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Medicines Monitoring

Hydroxycarbamide monitoring

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Topics: HydroxycarbamideMonitoring
Using this page · Individualise medicines monitoring

This medicines monitoring page has been written using publications and expert opinion. It is designed to save clinician time, but not replace professional responsibility. When using this page you should: ensure an individualised monitoring plan is developed in partnership with the patient and take account of any locally agreed advice and guidance.

Contents

  1. Before starting
    1. Required
    2. Sickle cell disease
    3. Consider in patients at risk of infection
  3. After started or dose changed
    1. Sickle cell disease
    2. Other indications
  5. Ongoing once stable
    1. Sickle cell disease
    2. Other indications
  7. Abnormal results
    1. Monitor trends
    2. Respond to absolute blood count levels
  9. Notes
    1. Advice to patients
    2. Secondary malignancies
    3. Vaccinations
  11. Bibliography
  12. Update history

Before starting

Required

  • Baseline
    • Estimated glomerular filtration rateavoid if less than 30 mL/minute/1.73 m2; half the dose if less than 60mL/minute/1.73m2
    • Full blood countcontraindicated if platelet count less than 100 x 109/L
    • Liver function testsavoid use in severe impairment; caution in mild to moderate impairment
    • Uric acid

Sickle cell disease

  • Baseline
    • Estimated glomerular filtration rateavoid if less than 30 mL/minute/1.73 m2; half the dose if less than 60mL/minute/1.73m2
    • Full blood count
    • Liver function testsavoid in severe impairment; caution in mild to moderate
    • Lactate dehydrogenase (LDH)
    • Reticulocyte count
    • Urea and electrolytes
    • Uric acid

Consider in patients at risk of infection

  • Baseline
    • Hepatitis B
    • Hepatitis C

After started or dose changed

Sickle cell disease

  • Every 2 weeks for the first 2 months
    • Full blood count

Other indications

  • Every 1 - 2 weeks
    • Full blood countuntil stable on the effective dose.

Ongoing once stable

Sickle cell disease

  • Every 2-3 months; every 2 weeks if on maximum dose
    • Full blood count
  • Every 2 - 3 months
    • Lactate dehydrogenase (LDH)
    • Liver function testsavoid in severe impairment; caution in mild to moderate impairment
    • Uric acid
    • Urea and electrolytes

Other indications

  • Every 1 - 3 months
    • Full blood count
    • Estimated glomerular filtration rate
    • Liver function testsavoid in severe impairment; caution in mild to moderate impairment
    • Uric acid

Abnormal results

Monitor trends

Be aware of trends in results and respond accordingly.

Respond to absolute blood count levels

Consider stopping treatment, contacting a specialist, and ensuring levels recover before re-starting if any of the following develop:

Full blood count

  • WCC less than 2.5 x 109/L
  • Neutrophils less than 1.0 x 109/L
  • Platelets less than 80 x 109/L
  • Reticulocytes less than 80 x 109/L and haemoglobin less than 90g/L
  • Haemoglobin below 45g/L or dropped by over 30g/L from baseline

Notes

Advice to patients

Advise patients to:

  • maintain a high fluid intake during treatment
  • protect skin from sun exposure if on long-term therapy

Secondary malignancies

Patients receiving long-term therapy for malignant disease should be monitored for secondary malignancies during routine follow-up appointments.

Vaccinations

Live vaccines should be avoided during treatment and for at least 6 months after treatment has finished.

Bibliography

Update history

  1. Republished
  2. Full review and update. Minor changes to article made only.
  1. Link to Scottish Paediatric & Adult Haemoglobinopathy Network guideline updated.
  1. Published