Frequently Asked Questions about Arthritis Medications.

Last updated Friday, January 07, 2005

About medications

This article provides an overview of the medications used to treat arthritis. It provides general information only and does not replace specific information given to you by your doctor, pharmacist, or other health care provider. Be sure to consult one of them if you have questions.

What can arthritis medications do?

A drug's action is what the drug does in your body. Arthritis medications can be classified on the basis of three main actions:

Reduction of inflammation
Slowing down the disease process
Reduction of uric acid levels

Each of the three actions is described in this page, along with examples of generic (non-brand-name) and brand-name drugs.

Reduce inflammation

Many arthritis drugs are used to decrease inflammation. Inflammation is a body process that results in pain, swelling, warmth, redness, and sometimes stiffness.

There are two main categories of drugs that reduce inflammation quickly--the nonsteroidal anti-inflammatory drugs (NSAIDs) and the corticosteroids. Corticosteroids are synthetic drugs that closely resemble cortisone, a natural body hormone.

Slow down the disease process

Some drugs are referred to as "disease modifying" or "remission inducing." It is believed that these drugs can slow down the progress of the underlying disease. How this occurs is not clear. It is known that these drugs may require several weeks or months to work. They are also potentially dangerous and need careful monitoring by you and your doctor for side effects.

Some drugs that can slow down the disease process are immunosuppressives or cytotoxics. It is believed that these drugs act by slowing down cell division, thus reducing the activities of the entire immune system. However, normal cells can also be reduced, and this can cause low blood counts. Therefore, close supervision by your doctor is also very important when you are taking these drugs.

Reduce uric acid levels

Uric acid is a normal product of cell breakdown found in the body. At extra high levels, however, uric acid can form into crystals in and around joints, especially the joint of the big toe. The resulting pain and inflammation is called gout. Gout is treated with two different kinds of drugs: one to reduce the inflammation caused by uric acid crystals and the other to reduce the uric acid level itself.

What should people with arthritis ask their doctors about their medications?

Taking any kind of medicine, particularly on a regular basis, is serious business. Unfortunately, not enough people regard this as seriously as they should. On average, one-half to three-fourths of the people who take medications take them at the wrong time of the day or in the wrong amount, skip doses, or stop the drug too soon.

Here are some basic questions to ask your doctor and pharmacist. Write the answers down so you'll remember them.

What is the name of the medicine?
When should I take it? For example, before, after, or with meals?
How long should I take it?
How often should I take it?
Can this drug be taken with other medications? (Tell your doctors and pharmacist about all the medications you're taking.)
Is there a generic form available, and if so, can I take it?
Are there other less expensive alternatives?
What benefits will I notice, and how soon will these become apparent?
What side effects might I experience, and what should I do if I notice them?
If I feel better, can I stop taking the medicine? If I feel no effects or feel worse, can I stop on my own?
When and how will this drug be assessed for benefits and/or toxicity?
What should I do if I miss a dose?
Under what conditions can I increase or decrease the total daily dose of my medication?

Getting the answers to these questions before taking the medicine may help you avoid serious side effects.

Minimize side effects

All drugs, whether bought with a prescription or over-the-counter, have side effects. These can be due to an allergic reaction or to an unusual susceptibility to a particular effect of the drug.

Here are some general steps you can take to reduce side effects:

Take your medicine as prescribed. Follow your doctor's advice about how much and when to take your medicine. If you're having problems with the drug, call your doctor. He or she may be able to change your dosage schedule or the type of drug to better suit your needs. Some drug labels warn: "Do not take on an empty stomach," or "Do not take with food." Take these warnings seriously. It is necessary to take some drugs with food to reduce stomach upset, and it is important that NSAIDs be taken with meals. However, spicy and acidic foods may cause additional stomach upset, and food in the stomach and intestines can make a drug such as penicillamine less effective. Food can also slow down or speed up the medicine's effect on the body. Ask your doctor or pharmacist whether or not to take your medicine with food.
Be careful of drinking alcohol, which can increase or decrease a drug's effects. If the medication causes stomach upset, adding alcohol can increase the discomfort. It may be best to reduce your alcohol intake or to stop altogether.
Monitor yourself. Know what benefits to expect and when they are likely to occur. Find out the side effects of your drugs and what to do if they occur. Be aware of how your body is reacting to the drug.

Over-the-counter drugs

Follow your doctor's advice when you consider using over-the-counter (OTC) drugs.

These drugs may seem harmless because they can be bought easily. However, if they are abused, they can cause serious side effects. All drugs-prescription or over-the-counter-can interact with each other inside your body. The interaction between drugs can cause serious side effects.

Many OTC medications, such as cough medicines or cold tablets, contain aspirin or ibuprofen. If you take these in addition to prescribed aspirin or another NSAID, you might experience a harmful effect. Before buying an OTC drug, read the label carefully. Be sure to ask your doctor or pharmacist before you take an OTC drug with your prescribed medications.

