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It is considered to be the most effective agent for arresting the rheumatoid process. It reduces macrophage and lysosomal activity and inhibits cell mediated immunity (CMI), but the exact mechanism is not known. It has an effect on synovial membrane and collagen to prevent joint destruction; may induce healing of bony erosions. It is effective in psoriatic arthropathy also.


Rheumatoid arthritis.


6 mg daily in 2 div. doses or as a single dose for minimum 3-6 months. If response inadequate increase to max. 3 mg thrice daily.


Pregnancy, lactation. Severe blood dyscrasias. Progressive renal disease. Severe hepatic disorder. SLE. History of necrotising enterocolitis, pulmonary fibrosis, exfoliative dermatitis, bone marrow aplasia.

Special Precautions

Periodically monitor blood counts & urinary protein. Women of child bearing potential should use effective contraception during & at least 6 months after treatment. Renal & hepatic dysfunction. History of bone marrow depression. Paediatrics: Not recommended. Pregnancy: Contraindicated. Lactation: Contraindicated. Elderly: No special problems.

Side Effects

Diarrhoea, nausea, abdominal pain, ulcerative enterocolitis, rashes, pruritus, alopecia, blood dyscrasias, taste disturbance, pulmonary fibrosis, nephrotic syndrome.

Drug Interactions

Potentiation of other myelosuppressive drugs, increased level of phenytoin, penicillamine chelates gold.

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