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MEDICATIONS
A CONSUMER S GUIDE
Endorsed by the Canadian Rheumatology Association
www.arthritis.ca
1.800.321.1433
WELCOME
CONTENTS
This is a very exciting time in the treatment of arthritis. Several new medications
have recently been developed to combat joint pain and inflammation, and more
are on the way! Many of these medications are safer and more effective than ever
before, expanding the treatment options for people with arthritis.
Welcome
The way in which doctors treat arthritis has changed. We now know that, for the
best long-term health, as well as prevention of bone and joint damage, inflammatory
arthritis (such as rheumatoid arthritis) needs to be treated early and aggressively.
Think of arthritis like a fire in the joints. Imagine there was a fire in your kitchen.
If you left it burning, it would eventually destroy the kitchen and likely spread to
other rooms in the house. The same is true for rheumatoid arthritis. If you leave
the fire of arthritis burning, it will eventually damage the bones and cartilage.
The idea is to get the fire put out as quickly as possible to prevent the joints from
becoming damaged. Again, if your kitchen was on fire, it might take two or three
fire trucks with their hoses to put the fire out. The same is true for arthritis. It
might take two or three different medications to put the fire out. With this new
approach to arthritis, we are helping more and more people lead normal, active
lives for years to come.
An Introduction to Arthritis
6-8
What is arthritis?
Osteoarthritis and inflammatory arthritis
Symptom Control
Pain management
10
11
12-13
14-18
We now know that, for the best longterm health, as well as prevention of
bone and joint damage, inflammatory
arthritis needs to be treated early and
aggressively.
19-20
www.arthritis.ca
Joint Injections
20
21
22-35
Corticosteroids
35-40
Biologics
The need to effectively monitor new drugs once they have been approved and
introduced into the market has been a key issue for The Arthritis Society for several
years. This helps to ensure that unfavourable side effects are reported, documented
and addressed. All medications have potential side effects, whether they are
taken by themselves or in combination with other herbal, over-the-counter and
prescription medications. It is therefore important for patients to discuss the
benefits and potential side effects of all their medications with their doctor.
In an effort to make it easier for consumers to report side effects from health
products, Health Canada has released a new online form. The form can be found
at www.hc-sc.gc.ca/dhp-mps/medeff/report-declaration/index-eng.php#a1
or www.hc-sc.gc.ca/dhp-mps/medeff/report-declaration/index-fra.php or
via Health Canadas MedEffect website www.healthcanada.gc.ca/medeffect or
www.santecanada.gc.ca/medeffet. A PDF version of the form can be downloaded and mailed to Health Canada using a downloadable postage paid label
(www.hc-sc.gc.ca/dhp-mps/medeff/report-declaration/index-eng.php#a1
or www.hc-sc.gc.ca/dhp-mps/medeff/report-declaration/index-fra.php).
Consumers can still report side effects by calling toll-free at 1-866-234-2345.
?
40-60
Index
61-63
www.arthritis.ca
AN INTRODUCTION
TO ARTHRITIS
WHAT IS ARTHRITIS?
The word arthritis literally means inflammation of the
joint (arth meaning joint and itis meaning inflammation).
Inflammation is a medical term meaning pain, stiffness,
redness and swelling.
WHAT IS OSTEOARTHRITIS?
Osteoarthritis (OA) occurs when cartilage (the tough elastic material that covers
and protects the ends of bones) begins to wear away. Cartilage is an essential
part of the joint; not only does it act as a shock absorber, it also enables the joint
to move smoothly. With osteoarthritis, the cartilage erodes, eventually
resulting in pain, stiffness, swelling and bone-on-bone movement in the
affected joint.
Inflammatory arthritis causes aching, pain, stiffness, warmth and swelling in the
joints that are affected. The most striking characteristic is feeling stiff in the joints
after rest. This is particularly apparent in the morning when the stiffness may take
hours before disappearing. In some people, the inflammation in the joints may
be accompanied by a loss of energy (fatigue). Other symptoms might include low
grade fevers, weight loss, muscle pain or numbness and tingling in the fingers.
This type of arthritis tends to affect the joint at the base of the
thumb, the end and/or middle joints of the fingers, the hips,
the knees and the joints at the base of the big toe. While
not a disease of the elderly, OA is more common as we age.
Most people have symptoms that continue steadily. Others have symptoms
that seem to wax and wane, with times of more severe joint pain and stiffness
alternating with better times. The severity of symptoms varies greatly from
person to person.
Inflammatory Arthritis
Osteoarthritis
What are
examples of
diseases?
Rheumatoid arthritis
Psoriatic arthritis
Ankylosing spondylitis
Systemic lupus erythematosus
Osteoarthritis
What is the
cause?
Deterioration of cartilage
How quickly
does it start?
What are
the usual
symptoms?
What amount of
morning stiffness
is experienced?
What
medications
are available
LIVING WITH
ARTHRITIS
I HAVE BEEN DIAGNOSED
WITH ARTHRITIS
If you have been diagnosed with arthritis, youre
certainly not alone; there is hope. A famous
Canadian rheumatologist, Dr. Duncan Gordon,
is noted for saying, Everyone with arthritis can
be helped. The management of arthritis involves
a team, including doctors, surgeons, nurses,
physiotherapists, occupational therapists, social
workers, pharmacists, dietitians and YOU! Yes, you
are an active member of your health-care team.
www.arthritis.ca
SYMPTOM CONTROL
PAIN MANAGEMENT
Pain from arthritis can be so intense and constant that it dominates your every
waking moment (and can cause many sleepless nights). Due to the pain, you may
be unable to continue with your routine daily activities and you may become less
active in an attempt to keep your joints as comfortable as possible. Unfortunately,
this inactivity can then have negative effects on your muscles and joints. This can
then lead to a loss of strength, reduced flexibility and more pain. Therefore, good
pain control is essential in the treatment of arthritis.
