Table 2.

Main drugs used in sarcoidosis

Drug	Main adverse effects	Baseline and monitoring examinations
Glucocorticoid	Weight gain, fluid retention, osteoporosis, hyperglycaemia, hypertension, gastritis, muscle weakness, opportunistic infections, psychosis, mood swings, insomnia, thrush, cataract, glaucoma, osteonecrosis of femoral head	Weight, blood pressure, serum lipids and glucose at baseline and every 3 months, bone mineral density and ophthalmologic examination yearly
Methotrexate	Dyspepsia, mucositis, liver and bone marrow toxicity, fatigue, alopecia, increased risk of infections including opportunists, hypersensitivity pneumonia	Blood, liver and renal indices at baseline and at every 2–4 weeks for the first 3 months, every 2–3 months thereafter; contraindicated in patients with underlying liver disease and chronic viral hepatitis
Azathioprine	As for MTX and also jaundice, myalgia, blurred vision	As for MTX
Leflunomide*	As for MTX and also diarrhoea, skin rash, peripheral neuropathy, alopecia, systemic hypertension	As for MTX
Mycophenolate	Diarrhoea, nausea, vomiting, leukopenia, anaemia, cytomegalovirus viraemia, infections, hyperglycaemia, hepatitis	As for MTX; it may cause increase in blood concentrations of creatinine
Cyclophosphamide	As for MTX and also haemorrhagic cystitis, cytopenia	As for MTX. Urinalysis every month
Hydroxychloroquine	Rash, neuromyopathy, retinopathy; cardiomyopathy, gastrointestinal intolerance, skin pigmentation	Eye examination at baseline and then every 6–12 months
Infliximab and adalimumab	Allergic local reactions, skin rashes, demyelinating disease, lupus-like syndrome, congestive heart failure, thromboembolic disease, increased risk of reactivation of latent infections including tuberculosis	As for MTX; close monitoring during injection, dermatological evaluation at baseline. Contraindicated in cases of severe congestive heart failure
Rituximab	Reactivation of hepatitis, progressive multifocal leukoencephalopathy, headache, muscle spasms, pancytopenia, fatigue	Serum immunoglobulins every 3–6 months, blood chemistry every 1–3 months Contraindicated in cases of severe congestive heart failure. Overall, there is less probability of immune response to various vaccines

MTX  methotrexate

*Some authors suggest an initial dose of 80–160 mg and then 80 mg every other week