Arthritis Drug Information Sheets
by Victoria Ruffing, RN
Research Nurse in the Johns Hopkins Arthritis Center
- Leflunomide (Arava®)
- Ibandronate Sodium (Boniva®)
- Zolendronic Acid (Reclast®)
- Celecoxib (Celebrex®)
- Etanercept (Enbrel®)
- Infliximab (Remicade®)
- Rituximab (Rituxan®)
- Adalimumab (Humira®)
- Abatacept (Orencia™)
- Anakinra (Kineret®)
- Rofecoxib (Vioxx®) Removed from market on 9/30/04.
- Valdecoxib (Bextra®) Removed from market on 4/7/05
- Teriparatide (Forteo®)
- Alendronate (Fosamax®)
- Risedronate (Actonel®)
- Methotrexate
- Azathioprine (Imuran®)
- Prednisone
- Hyaluronate (Synvisc® & Hyalgan®)
- Narcotic Analgesics
- Non-Steroidal Anti-Inflammatory Drugs
- Hydroxychloroquine (Plaquenil®)
- Sulfasalazine (Azulfidine®)
*Print copy of Arava information sheet using Adobe Acrobat Reader. This can be downloaded at no cost.
What is Leflunomide (Arava®)?
Leflunomide is an anti-inflammatory agent used to treat rheumatoid arthritis and other inflammatory conditions. It works by suppressing the blood cells that cause inflammation. The brand name for this medicine is Arava®.
How do I take it?
Arava® is taken once a day. The pills are 10 or 20-mg. each and the usual dose is 20 mgs. per day. Sometimes a patient is given a "loading dose" when first beginning this drug. This is a high dose (100 mg.) over a short amount of time (3 days). Follow your doctor’s directions. Do not take more or less medicine than ordered. This medicine can be taken with food.
What else should I know?
Arava® may cause birth defects in the children of both men and women taking this drug. If you are pregnant or considering having a child, discuss this with your doctor before beginning this medication. Use of an effective form of birth control is critical throughout the course of this treatment and for months after it is stopped.
Arava® can cause mild liver irritation. Please tell you doctor if you have a history of any alcohol abuse, hepatitis, yellow jaundice, or liver disease. While on Arava® you must limit yourself to 2 alcoholic beverages per week.
Diarrhea may occur after starting medication but this generally is mild and goes away over time. You may take over the counter imodium or kaopectate. Notify your doctor if the diarrhea is severe or does not get better.
Although Arava® does not cause increased susceptibility to infections, your doctor may want to stop methotrexate if you develop a serious infection. Notify your doctor if you have signs or symptoms of an infection.
When you are taking Arava®, it is very important that your doctors know if you are taking any other medicine. This includes prescription and non-prescription medicines as well as birth control pills, vitamins, and herbal supplements.
*Print copy of Boniva information sheet using Adobe Acrobat Reader. This can be downloaded at no cost.
What is Ibandronate Sodium (Boniva®)?
Ibandronate Sodium is used to treat or prevent osteoporosis. Osteoporosis is a disease which causes bones to become thin. You are at risk for osteoporosis if you are:
Thin |
Do not exercise |
|
Smoke |
Drink alcohol often |
|
Caucasian |
Do not get enough calcium or vitamin D |
|
Going through or past menopause |
Have a family history of osteoporosis |
|
Take or have taken bone thinning medications like prednisone |
||
How do I take it?
Ibandronate Sodium may be taken by mouth or make be given as an injection. Ibandronate Sodium tablets are taken once a month. Take the tablet first thing in the morning before you have had anything to eat or drink. Swallow the tablet with plain water only. Do no chew or crush the tablet. After taking Ibandronate Sodium wait one hour before: eating or drinking, lying down, taking other medications.
Ibandronate Sodium injections are taken every three months. The injection must be administered by a health care professional.
You should not take Ibandronate Sodium if you are pregnant, breast feeding, have kidney problems, or have low blood calcium. If you cannot sit or stand for at least 1 hour, you should not take the tablet form of this medication.
What about side effects?
The most common side effects with the injection are bone, muscle and joint pains, flu like illness and headache. The flu like symptoms generally disappears after 24-48 hours and usually occurs only after the first injection. The most common side effects with the pill are diarrhea, pain in the extremities, and upset stomach. Less common side effects may be pain or trouble swallowing, heartburn and stomach ulcers.
Rarely patients have reported severe bone, joint and muscle pain that begins from 1 day to one month after starting any bisphosphonate, including Ibandronate Sodium. Most patients report relief from these symptoms after stopping the medication.
In rare cases some patients have experienced jaw problems when taking bisphosphonates including Ibandronate Sodium. This included delayed healing and infection.
What about other medications?
Do not take other medications within 1 hour of taking the Ibandronate Sodium pill.
What else should I know?
Contact your doctor if you have any questions about this or any of your medications. Contact your doctor if you experience any troubling side effects.
Zolendronic Acid (Reclast®)
*Print copy of Reclast information sheet using Adobe Acrobat Reader. This can be downloaded at no cost.
What is Zolendronic acid (Reclast®)?
