Rheumatoid Arthritis Drug Summary

Drug	Dosage	Remarks
Tramadol1	50-100 mg PO 4-6 hourly Extended-release: 50-100 mg PO 12-24 hourly Max dose: 400 mg/day	Adverse Reactions GI effects (nausea/vomiting, constipation, dry mouth); CNS effects (drowsiness, confusion, dizziness, headache, changes in mood); CV effects (bradycardia, tachycardia, palpitations) Large doses may cause resp depression/failure, renal failure, hypotension, deepening coma Special Instructions Avoid use in patients with acute respiratory depression, obstructive airway disease, acute alcoholism, convulsive disorder, head injuries, increased intracranial pressure, at risk of paralytic ileus, or in patients who require mental alertness (eg driving, operating machines) Use with caution in patients with hypothyroidism, asthma, renal or hepatic impairment, adrenocortical insufficiency, prostatic hyperplasia, hypotension, shock, inflammatory or obstructive bowel disease, myasthenia gravis

¹Combination with Paracetamol is available. Please see the latest MIMS for specific formulations and prescribing information.

Drug	Dosage	Remarks
Tacrolimus	3 mg PO 24 hourly	Adverse Reactions CNS effects (headache, tremor, paresthesia, hearing loss, visual disturbances, peripheral neuropathies, convulsions); CV effects (hypertension, cardiac arrest, heart failure, ventricular arrhythmias, palpitations, cardiomyopathies); GI effects (nausea, diarrhea, dyspepsia, constipation, GI hemorrhage and ulceration); Respiratory effects (dyspnea, parenchymal lung disorders, pleural effusions, cough, nasal congestion, pharyngitis, asthma); Dermatologic effects (acne, alopecia, skin rashes, pruritus); Musculoskeletal effects (muscle cramps, asthenia, arthralgia); Hematologic effects (pancytopenia, agranulocytosis, coagulation disorders); Other effects (renal impairment, hyperlipidemia, febrile disorders, edema, liver dysfunction) Potentially fatal: Polyoma virus infections, GI perforation Special Instructions Use with caution in patients with renal impairment and hepatic impairment, patient with risk factors for QT prolongation

All dosage recommendations are for non-pregnant and non-breastfeeding women and non-elderly adults with normal renal and hepatic function unless otherwise stated. 
Not all products are available or approved for above use in all countries. 
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs. 
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.