Ask your doctor before substituting an OTC medication for prescription medication. If you have had a drug prescribed for your arthritis and the drug is now available over-the-counter, you certainly may buy it. Sometimes it costs less. These OTC equivalents, however, are available in much lower dosages than your prescription drug. You might need to take extra tablets just to meet your prescribed dosage. There is no danger in doing this if you get the proper amount that is needed to keep your arthritis under control. Ask your doctor to be sure.

Reduce costs

Medications can be expensive. Some ways to reduce costs include:

Ask your doctor about taking the generic form of the drug. A generic drug contains the chemical that you need to treat your arthritis. When generic drugs are available, you are usually getting the drug you need at a lower cost.
Ask your doctor about switching to a less expensive drug.
Take your medication as prescribed. Some people don't take the prescribed amount of medication. They feel that if they "save" some of it, they won't have to buy so much and will save money. However, this could actually increase the cost. If you don't take enough, then the drug won't be an effective treatment. Your doctor, not knowing you're not taking enough, may decide you need a stronger or more costly drug. So take your medication as your doctor has ordered it.
Try to reduce the number of narcotic pain relievers and tranquilizers you take. Although they may dull the pain, some of these drugs can actually make you feel "down." It may be necessary to use these drugs on a short-term basis for very severe pain. Learn to use other forms of pain relief, such as relaxation techniques, hot packs, hot baths, cold packs, joint protection, energy conservation, mental distraction, or exercise. By using some of these techniques, you will not only reduce the chances of addiction and drug interactions, but also your cost.
Carefully check labels on over-the-counter drugs. Brand-name drugs are usually more costly than generic equivalents. In addition, be sure you're not paying for extra ingredients, such as caffeine, that you do not need.
Shop for the best prices. Check your local pharmacies for the best prices on the medicines you take.

General tips

Do's:

Know these facts about every drug you take:

WHAT: Know the generic and brand names of your medications. Know the common side effects.
WHY: Know why you are taking the drug and what it can do for you.
HOW:Know how to take the drug correctly.

Take your medicine exactly as your doctor prescribes. Never change the dosage on your own.
Find out if you should take your medicines with food. Many arthritis medications, especially NSAIDs, irritate the stomach lining. Taking the drug with food can help to avoid this problem. Use the "sandwich technique": Eat a little food. Take your medication. Eat a little more food.
Keep each medication in a labeled container.
Give your medications time to work. Find out from your doctor how long each drug will take to show results. Some of the best drugs start to work slowly.
Keep your medications away from children by storing the drugs in a dry, locked cabinet or drawer, if necessary. Ask your pharmacist for regular containers if you have trouble removing child-proof caps.
Always bring a list of your medications with you to medical appointments. Have it near the telephone if you call the doctor about your condition.
Report possible side effects or unusual reactions. These often include rash, fever, nausea, vomiting, and headaches.
Always tell your doctor about any other drugs you are taking. This includes OTC medications or drugs prescribed by another doctor. This is important because of harmful interactions between drugs.
Be honest with your doctor. If you have not been taking your medication as prescribed, tell the truth. Otherwise, the doctor might make changes in your treatment that could be harmful, expensive, and/or unnecessary.
Get your prescriptions filled at one pharmacy so that your pharmacist can watch for duplications and potential interactions. Ask the pharmacist for advice on how to save money and get the most out of medicines.

Don'ts:

Don't stop taking your medicine. Call your doctor first.
Don't use someone else's medication or let them use yours. What is right for one person may be dangerous for another.
Don't drive or operate heavy machinery if you feel drowsy from your medicine.
Don't mix medications in one container. Storing more than one medication together could lead to harmful chemical interactions of the drugs. Also, you could take the wrong drug accidentally.
Don't let your medicines run out. Monitor your supply. Stopping your medication could cause your disease to flare (become worse).
Don't take old medication. Outdated medicine may not be as effective-it might even be dangerous.
Don't expect your medications to make you feel better right away. It may take days, weeks, or even months before you notice a difference in the way you feel.
Don't change your medication dose on your own. If one tablet is good for you, two are not necessarily better and may even be dangerous. Ask your doctor if and when you can add or delete doses on your own.
Don't expect medication alone to do the job. Medication is generally only a part of a complete treatment program prescribed by your doctor. Depending on the form of arthritis you have, other therapies may include rest, exercise, tips for using your joints wisely, weight control, and continued medical follow-up.
Don't drink alcohol while taking your medications.
Never give your medications to others, and never take medicine prescribed for someone else. Although you both may have the same type of arthritis, a drug that works for another person may not help you. It's possible that the drug you take may be harmful to someone else. Each person should see a doctor for a specific treatment.

Storing medication

Check the label or ask the pharmacist for storing instructions.
Don't transfer medicines from one container to another. You may confuse dosage information and may forget which drug you are taking.
Don't keep prescription medications or OTC drugs beyond their expiration dates. Dispose of old medications by flushing them down the toilet so they can't be found by children.
Don't store medicines in a humid area of the home or where there is excessive heat or cold.

Credits

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.