Zolendronic acid is used to treat or prevent osteoporosis. Osteoporosis is a disease which causes bones to become thin. You are at risk for osteoporosis if you are:
Thin |
Do not exercise |
|
Smoke |
Drink alcohol often |
|
Caucasian |
Do not get enough calcium or vitamin D |
|
Going through or past menopause |
Have a family history of osteoporosis |
|
Take or have taken bone thinning medications like prednisone |
||
How do I take it?
Zolendronic acid is given as an infusion (through a vein in your arm) lasting 15 minutes. You should drink 2 glasses of fluid at least one hour before receiving your infusion. You may eat normally before your infusion. Zolendronic acid infusions are once a year. The infusion must be administered by a health care professional.
You should not take Zolendronic acid if you are pregnant, breast feeding, have kidney problems, or have low blood calcium.
What about side effects?
The most common side effects with the injection are bone, muscle and joint pains, flu like illness and headache. The flu like symptoms generally disappears after 24-48 hours and usually occurs only after the first injection. The most common side effects with the pill are diarrhea, pain in the extremities, and upset stomach. Less common side effects may be pain or trouble swallowing, heartburn and stomach ulcers.
Rarely patients have reported severe bone, joint and muscle pain that begins from 1 day to one month after starting any bisphosphonate, including Zolendronic acid. Most patients report relief from these symptoms after stopping the medication.
In rare cases some patients have experienced jaw problems when taking bisphosphonates including Zolendronic acid. This included delayed healing and infection.
What about other medications?
Some medicines may cause low blood calcium levels or may harm your kidneys if taken with Zolendronic acids. Tell your doctor if you are taking Zometa, a diuretic or “water pill”, or an antibiotic. Take your calcium and vitamin D as recommended by your doctor.
What else should I know?
Your doctor may order bone density tests to follow your osteoporosis. Contact your doctor if you have any questions about this or any of your medications. Contact your doctor if you experience any troubling side effects.
*Print copy of Celebrex information sheet using Adobe Acrobat Reader. This can be downloaded at no cost.
What is Celecoxib (Celebrex®)?
Celecoxib is commonly known by the brand name Celebrex®. Celecoxib (Sell-e-COX-eb) is used to relieve some symptoms caused by arthritis, such as inflammation, swelling, stiffness, and joint pain. However, this medicine does not cure arthritis and will help you only as long as you continue to take it.
How do I take it?
Celecoxib is taken once or twice a day. The pills are100 or 200mg. each. The usual dose is 200 to 400-mg. per day. This drug is used for both rheumatoid arthritis and osteoarthritis. You doctor will tell you how many pills to take and how often. Follow your doctor’s directions. For the best results, take these pills at the same time every day. Do not take more or less medicine than ordered. This medicine may be taken with or without food.
What else should I know?
Celecoxib is less likely to cause stomach upset and ulcers than NSAIDS. However, in some cases patients have complained of upset stomachs, indigestion, or diarrhea. Stomach problems may be more likely to occur if you drink alcoholic beverages while being treated with this medicine. IF YOU HAVE A KNOWN ALLERGY TO SULFA DRUGS, DO NOT TAKE THIS MEDICINE UNTIL YOU TALK TO YOUR DOCTOR.
What about other medications?
When you are taking Celecoxib, it is very important that your doctors know if you are taking any other medicine. This includes prescription and non-prescription medicines as well as vitamins and herbal supplements.
Celecoxib can be taken with other medications, however it is best to have your doctor’s advice before adding another drug to your daily routine.
*Print copy of Enbrel information sheet using Adobe Acrobat Reader. This can be downloaded at no cost.
What is Etanercept (Enbrel®)?
Etanercept is injected under the skin to reduce signs and symptoms of rheumatoid arthritis, such as joint swelling, pain, fatigue, and length of morning stiffness. Etanercept is commonly known as Enbrelâ.
How do I take it?
Etanercept is injected under the skin (similar to insulin injections) once a week. The injections are 50 mg each and are available in either a prefilled syringe or an automatic “pen” injector. You will be instructed on how to give yourself injections. This medication must be refrigerated. Do not freeze this medicine.
What about side effects?
The most common side effect is serious infection. Etanercept can lower the body’s ability to fight infection. Be sure to contact your physician if you have any type of infection or if you are planning a surgery. You may have to stop etanercept while being treated for an infection.
You will need to have a negative tuberculosis (TB) skin test before beginning etanercept therapy.
You should not take a live vaccine (Flu-Mist, chicken pox vaccine, shingles vaccine) while on abatacept. The flu-shot is not a live virus and all patients should consider having this vaccination yearly.
Occasionally some patients develop a reaction at the injection site such as, redness, pain or swelling. Notify your doctor to find out the best way to handle any reactions.
What about other medications?
When you are taking Etanercept, it is very important that your doctors know if you are taking any other medicine. This includes prescription and non-prescription medicines as well as birth control pills, vitamins, and herbal supplements. Etanercept can be taken with other medications – NSAIDS (Celebrexâ, ibuprofen, naproxen), prednisone, methotrexate, and plaquenil.
What else should I know?
You must continue your regular visits to the rheumatologist. Your doctor will monitor you for any improvements in your rheumatoid arthritis and for any signs of infections. Most patients notice an improvement in symptoms after the first or second injection.
