Malaise subcutaneous

Methotrexate, an antimetabolite, is indicated for moderate to severe psoriasis. It is particularly beneficial for psoriatic arthritis. It is also indicated for patients refractory to topical or UV therapy. Methotrexate can be administered orally, subcutaneously, or intramuscularly. The starting dose is 7.5 to 15 mg per week, increased incrementally by 2.5 mg every 2 to 4 weeks until response maximal doses are approximately 25 mg/wk. Adverse effects include nausea, vomiting, mucosal ulceration, stomatitis, malaise, headache, macrocytic anemia, and hepatic and pulmonary toxicity. Nausea and macrocytic anemia can be ameliorated by giving oral folic acid 1 to 5 mg/day. Methotrexate should be avoided in patients with active infections and in those with liver disease. It is contraindicated in pregnancy because it is teratogenic. 

Most cytokines (including TNF-o-, IFN-r, IL-2, G-CSF (filgrastim), and GM-CSF) have very short serum half-lives (minutes). The usual subcutaneous route of administration provides slower release into the circulation. Each cytokine has its own unique toxicity, but some toxicities are shared. Thus, IFN-n, IFN-B, IFN-r, IL-2, and TNF- all induce fever, flu-like symptoms, anorexia, fatigue, and malaise. 

Inactivated anthrax vaccine is mainly used for protection against occupational anthrax exposure. A complete vaccine series consists of three 0.5-ml subcutaneous doses at 2-week intervals, followed by three additional doses 6, 12, and 18 months after the first dose. Mild local reactions occur in 30% of vacci-nees, including local erythema and tenderness, which occurs within 24 hours and begins to subside within 48 hours. The reactions tend to increase in severity by the fifth injection. Systemic reactions are rare and usually characterized by malaise and lassitude, chills, and fever (1). 

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