Table VII. Dosing and monitoring guidelines for the use of selected systemic agents.

Drug	Dosing	Baseline Monitoring	Follow-up Monitoring	Miscellaneous
Cyclosporine	150-300mg/day Pediatric:  3 - 6 mg/kg per day	Blood pressure × 2 measurements Renal function Urinalysis with micro Fasting lipid profile CBC/diff/platelets Liver function Magnesium Potassium Uric acid TB testing HIV if indicated HCG if indicated	Blood pressure every visit Every 2 weeks for 2-3 months, then  monthly: renal function, liver function,  lipids, CBC/diff/platelets, Mg+, K+, uric  acid If dose increased, check labs 2-4 weeks  after HCG if indicated  Annual TB testing	If Cr increases > 25% above baseline, reduce  dose by 1 mg/kg per day for 2-4 weeks and  recheck. Stop CSA if Cr remains > 25%  above baseline; hold at lower dose if level is  within 25% of baseline Whole-blood CSA trough level in children if  inadequate clinical response or concomitant  use of potentially interacting medications
Azathioprine	1-3 mg/kg/day Pediatric: 1-4 mg/kg/day	Baseline TPMT CBC/diff/platelets Renal function Liver function Hepatitis B and C TB testing HIV if indicated HCG if indicated	CBC/diff/platelets, liver function, renal function twice per month × 2 months, monthly × 4 months, then every other month and with dose increases HCG if indicate Annual TB testing	Dosing may be guided by TPMT enzyme  activity
Methotrexate	7.5-25mg/week Pediatric: 0.2 – 0.7  mg/kg/week Consider test dose: 1.25 – 5 mg Check CBC in 5-6  days; if normal,  increase dose  gradually to  desired  therapeutic effect	CBC/diff/platelets Liver function Renal function Hepatitis B and C TB testing HIV if indicated HCG if indicated Pulmonary function tests if indicated	CBC/diff/platelets, liver function weekly for  2-4 weeks and 1 week after each major  dose increase, then every 2 weeks for 1  month and every 2-3 months while on  stable doses Renal function every 6-12 months Annual TB testing HCG as indicated	Liver enzymes transiently rise after MTX  dosing; obtain labs 5-7 days after the last  dose. Significant elevations of liver enzymes: - exceeding 2× normal, check more frequently - exceeding 3× normal, reduce the dose and recheck - exceeding 5× normal, discontinue Avoid in patients at risk for hepatotoxicity Liver biopsy may be considered at 3.5- 4.0 g of  cumulative methotrexate in adults No standard liver biopsy recommendations for  children Consider pulmonary function tests prior to  initiation and during therapy in consultation  with a pulmonologist for patients with asthma  or chronic cough, or consider alternative  therapies CXR if respiratory symptoms arise
Mycophenolate Mofetil	1.0-1.5 g orally  twice daily Pediatric: 1200 mg/m2 daily, which corresponds to 30–50 mg/kg daily	CBC/diff/platelets Renal function Liver function TB testing HIV if indicated HCG if indicated	CBC/diff/platelets, liver function every 2 weeks for 1 mo; then monthly for 3 months; then every 2-3 months thereafter HCG if indicated Annual TB testing

AD, atopic dermatitis; MTX, methotrexate; CSA, cyclosporine; CBC, complete blood cell; PPD, purified protein derivative; HIV, human immunodeficiency virus; HCG, human chorionic gonadotropin; CXR, chest radiograph; diff; differential; Mg+, magnesium; K+, potassium; Cr, creatinine; TPMT, thiopurine methyltransferase; TB, tuberculosis