*Print copy of Remicade information sheet using Adobe Acrobat Reader. This can be downloaded at no cost.
What is Infliximab (Remicade®)?
Infliximab is used to reduce signs and symptoms of rheumatoid arthritis, such as joint swelling, pain, tiredness, and duration of morning stiffness. The brand name for Infliximab is Remicade®. You will also take Methotrexate while on Infliximab.
How do I take it?
Infliximab is an infusion (intravenous medication). After you receive your first dose you will get your second dose 2 weeks later and the third dose 4 weeks after the second dose. The maintenance dose begins after the third dose. The infusion for maintenance is every 8 weeks.
What else should I know?
Infliximab works quickly. Patients, who respond to infliximab, generally feel better within 2 weeks of starting therapy. The infusion usually takes about 2 hours. Occasionally patients have a reaction to the infusion. These reactions are usually treated with Tylenol or Benadryl. Blood work will be done every 4-8 weeks to check your liver function since you will still be on Methotrexate.
Notify your doctor if you have any signs or symptoms of a serious infection, such as high fever, pneumonia, sinus infection or kidney infection.
What about other medications?
When you are taking Infliximab, it is very important that your doctors know if you are taking any other medicine. This includes prescription and non-prescription medicines as well as birth control pills, vitamins, and herbal supplements.
Infliximab will be taken with methotrexate. Your doctor will advise you on other medications.
*Print copy of Rituxan information sheet using Adobe Acrobat Reader. This can be downloaded at no cost.
What is Rituximab (Rituxan®)?
Rituximab is used to reduce signs and symptoms of moderate to severe rheumatoid arthritis (RA), such as joint swelling, pain, and fatigue. Your doctor has prescribed Rituximab because you have not had an adequate response to other RA medications. Rituximab works by reducing specific cells that may be responsible for the pain and inflammation seen in RA. The brand name for Rituximab is Rituxan®.
How do I take it?
Rituximab is an infusion (intravenous medication). A course of treatment is 2 separate IV infusions of Rituximab 2 weeks apart. You will receive a dose of corticosteroids by IV before your dose of Rituximab. This is to help prevent any side effects during the infusion. Your vital signs (blood pressure, heart rate, etc) will be monitored by nurses while you receive the medication. The infusion lasts about 4½ hours. Many people will require another course of treatment about 6 months after the first course. Your doctor will monitor your RA activity and help your decide when and if you need another course of treatment.
What about side effects?
The most common side effect is a reaction during your infusion. The medication you receive before your infusion will help to prevent any type of reaction. Another side effect is infection. Rituxan can lower the body’s ability to fight infection. Be sure to contact your physician if you have any type of infection or if you are planning a surgery.
Make sure your doctor knows if you have ever had Hepatitis B or Hepatitis C. Hepatitis B can be reactivated by Rituximab. You should not take Rituximab if you have ever had Hepatitis B.
You should not take a live vaccine (Flu-Mist, chicken pox vaccine, shingles vaccine) while on abatacept. The flu-shot is not a live virus and all patients should consider having this vaccination yearly. It is unknown if immunizations are as effective in patients receiving Rituximab. If possible you may want to complete any immunization series before starting this medication.
What about other medications?
Never take Rituximab with any TNF blocker such as HumiraÒ, EnbrelÒ, or RemicadeÒ.
When you are taking Rituximab, it is very important that your doctors know if you are taking any other medicine. This includes prescription and non-prescription medicines as well as birth control pills, vitamins, and herbal supplements.
What else should I know?
You must continue your regular visits to the rheumatologist. Your doctor will monitor you for any improvements in your rheumatoid arthritis. It may take 2 months before any improvement in symptoms occurs.
*Print copy of Humira information sheet using Adobe Acrobat Reader. This can be downloaded at no cost.
What is Adalimumab (Humira™)?
Adalimumab is in a class of drugs called biologics. Adalimumab is injected under the skin to reduce signs and symptoms of rheumatoid arthritis, such as joint swelling, pain, fatigue, and length of morning stiffness. It is also approved for treatment of Psoriatic arthritis and ankylosing spondylitis. Adalimumab is commonly known as Humira™.
How do I take it?
Adalimumab is injected under the skin (similar to insulin injections) once every other week. The injections are 40 mg each and are available in either a prefilled syringe or an automatic “pen” injector. You will be instructed on how to give yourself injections. This medication must be refrigerated. Do not freeze this medicine.
What about side effects?
The most common side effect is serious infection. Adalimumab can lower the body’s ability to fight infection. Be sure to contact your physician if you have any type of infection or if you are planning a surgery. You may have to stop Adalimumab while being treated for an infection.
You will need to have a negative tuberculosis (TB) skin test before beginning Adalimumab therapy.
You should not take a live vaccine (Flu-Mist, chicken pox vaccine, shingles vaccine) while on abatacept. The flu-shot is not a live virus and all patients should consider having this vaccination yearly.
Occasionally some patients develop a reaction at the injection site such as, redness, pain or swelling. Notify your doctor to find out the best way to handle any reactions.
What about other medications?
