http://www.nelm.nhs.uk/en/NeLM-Area/Evi ... psoriasis/
and in more detail...Adverse effects, including diarrhoea, abdominal pain and facial flushing, are common at the start of treatment with Fumaderm® and lead to discontinuation and/or non-compliance in 30 to 40% of patients. Reversible leucopenia, lymphopenia and transient eosinophilia are frequently observed
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Here's some info on the dosage of fumaderm used in psoriasis patients.Adverse effects are common when starting Fumaderm® and lead to discontinuation and/or non-compliance in 30 to 40% of patients [2]. Two thirds of patients experience gastrointestinal symptoms of diarrhoea, abdominal pain and flatulence and one third report facial flushing lasting minutes to hours, sometimes associated with headache [2,4]. These adverse effect rates occur despite initial use of low doses and gradual dose increases as recommended by the manufacturer [3]. Dose reduction may alleviate symptoms but Fumaderm® should be stopped if no improvement is seen [2]. Fumaderm® can be stopped abruptly as relapse or rebound phenomena do not occur [12,28].
Reversible leucopenia, lymphopenia and transient eosinophilia are also frequently observed [2]. Leucopenia occurs in a quarter of patients [8,29]. A reduction in lymphocyte count occurs in around 70% of patients [6,8,25,29] and can exceed 50% in about 10% of patients [4]. The dose of Fumaderm® should be reduced if lymphocytes fall below 0.5x109/L or leucocytes fall below 3.0x109/L; if blood counts improve, treatment can continue at the reduced dose, but otherwise Fumaderm® should be stopped [9]. It has been reported that patients with lymphopenia are significantly more likely to show improvement in psoriasis than those whose lymphocyte count stays within the normal range [6,22,24]. Eosinophilia occurring between the fourth and tenth week of treatment [28], in up to a third of patients, generally lasts for one to two months and resolves without intervention [6-8,14,17,22-24,29]. The clinical significance of these changes is not known but long-term follow-up of patients with haematological abnormalities does not suggest they are at an increased risk of infection or cancer [22,29].
Observational studies following patients for up to 14 years do not indicate that Fumaderm® causes serious or permanent adverse effects [6-8,18,19,22,29]. There have been rare case reports of patients developing acute renal failure or proteinuria when given Fumaderm® [1,2,4,10]. Some studies report raised serum creatinine and/or the presence of urinary protein in up to 30% of patients; in the majority of patients the changes were transient and needed no intervention [8,14,17,19,25,27,29]. Transient and/or reversible increases in liver enzymes and hypercholesterolaemia have also been reported [2,6-8,14,17,22,29]. It is recommended that kidney and liver function should be monitored regularly during treatment [3].
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NHEIt is available in two strengths, Fumaderm® Initial 105mg tablets and Fumaderm® 215mg tablets. Patients start on 105mg once daily and the dose is increased weekly by one tablet to a maximum of 1,290mg daily in three divided doses [3].