Drug Formulary

Name: Methotrexate
Tablets:2.5mg
Injections: 7.5mg up to 25mg
Indications: Antineoplastic chemotherapy, Rheumatoid Arthritis, severe Crohn’s disease
Mechanism of action: Methotrexate is a folic acid antagonist and inhibits DNA and RNA
synthesis by competitively inhibiting dihydrofolate reductase which is essential for normal
cell division.
Dosage:7.5mg to 20 mg orally Once a Week
Adverse reactions: GI discomfort (bleeding, ulceration, diarrhoea), hypotension, fever,
headache, myalgia, renal failure, visual disturbance, changes in nail and skin pigmentation
Drug interactions: Vaccines (methotrexate is a immunosuppressant), Diclofenamide,
dipyrone (increased exposure and toxity) filgrastim, lenograstim, lipeggrastim ( increased
risk of myelosuppression)
Precautions: Hepatic impairment, renal impairment
Pregnancy and breast feeding- contraindicated due to cytotoxicity
Follow up and monitoring: If blood dyscrasias (bad mix) and liver cirrhosis full blood count
and hepatic function tests before starting and repeated every 1-2 weeks until stable for 6
weeks. Then monitored every 4-8 weeks
Report all symptoms of infection especially sore throat
What to tell patient: Take the medication only once a week on the same day each week.
See the doctor immediately in the case of a sore throat, bruising nausea and vomiting or
shortness of breath. Limit sun exposure and alcohol intake to 1-2 standards a once or twice
a week. Tell the doctor before taking any anti-inflamatory(NSAIDS) pain relievers such as
ibuprofen or diclofenac
Is the drug subsidised?: Full subsidy with restrictions
Comments and experience: None yet

Name: Prednisone
Tablets: 1mg, 2,5mg, 5mg, 20mg
Indications: acute asthma, rheumatoid arthritis, acute gout, COPD, transplant rejection
Mechanism of action: Glucocorticoids reduce inflammation by reducing the expression of
pro-inflammatory genes and increasing the expression of anti-inflammatory genes. They
also are immunosuppressive due to inhibition of lymphocyte proliferation and function.
Dosage: Autoimmune/inflammatory disease (5-60mg) Acute gout(20-40mg over 10-14 days)
Exacerbation of COPD (40mg over 5-7 days) Acute asthma (40-50mg for 5 days) all taken
once daily
Adverse reactions: hypertension, myopathy, osteoporosis, peptic ulcer, psychiatric
reactions, Cushing’s syndrome, growth suppression, weight gain, increased susceptibility to
infection, adrenal suppression, GI
Drug interactions: Vaccines (due to immunosuppression), dinutuximab (additive
immunsupressive effects), lumateperone (prednisone causes decreased bioavailability),
macimorelin( increased hypokalemia), mifamurtide (reduced efficacy)
Precautions: Hepatic impairment, renal impairment, children(irreversible growth
restriction), hypertension, recent MI, diabetes mellitus, osteoporosis,hypothyroidism.
Pregnancy and breast feeding- Used if benefit of treatment with glucocorticoids outweighs
the risks. Some evidence may cause small increase in incidence of cleft palate or lip.
Follow up and monitoring: Close monitoring during withdrawal as prednisone is tapered off
due to adrenal suppression. Monitoring of signs of infections and psychiatric reactions.
Frequent monitoring if history of tuberculosis
What to tell patient: Take the tablet just after or with food each day and do not stop taking
this medication unless your doctor tells you to stop(due to adrenal suppression). Prednisone
can increase your chance of getting infections so avoid contact with people with chicken
pox/ shingles and measles. Prednisone can alter your mood and behaviour in the beginning
of treatment. Make sure to tell your doctor if you are concerned about your mood changes,
have signs of an infection or have any changes in your vision
Is the drug subsidised?: Full subsidy with restrictions
Comments and experience: None yet

Name: Morphine Salts

Tablets:10mg,20mg,30mg, 60mg, 100mg
Injections: 1mg/ml to 30mg/ml
Indications: acute and chronic pain
Mechanism of action: Morphine is an opioid agonist which binds to opiate receptors
causing inhibition of pain pathways.
Dosage: Acute pain(oral and subcutaneous 5-10mg every 4 hours IV 5mg at 1-2mg per
minute every 4 hours)
Chronic pain (oral 5-10mg every 4 hours immediate release or 10-20mg every 12 hours
modified release; subcutaneous injection 5-10mg every 4 hours)
Adverse reactions: respiratory depression, bardychardia, hypotension, nausea and
vomiting, anaphylaxsis, mood changes, sexual dysfunction
Drug interactions: eluxadoline(increased constipation) ozanimod(increases risk of adverse
effects) alprazolam( enhanced sedation and respiratory depression)
Precautions: impaired respiratory function, neurological disorders, hypotension or shock,
endocrine disorders, hepatic and renal impairment
Pregnancy and breast feeeding- can cause respiratory depression and withdrawl in newborn
Follow up and monitoring: dosage is adjusted according to response
What to tell patient: Take the medication every 4 hours or 12 hours depending on the type
and tell your doctor if it is helping with the pain. This medicine makes you sleepy so do not
drive or use machines when drowsy. Do not drink alcohol with this medication
Is the drug subsidised?: Variety of different quantities and mediums for morphine that are
full subsidised
Comments and experience: None yet