When you are taking Adalimumab, it is very important that your doctors know if you are taking any other medicine. This includes prescription and non-prescription medicines as well as birth control pills, vitamins, and herbal supplements. Adalimumab can be taken with other medications – NSAIDS (Celebrexâ, ibuprofen, naproxen), prednisone, methotrexate, and plaquenil.
What else should I know?
You must continue your regular visits to the rheumatologist. Your doctor will monitor you for any improvements in your disease and for any signs of infections. Most patients notice an improvement in symptoms after the first or second injection.
Abatacept (Orencia™)
*Print copy of Orencia information sheet using Adobe Acrobat Reader.
What is Abatacept (Orencia™)?
Abatacept is used to reduce signs and symptoms of moderate to severe rheumatoid arthritis, such as
joint swelling, pain, and fatigue. Your doctor has prescribed Abatacept because you have not had an
adequate response to other RA medications. The brand name for Abatacept is Orencia™.
How do I take it?
Abatacept is an infusion (intravenous medication). After you receive your first dose you will get
your second dose 2 weeks later and the third dose at 4 weeks. The maintenance dose begins after the
third dose. The infusion for maintenance is every 4 weeks. The infusion takes about 30 minutes.
What about side effects?
The most common side effect is serious infection. Abatacept can lower the body’s ability to fight
infection. Be sure to contact your physician if you have any type of infection or if you are planning
a surgery. You may have to stop abatacept while being treated for an infection.
You will need to have a negative tuberculosis (TB) skin test before beginning abatacept therapy.
Make sure your doctor knows if you have chronic obstructive pulmonary disease (COPD), as your
condition could worsen.
You should not take a live vaccine (Flu-Mist, chicken pox vaccine, shingles vaccine) while on
abatacept. The flu-shot is not a live virus and all patients should consider having this vaccination
yearly.
What about other medications?
Never take Abatacept with any TNF blocker such as Humira®, Enbrel®, or Remicade®.
When you are taking Abatacept, it is very important that your doctors know if you are taking any
other medicine. This includes prescription and non-prescription medicines as well as birth control
pills, vitamins, and herbal supplements.
What else should I know?
You must continue your regular visits to the rheumatologist. Your doctor will monitor you for any
improvements in your rheumatoid arthritis and for any signs of infections. It may take 2 months of
Abatacept treatment before any improvement in symptoms occurs.
*Print copy of Kineret information sheet using Adobe Acrobat Reader. This can be downloaded at no cost.
What is Anakinra (Kineret®)?
Anakinra is injected under the skin to reduce signs and symptoms of rheumatoid arthritis, such as joint swelling, pain, tiredness, and duration of morning stiffness. Anakinra is commonly known as Kineret® and is an IL-1 inhibitor.
How do I take it?
Anakinra is injected under the skin (similar to insulin injections) every two week. The injections are 100-mg. each. You will be instructed on how to give yourself injections. You should make sure you have a complete understanding of how to prepare and give the injection, and how to dispose of the empty syringes before beginning this treatment. Do not take more or less medicine than ordered. THIS MEDICATION MUST BE REFRIGERATED. Do not freeze this medicine.
What else should I know?
Inform your doctor if you have a history of recurring infections. Your physician will do periodic blood tests to check your blood counts. Let your doctor know if you have a latex allergy, (syringes and gloves contain latex products). You will be monitored periodically to check the effectiveness of this treatment. Your doctor may want to stop Kineret if you develop a serious infection.
Notify your doctor if you have any signs or symptoms of a serious infection, such as high fever, pneumonia, sinus infection or kidney infection.
What about other medications?
When you are taking Anakinra, it is very important that your doctors know if you are taking any other medicine. This includes prescription and non-prescription medicines as well as birth control pills, vitamins, and herbal supplements.
Anakinra can be taken with other medications - NSAIDS (Celebrex®, Vioxx®, ibuprofen, naproxen), prednisone, methotrexate, and plaquenil. It cannot be taken with TNF inhibitors, such as Enbrel®, Remicade®, and Humira™.
The makers of VIOXX® removed this drug from the market on 9/30/04.
What is Rofecoxib (Vioxx®)?
Rofecoxib is commonly known by the brand name Vioxx®. Rofecoxib (Ro-fe-COX-eb) is used to relieve some symptoms caused by arthritis, such as inflammation, swelling, stiffness, and joint pain. However, this medicine does not cure arthritis and will help you only as long as you continue to take it.
How do I take it?
Rofecoxib is taken once a day. The pills are 12.5mg. or 25mg. each. This drug is used for both rheumatoid arthritis and osteoarthritis. You doctor will tell you how many pills to take and how often. Follow your doctor’s directions. For the best results, take these pills at the same time every day. Do not take more or less medicine than ordered. This medicine may be taken with or without food.
What else should I know?
Rofecoxib is less likely to cause stomach upset and ulcers than NSAIDS. However, in some cases patients have complained of upset stomachs, indigestion, or diarrhea. Stomach problems may be more likely to occur if you drink alcoholic beverages while being treated with this medicine.
What about other medications?
When you are taking Rofecoxib, it is very important that your doctors know if you are taking any other medicine. This includes prescription and non-prescription medicines as well as birth control pills, vitamins, and herbal supplements.
