Trellus Health®

Glossary of Medication Monitoring

 

IBD Medication Common Brands Recommended Safety Checks
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).
  • Traveling Soon? You may be considered high-risk for TB if you are traveling to certain countries. Check if your destination is high-risk for TB here: https://wwwnc.cdc.gov/travel/destinations/list
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 (risankizumab, mirikizumab)
Stelara®
Skyrizi®
Omvoh®
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, and up to 6 months for Omvoh.
  • Consider requesting a lab order to measure drug concentrations to ensure there is a therapeutic amount in your system, especially when you are symptomatic.
  • Traveling Soon? You may be considered high-risk for TB if you are traveling to certain countries. Check if your destination is high-risk for TB here: https://wwwnc.cdc.gov/travel/destinations/list
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.

Considering Pregnancy? It is recommended to stop this therapy 3-6 months prior to getting pregnant. Please include your GI provider in discussions when family-planning so they can support you in having a healthy pregnancy while keeping your IBD under control.

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.
Traveling Soon? You may be considered high-risk for TB if you are traveling to certain countries. Check if your destination is high-risk for TB here: https://wwwnc.cdc.gov/travel/destinations/list.Considering Pregnancy? Your GI provider may need to adjust your IBD care plan, so please include your GI provider in discussions when family-planning.

small molecules – S1P Receptor Molecules (ozanimod, etrasimod) Zeposia®
Velsipity®
Prior to Initiating Therapy
  • Complete an Electrocardiogram (EKG) to screen for preexisting heart rhythm abnormalities.
  • Complete blood pressure monitoring
  • Review all your medications with your provider to ensure they don’t impact your heart rate.
  • Visit an ophthalmologist prior to or near the start of treatment especially 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.
  • Skin checks are recommended prior to or near the start of treatment.
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.
  • Skin and eye examinations are recommended periodically while on therapy.

NOTE: Bloodwork should be monitored more often in the first 3 months of therapy and should be discussed with your provider.
Considering Pregnancy? It is recommended to stop this therapy 3-6 months prior to getting pregnant. Please include your GI provider in discussions when family-planning so they can support you in having a healthy pregnancy while keeping your IBD under control.