your eye
• Complete initial/baseline bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)]
• Consider the Inactive Herpes Zoster vaccine (Shingrix), especially if above the age of 50. Please discuss with your GI provider and primary care provider

While on Therapy

• Complete routine bloodwork such as complete blood count, renal function, liver function [often part of a Basic or Comprehensive Metabolic Panel (BMP/CMP)] every 3-6 months

Initial Dosing Schedule

NOTE: Bloodwork should be monitored more often in the first 3 months of therapy and should be discussed with your provider