Rofecoxib should not be taken with other NSAIDS (Celebrex®, Vioxx®, ibuprofen, naproxen), however, if you are on low dose aspirin therapy, this should be continued. The addition of any new medication should always be discussed with you doctor.
*Print copy of Bextra information sheet using Adobe Acrobat Reader. This can be downloaded at no cost.
What is Valdecoxib (Bextra®)?
Valdecoxib is commonly known by the brand name Bextra®. Valdecoxib (val-de-COX-eb) is used to relieve some symptoms caused by arthritis, such as inflammation, swelling, stiffness, and joint pain. However, this medicine does not cure arthritis and will help you only as long as you continue to take it.
How do I take it?
Valdecoxib is taken once a day. The pills are 10-mg. or 20-mg. each. This drug is used for both rheumatoid arthritis and osteoarthritis. You doctor will tell you how many pills to take and how often. Follow your doctor’s directions. For the best results, take these pills at the same time every day. Do not take more or less medicine than ordered. This medicine may be taken with or without food.
What else should I know?
You should stop taking Valdecoxib and call your doctor if you develop a skin rash. Valdecoxib is less likely to cause stomach upset and ulcers than NSAIDS. However, in some cases patients have complained of upset stomachs, indigestion, or diarrhea. Stomach problems may be more likely to occur if you drink alcoholic beverages while being treated with this medicine. IF YOU HAVE A KNOWN ALLERGY TO SULFA DRUGS, DO NOT TAKE THIS MEDICINE.
What about other medications?
When you are taking Valdecoxib, it is very important that your doctors know if you are taking any other medicine. This includes prescription and non-prescription medicines as well as birth control pills, vitamins, and herbal supplements.
Valdecoxib should not be taken with other NSAIDS (Celebrex®, ibuprofen, naproxen), however, if you are on low dose aspirin therapy, this should be continued. The addition of any new medication should always be discussed with you doctor.
*Print copy of Forteo information sheet using Adobe Acrobat Reader. This can be downloaded at no cost.
What is Teriparatide (Forteo®)?
Teriparatide is commonly known by the brand name Forteo®. Forteo® is used in the treatment of osteoporosis. Forteo is a synthetic form of parathyroid hormone (PTH), which is naturally found in the body, that stimulates the formation of new bone and leads to increased bone mineral density.
How do I take it?
Forteo® is administered by injection once a day in the thigh or abdomen. The recommended dose is 20 mcg per day. Follow your doctor’s directions.
What else should I know?
Persons with elevated calcium levels, women who are pregnant or nursing, or persons who have ever been diagnosed with bone cancer or other cancers that have spread to the bones, should not use Forteo®. Because long-term treatment effects are not known at this time, therapy for more than two years is not recommended. In animal studies, there was an increase in bone cancer. Although this was not found in humans treated with Forteo®, increased risk of developing this cancer cannot be ruled out.
What about other medications?
When you are taking Forteo®, it is very important that your doctors know if you are taking any other medicine. This includes prescription and non-prescription medicines as well as vitamins and herbal supplements.
*Print copy of Fosamax® information sheet using Adobe Acrobat Reader. This can be downloaded at no cost.
What is Alendronate (Fosamax®)?
Alendronate is commonly known by the brand name Fosamax®. Fosamax® is a bisphosphonate and is used in the treatment of osteoporosis. Fosamax® decreases the rate bone cells are absorbed. This reduced absorption allows the body to increase bone density, which in turn reduces the risk of fracture.
How do I take it?
Fosamax® is taken once weekly or once daily. The pills are available in 5 mg, 10mg, 35 mg, 40 mg, and 70 mg strength. The usual dosage for osteoporosis prevention is 35 mg once weekly, or 5 mg once daily. The usual dosage for osteoporosis treatment is 70 mg once weekly, or 10 mg once daily. You doctor will tell you how many pills to take and how often. Follow your doctor’s directions. For the best results, take these pills at the same time every day. Take it on an empty stomach with a full glass of water, at least two hours after, or a full half hour before eating. Do not take it in combination with other medications or any vitamin or food supplements. DO NOT LIE DOWN FOR A FULL HALF HOUR TO REDUCE THE RISK OF UNWANTED SIDE EFFECTS.
What else should I know?
Fosamax® may cause irritation or ulceration of the esophagus, however, this is very unlikely if you are able to stand or sit upright for at least 30 minutes after taking the medication. Individuals with untreated calcium deficiency or esophageal disease should not use this treatment. Do not use Fosamax® if you are pregnant or nursing.
What about other medications?
When you are taking Fosamax®, it is very important that your doctors know if you are taking any other medicine. This includes prescription and non-prescription medicines as well as vitamins and herbal supplements.
Fosamax® treatment should be taken on its own without any other medications, and you must wait at least 30 minutes before taking other drugs. It is best to have your doctor’s advice before adding another medication to your daily routine.
*Print copy of Actonel® information sheet using Adobe Acrobat Reader. This can be downloaded at no cost.
What is Risedronate (Actonel®)?
