Igura

Indications

Iguratimod is a disease-modifying antirheumatic drug (DMARD), a medicine that slows down the disease process rather than only easing pain. It is used to treat rheumatoid arthritis, a long-term condition in which the immune system attacks the joints and causes pain, swelling and stiffness. It may be used alone or together with Methotrexate.

How It Works

Iguratimod calms the overactive immune response in rheumatoid arthritis. It reduces the production of inflammatory messengers (cytokines) such as interleukins and tumour necrosis factor, lowers the production of antibodies by immune B cells, and blocks a signalling pathway (NF-kB) that switches on inflammation. Over several weeks this reduces joint swelling, pain and damage.

Dosage and Administration

Take exactly as prescribed by your doctor, usually a rheumatologist. Treatment is commonly started at 25 mg once daily after a meal for the first 4 weeks, and then increased to 25 mg twice daily (after breakfast and dinner) if it is well tolerated. Swallow the tablet with water. Benefits usually appear gradually over several weeks. Regular blood tests are needed during treatment. Do not stop or change the dose without medical advice.

Interactions

• Warfarin: Iguratimod can strongly increase the blood-thinning effect and cause serious bleeding; the two should not be used together.
• Non-steroidal anti-inflammatory drugs (NSAIDs) such as Diclofenac or Ibuprofen: higher risk of stomach ulcers and bleeding.
• Other medicines that affect the liver or the blood count, such as Methotrexate or Leflunomide: closer monitoring is needed.
• Cimetidine and Phenobarbital may change Iguratimod levels.

Tell your doctor about all medicines, supplements and herbal products you use.

Contraindications

• Allergy to Iguratimod or any ingredient of the tablet.
• Pregnancy or possible pregnancy.
• Severe liver disease.
• Active stomach or duodenal ulcer.
• Patients taking Warfarin.

Side Effects

Common side effects include raised liver enzymes on blood tests, nausea, stomach pain, loss of appetite, mouth ulcers, rash, itching and headache. Less often it can lower white blood cells or platelets, cause stomach ulcers or affect kidney function.

Get urgent medical help if you have yellowing of the skin or eyes, dark urine, black or bloody stools, vomiting blood, unusual bruising or bleeding, fever or sore throat that does not go away, severe rash or blistering, or difficulty breathing.

Pregnancy and Lactation

Iguratimod must not be used during pregnancy because animal studies showed harm to the unborn baby. Women who could become pregnant should use reliable contraception during treatment. It is not known whether it passes into breast milk; breastfeeding should be avoided while taking it. Discuss family planning with your doctor.

Precautions and Warnings

• Liver function and blood counts should be checked before starting and regularly during treatment, especially in the first months.
• Use with caution in people with a history of stomach ulcers, kidney problems, low blood counts or liver disease.
• It may lower resistance to infection; report fever or signs of infection promptly.
• Elderly patients may be more sensitive to side effects.
• Limit alcohol, which adds strain to the liver.

Overdose

Taking too much may increase side effects such as stomach upset, liver injury or bleeding. If an overdose is suspected, contact a doctor or go to the nearest hospital straight away and take the medicine pack with you.

Therapeutic Class

Disease-modifying antirheumatic drug (DMARD), immunomodulator.

Storage

Store below 30°C in a dry place, away from light and out of the reach of children.