|Last updated: Thursday, December 30, 2004 |
What are they?
Cytotoxic drugs are very powerful medicines. They work by affecting the growth and action of some cells that cause the joint pain, swelling, warmth and damage of arthritis.
Cytotoxic drugs work over a long period of time. You may not notice much effect from the drugs for the first several weeks or months of treatment.The three cytotoxic drugs usually used to treat arthritis and related conditions are:
These drugs are usually given in pill form but some may be given intravenously or by injection.
This information does not cover all generic and brand names possible uses actions precautions side effects or interactions of cytotoxic drugs. It should not replace the advice and guidance given by your doctor. If you have questions about these or other medications contact your doctor or pharmacist.
Uses of Cytotoxic Drugs
Conditions treated by cytotoxic drugs
Cytotoxic drugs can be used to treat many forms of arthritis including juvenile rheumatoid arthritis, psoriatic arthritis, rheumatoid arthritis and systemic lupus erythematosus as well as conditions such as steroid-resistant polymyositis or dermatomyositis, Wegener's granulomatosis polyarteritis or some forms of vasculitis.
If cytotoxic drugs are recommended for you be sure to consult a doctor who has experience using these drugs. When considering treatment with cytotoxic drugs you your doctor and your family will want to consider factors such as:
As with other drugs there are no guarantees that cytotoxic drugs will work for you. On the other hand it isn't certain that serious negative effects will occur if you try these drugs. For severe cases of arthritis many experts agree that when properly used the risk of side effects from the drugs may be less than the risk to your health from the disease itself. Talk to your doctor about the side effects and whether the benefits of the medicine outweigh the risks.
Tips for taking these drugs
Taking cytotoxic drugs incorrectly can result in serious side effects. Here are some tips for taking them:
The Arthritis Foundation and the University of Washington Department of Orthopedics do not endorse any brand name or generic name medication listed here. Portions of the information presented here are adapted from the USP DI copyright 1990 the United States Pharmacopeial Convention Inc. (USP). Permission granted.
Some of this material may also be available in an Arthritis Foundation brochure. Contact the Washington/Alaska Chapter Helpline: (800) 542-0295. If dialing from outside of WA and AK contact the National Helpline: (800) 283-7800.
Adapted from a pamphlet originally prepared for the Arthritis Foundation. This material is protected by copyright.
Dangers and Side Effects
Serious side effects
Cytotoxic drugs cause different side effects in different people.
One of the most serious side effects is the suppression of certain cells:
When to contact the doctor
Contact your doctor right away if you notice these side effects:
While these side effects don't happen very often you should still be aware of them. Some of them are signs of serious problems which should be treated right away.
Other side effects
Other side effects may occur with these drugs. If you have any of these side effects or other problems not listed here check with your doctor or pharmacist:
What to do for side effects
The most important thing you can do to treat and help avoid some side effects is to have regular checkups. Here are some other things you can do to handle the following side effects:Risk of infection Stay away from adults and children who have contagious illnesses such as colds the flu or chickenpox. Do NOT have any immunizations without checking with your doctor because they could lead to infection. Report any sign of an infection to your doctor right away.
Loss of appetite Plan meals when you're not feeling nauseous. Try eating small more frequent meals. Ask your doctor if you can take the medicine at bedtime to reduce this side effect.
Mouth sores Contact your doctor if these develop. Use a soft-bristled toothbrush. Use salt water or peroxide as a mouth wash. Eat soft non-spicy foods of medium to cold temperature. If the pain doesn't go away ask your doctor about using a topical pain reliever before meals.
Easy bruising or bleeding This could be a sign of serious problems so you should contact your doctor right away.
Talk to the doctor
Your doctor needs to know about the following conditions in order to decide whether to recommend cytotoxic drugs:
Each cytotoxic drug is different and has its own special instructions.
Azathioprine (Imuran) is usually given in pill form (2-3 tablets daily) or by injection. The dose may be lowered after the desired response is obtained.
Cyclophosphamide (Cytoxan) is usually given in pill form or intravenously according to a prescribed schedule. It is probably the strongest cytotoxic drug. It may cause additional side effects such as cystitis (inflammation of the bladder marked by blood in the urine and painful urination) as well as bladder cancer.
Methotrexate (Rheumatrex) is usually given in pill form and sometimes by weekly injections. This drug can cause additional side effects such as liver scarring (cirrhosis) and a lung problem similar to pneumonia which causes shortness of breath cough and a fever.