Risedronate is commonly known by the brand name Actonel®. Actonelâ is a bisphosphonate and is used in the prevention and treatment of osteoporosis. Actonel decreases the rate bone cells are absorbed. This reduced absorption allows the body to increase bone density, which in turn reduces the risk of fracture.
How do I take it?
Actonel® is taken once weekly or once daily. Pills are available in 5mg, 30mg, and 35mg strength. The usual dosage for osteoporosis prevention and treatment is 35 mg once weekly, or 5 mg once daily. You doctor will tell you how many pills to take and how often. Follow your doctor’s directions. For the best results, take these pills at least 30 minutes before the FIRST food or drink of the day with a full glass of water (6 to 8oz.). Do not take it in combination with other medications or any vitamin or food supplements. DO NOT LIE DOWN FOR A FULL HALF HOUR TO REDUCE THE RISK OF UNWANTED SIDE EFFECTS.
What else should I know?
Actonel® may cause irritation or ulceration of the esophagus, however, this is very unlikely if you are able to stand or sit upright for at least 30 minutes after taking the medication. Individuals with untreated calcium deficiency or with severe renal impairment should not use this treatment. The effects of Actonel® during pregnancy or while nursing are unclear and should be discussed with your doctor.
What about other medications?
When you are taking Actonel®, it is very important that your doctors know if you are taking any other medicine. This includes prescription and non-prescription medicines as well as vitamins and herbal supplements.
Actonel® treatment should be taken on its own without any other medications, and you must wait at least 30 minutes before taking other drugs. It is best to have your doctor’s advice before adding another medication to your daily routine.
*Print copy of Methotrexate information sheet using Adobe Acrobat Reader. This can be downloaded at no cost.
What is Methotrexate?
Methotrexate is an anti-inflammatory agent used to treat rheumatoid arthritis and other inflammatory conditions. It works by suppressing the blood cells that cause inflammation. It is a chemotherapy agent used to treat cancer, but in 1988, the FDA approved it to be used by rheumatoid arthritis patients (in much lower doses). Nearly 60% of all rheumatoid arthritis patients are currently on or have been on methotrexate.
How do I take it?
Methotrexate is taken ONCE A WEEK. The pills are 2.5mg. each and the usual dose is 3 to 10 pills. The pills are taken together as a single dose on the same day each week (for example-every Friday). Follow your doctor’s directions. Do not take more or less medicine than ordered. This medicine can be taken with food. You should also take 1 mg. of folate (folic acid) each day. This will help prevent side effects.
What else should I know?
Methotrexate has caused mouth ulcers in a few patients, in the beginning of treatment. This should go away with time. Another possible side effect is nausea and vomiting. Your doctor should be informed if any of the side effects are bothersome. Methotrexate can cause mild liver irritation. Please tell you doctor if you have a history of any alcohol abuse, hepatitis, yellow jaundice, or liver disease. While on methotrexate you must limit yourself to 2 alcoholic beverages per week. Blood work will be done every 4-8 weeks to check your liver function. This blood work will also include a complete blood count (CBC) since methotrexate can also cause a decrease in blood counts.
Although methotrexate does not cause increased susceptibility to infections, your doctor may want to stop methotrexate if you develop a serious infection. Notify your doctor if you have signs or symptoms of an infection.
Methotrexate may cause birth defects in the children of both men and women taking this drug. If you are pregnant or considering having a child, discuss this with your doctor before beginning this medication. Use of an effective form of birth control is critical throughout the course of this treatment and for months after it is stopped.
What about other medications?
When you are taking methotrexate, it is very important that your doctors know if you are taking any other medicine. This includes prescription and non-prescription medicines as well as birth control pills, vitamins, and herbal supplements.
Methotrexate can be taken with other medications - NSAIDS (Celebrex®, Vioxx®, ibuprofen, naproxen), prednisone, Enbrel, plaquenil. You should not take methotrexate while taking any medicine containing trimethoprim-sulfa (Bactrim®, Sulfatrim®, etc...).
*Print copy of the Imuran information sheet using Adobe Acrobat Reader. This can be downloaded at no cost.
What is Azathioprine (Imuran®)?
Azathioprine is an anti-inflammatory agent used to treat rheumatoid arthritis and other inflammatory conditions. It works by suppressing the blood cells that cause inflammation. Azathioprine is used to reduce signs and symptoms of rheumatoid arthritis, such as joint swelling, pain, tiredness, and duration of morning stiffness. Azathioprine is commonly known by the brand name Imuran®.
How do I take it?
Azathioprine is available in 50 mg tablets. These should be taken with a meal to reduce stomach upsets. It may be prescribed as a single dose or to be taken twice a day. Your doctor may start you at a low dose, which will be increased over time until you feel better.
What else should I know?
It can take up to 8-12 weeks after you start taking azathioprine for you to see improvement in your arthritis. The most common side effect is nausea. Itchy rashes, a sore mouth or throat and mouth ulcers may occur. Blood work will have to be done every 4-8 weeks to monitor your blood counts. Azathioprine can cause mild liver irritation. Please tell your doctor if you have a history of any alcohol abuse, hepatitis, yellow jaundice, or liver disease. While on Azathioprine your doctor may limit your alcoholic beverage intake.
Azathioprine can suppress your immune system making you more susceptible to infection. Notify your doctor if you have signs or symptoms of an infection and avoid people with contagious diseases.
Azathioprine may cause birth defects in children of women taking this drug. If you are pregnant or considering having a child, discuss this with your doctor before beginning this medication. Use of an effective form of birth control is critical throughout the course of this treatment and for months after it is stopped. Breast-feeding while taking Azathioprine is not recommended.
What about other medications?
When you are taking azathioprine, it is very important that your doctors know if you are taking any other medicine. This includes prescription and non–prescription medicines as well as birth control pills, vitamins, and herbal supplements.
Allopurinol (a common gout medicine) may increase azathioprine's levels in your body. Please tell your doctor if you are taking allopurinol so that the dose of azathioprine can be properly adjusted. Aminosalicylates (olsalazine, mesalamine, sulfasalazine) may interfere with azathioprine and should be discussed with your doctor before beginning treatment.
Corticosteroids (i.e. Prednisone)
*Print copy of Corticosteroid information sheet using Adobe Acrobat Reader. This can be downloaded at no cost.
What are corticosteroids?
Corticosteroids are hormones naturally found in the body. Additional corticosteroids are given to lessen swelling and redness, and provide relief for inflamed areas such as joints. One commonly known brand name is prednisone. This medicine does not cure arthritis and will help you only as long as you continue to take it.
How do I take it?
Corticosteroids are taken daily. This drug is used for both rheumatoid arthritis and osteoarthritis. The dose for this medicine is dependent on the patient needs. Your doctor will tell you how many pills to take and how often. Follow your doctor’s directions. For the best results, take these pills at the same time every day. Do not take more or less medicine than ordered. This medicine may be taken with or without food.
What else should I know?
Corticosteroids have side effects, especially if high doses are taken for a long time. Upset stomach, bloating, increased appetite, and weight gain, are the most common side effects. Long-term use can also lead to bone loss or osteoporosis. Your doctor will monitor you frequently. Report any unpleasant effects to your doctor. You may want to watch your calorie intake to prevent excessive weight gain. It is also a good idea to limit your salt intake.
What about other medications?
When you are taking corticosteroids, it is very important that your doctors know if you are taking any other medicine. This includes prescription and non-prescription medicines as well as vitamins and herbal supplements.
Corticosteroids can be taken with other medications, however it is best to have your doctor’s advice before adding another drug to your daily routine.
Hyaluronate (Synvisc® & Hyalgan®)
*Print copy of Hyaluronate information sheet using Adobe Acrobat Reader. This can be downloaded at no cost.
What is Hyaluronate?
Hyaluronate (hye-a-loo-ROE-nate) is similar to cartilage, the natural substance that lubricates and acts as a shock absorber in the joints. It is injected into the joint to replace worn out cartilage and reduce pain from arthritis. Hyaluronate is commonly known as Hyalgan and Synvisc. This is not a cure for arthritis, but may delay the need for joint replacement.
How do I take it?
Hyaluronate is injected into the joint once a week for 3 consecutive weeks. The injections are 16mg. each. Your doctor will see you one week apart for 3 weeks to give the injection.
What else should I know?
You should limit any strenuous activity for 2 days after each injection. Strenuous activity is anything that puts heavy weight or pressure on your legs for more than one hour. Examples of strenuous activity are jogging, tennis, standing. If pain, redness, or swelling occur at the site of the injection, please contact your doctor.
What about other medications?
It is very important that your doctors are aware of all the medicines you take. This includes prescription and non-prescription medicines as well as birth control pills, vitamins and herbal supplements.
Hyaluronate can be taken with other medications - NSAIDS (Celebrex®, Vioxx®, ibuprofen, naproxen), prednisone, methotrexate, and plaquenil.
*Print copy of Narcotic Analgesics information sheet using Adobe Acrobat Reader. This can be downloaded at no cost.
What are Narcotic Analgesics?
Narcotic or opioid analgesics are pain relievers. They are usually combined with either acetaminophen or aspirin to provide more effective pain relief. Some common brand names are: Percocet®, Darvon®, oxycodone, oxycontin, Tylenol® with codeine, Tylox®, and Lortab®. These medicines are generally used for a short period of time for control of acute pain.
How do I take it?
The dose for these medicines is different for each person. This drug is used for both rheumatoid arthritis and osteoarthritis. The number of capsules or tablets that you take depends on the strength of the medicine and on the amount of pain you are having. Your doctor will tell you how many pills to take and how often. Follow your doctor’s directions. For the best results, take these pills at the same time every day. Do not take more or less medicine than ordered.
How do I take it?
Do not drink alcoholic beverages, and check with your doctor before taking any other medicines while you are using this medicine. This medicine can be habit forming if not taken correctly. This medicine may cause some people to become drowsy, dizzy, or lightheaded. Make sure you know how this medicine will affect you before you drive, use machines, or do anything else that could be dangerous. Nausea or vomiting may occur, especially after the first couple of doses. This effect may go away if you lie down for a while. These medicines can also cause dry mouth and/or constipation. A stool softener such as colace or pericolace, can be added if necessary. Your water intake should be increased. Hard candy can help ease the symptoms of dry mouth.
What about other medications?
When you are taking narcotics, it is very important that your doctors know if you are taking any other medicine. This includes prescription and non-prescription medicines as well as vitamins and herbal supplements.
Narcotics can be taken with other medications, however it is best to have your doctor’s advice before adding another drug to your daily routine. Some combinations of drugs can be dangerous or ineffective.
Non-Steroidal Anti-inflammatory Drugs
*Print copy of NSAIDs information sheet using Adobe Acrobat Reader. This can be downloaded at no cost.
What is a Non-Steroidal Anti-inflammatory drug?
A non-steroidal anti-inflammatory drug or NSAID is used to relieve some symptoms caused by arthritis, such as inflammation, swelling, stiffness, and joint pain. There are many NSAIDS on the market, available by prescription or over the counter. Some common names are Motrin®, Advil®, Aleve®, Voltaren®, and Indocin®.
How do I take it?
This medicine should also be taken with food. Follow your doctor’s directions. Do not take more or less medicine than ordered. Do not lie down for 15 to 30 minutes after taking this medicine. This will help prevent irritation and possible swallowing problems.
What else should I know?
These medicines should be taken regularly in order to be most effective. When first beginning on NSAIDS, it may take 2 weeks or more to get the maximum benefit. Please tell you doctor if you are to have any type of surgery, including dental work. Sometimes these drugs may be stopped for a short time prior to surgery.
NSAIDS can cause irritation to the lining of the esophagus, stomach, and intestine. Notify your doctor if you notice any black or bloody stools, chronic indigestion or heartburn, or vomiting of blood or "coffee ground" like material.
What about other medications?
When you are taking NSAIDS, it is very important that your doctors know if you are taking any other medicine. This includes prescription and non-prescription medicines as well as birth control pills, vitamins, and herbal supplements.
NSAIDS can be taken with other medications - but should not be taken with other blood thinners such as heparin, or other anti-coagulants. Please inform your doctor if you are taking any of these types of medicines.
Hydroxychloroquine (Plaquenil®)
*Print copy of Plaquenil information sheet using Adobe Acrobat Reader. This can be downloaded at no cost.
What is Hydroxychloroquine (Plaquenil®)?
Hydroxychloroquine is used in the treatment of arthritis to help relieve inflammation, swelling, stiffness, and joint pain and also to help control the symptoms of lupus erythematosus (lupus; SLE). A common brand name for hydroxychloroquine is Plaquenil®. This medicine was originally used to prevent and to treat malaria.
How do I take it?
Hydroxychloroquine is usually taken twice daily. The pills are 200-mg. each. The usual dose is 1 or 2 pills daily. This medicine should be taken at the same time every day. It will take 1 to 2 months to begin working. Follow your doctor’s directions. Do not take more or less medicine than ordered. This medicine should be taken with food or milk.
What else should I know?
Rarely, Hydroxychloroquine can cause vision problems. Your doctor may want you to have an eye exam before beginning this medication. You will then have an eye exam yearly with an ophthalmologist to check for any changes in the back of the eye. Notify your doctor if you experience any blurred vision or see black spots.
What about other medications?
When you are taking Hydroxychloroquine, it is very important that your doctors know if you are taking any other medicine. This includes prescription and non-prescription medicines as well as birth control pills, vitamins, and herbal supplements.
Hydroxychloroquine can be taken with other medications - NSAIDS (Celebrex®, Vioxx®, ibuprofen, naproxen), prednisone, Enbrel®.
*Print copy of Sulfasalazine information sheet using Adobe Acrobat Reader. This can be downloaded at no cost.
What is Sulfasalazine?
Sulfasalazine is commonly known by the brand name Azulfidineâ. Sulfasalazine (Sul-fa-SAL-a-zeen) is an anti-inflammatory agent used to treat rheumatoid arthritis and other inflammatory conditions. It works by suppressing the blood cells that cause inflammation.
How do I take it?
Sulfasalazine is taken twice daily. The pills are 500-mg. each. The usual dose for this drug is 2 to 6 pills daily. You doctor will tell you how many pills to take and how often. Follow your doctor’s directions. For the best results, take these pills at the same time every day. Do not take more or less medicine than ordered. This medicine should be taken with food. You should also drink a full glass of water with each dose.
What else should I know?
Sulfasalazine is less likely to cause gastric upset and ulcers than NSAIDS. However, in some cases patients have complained of upset stomachs, indigestion, or diarrhea. Stomach problems may be more likely to occur if you drink alcoholic beverages while being treated with this medicine. This medicine can occasionally affect the liver and some blood counts. Blood tests will be done every 2 months to check for problems. IF YOU HAVE A KNOWN ALLERGY TO SULFA DRUGS, DO NOT TAKE THIS MEDICINE UNTIL YOU TALK TO YOUR DOCTOR.
What about other medications?
When you are taking Sulfasalazine, it is very important that your doctors know if you are taking any other medicine. This includes prescription and non-prescription medicines as well as birth control pills, vitamins, and herbal supplements.
Sulfasalazine can be taken with other medications, however it is best to have your doctor’s advice before adding another drug to your daily routine.