Persistent, severe pain from arthritis requires a combination of therapies, as no
single pain management technique is powerful enough to provide non-stop
pain relief. You need to discover what works for you. This often means trying
many different therapies or combinations of therapies for prolonged pain relief.
These are medications used to control the pain, stiffness and swelling of your joints,
with the goal of improving your function. They are used for both inflammatory
arthritis and osteoarthritis.
10
Physiotherapy
Occupational
Therapy
Social Work
Support
Psychology
Relaxation techniques
Massage Therapy
Therapeutic massage
Dietitian Advice
Self Management
ACETAMINOPHEN
Acetaminophen is a very safe and effective medication for pain relief that can
be used for both short- and long-term pain control. If you have pain from
osteoarthritis that is present most of the time, your doctor may
recommend that you take acetaminophen regularly every 4-6 hours. When the
pain is there all of the time, there is no point in waiting for it to become unbearable
before taking your medication. Then, you have to wait for the effects of the
acetaminophen to catch up to the pain.
Although acetaminophen is safe, it does have its limits: you can take 2 regular
strength tablets (325 mg each) to a maximum of 12 tablets in a 24-hour
period, or 2 extra-strength tablets (500 mg each) every 6 hours to a maximum of
8 tablets in a 24-hour period, or 2 extended-release tablets (e.g. Tylenol-Arthritis,
650 mg each) every 8 hours to a maximum of 6 tablets in a 24-hour period.
Acetaminophen is found in other over-the-counter preparations, such as cough
and cold formulations. You must be careful to look at the ingredients of all of the
over-the-counter medications you are taking to ensure you are not taking too
much acetaminophen. The maximum daily recommended dose is 4 grams
(4000 mg). The suggested doses of acetaminophen are guidelines only and
should be discussed with your doctor or pharmacist.
www.arthritis.ca
11
PRESCRIPTION MEDICATIONS
FOR PAIN
Sometimes over-the-counter painkillers are not
strong enough for your pain. Your doctor can help
by prescribing stronger pain medications, such as
NSAIDs (more detailed information is available in the
table on page 15) or narcotics. Narcotics are a class
of pain medication that includes codeine and
morphine (see table on page 13). These medications
should be taken under the direct supervision of
your physician to monitor side effects. Common
side effects of narcotics include nausea, constipation,
drowsiness and dry mouth. Because these
medications slow down digestion and can cause
constipation, be sure to drink 6-8 tall glasses of
water throughout the day.
12
Product
Codeine
Morphine
Dilaudid, Hydromorph-Contin
Hydromorphone
Oxycodone
Demerol
Meperidine
Duragesic Patches
Fentanyl
TRAMADOL
Tramadol is a unique type of opioid pain-relieving medication indicated for the
treatment of moderate pain. It is available in both long- and short-acting forms,
as outlined in the table below. Common side effects of tramadol may include
nausea, vomiting, constipation, headache, dizziness and sleepiness.
Brand Names
Product
Common Dose
Tramacet
1-2 tablets
every 4-6 hours
Tridural
Ralivia
13
NON-STEROIDAL ANTI-INFLAMMATORY
DRUGS (NSAIDs & COXIBs)
14
Product
Class
Common Dose
Voltaren,
Voltaren-SR
Diclofenac
Acetic Acid
Arthrotec-50,
Arthrotec-75
Diclofenac with
Misoprostol
Ultradol
Etodolac
Toradol
Ketorolac
Celebrex
Celecoxib
COXIBs
Indocid
Indomethacin
Indoles
Clinoril
Sulindac
Relafen
Nabumetone
Mobicox
Meloxicam
Oxicams
Mobiflex
Tenoxicam
Feldene
Piroxicam
Ansaid,Froben, Flurbiprofen
Froben-SR
Motrin, Advil
Propionic Acids
Ibuprofen
Naprosyn,
Naprosyn-SR
Naproxen
Daypro
Oxaprozin
Surgam,
Surgam-SR
Tiaprofenic Acid
Aspirin
Acetylsalicylic
Acid (ASA)
Dolobid
Diflunisal
Salicylates
www.arthritis.ca
15
Even though you can purchase NSAIDs like Aspirin, Motrin and Advil without
a prescription, some people should avoid taking them. More detailed information
is available on pages 1718.
You dont normally need bloodwork while taking NSAIDs. However, if you take
NSAIDs regularly, your doctor will likely monitor your blood pressure and order
periodic blood tests to ensure the NSAIDs are causing no problems with stomach
bleeding or with your liver or kidneys.
16
Symptom
Common
If severe or persistent
Constipation
Common
If severe or persistent
Vomiting or diarrhea
Rare
If severe or persistent
Skin rash
Rare
Yes
Rare
Yes
Dizziness or lightheadedness
Rare
Yes
Increase in
blood pressure
Rare
Monitored periodically
by your doctor
Rare
Yes
Rare
Yes
Fluid retention
Rare
Yes
Rare
Yes
Kidney problems
Rare
Monitored by your
doctor through blood
and urine tests
www.arthritis.ca
17
18
www.arthritis.ca
19
JOINT INJECTIONS
20
There are a number of types of hyaluronan available. Most require you to have
an injection into the joint every week for 3 consecutive weeks. There is a new
preparation on the market that is given as a one-time single injection. The injections
may be repeated at a later date if they are felt to be helpful.
Although these medications can be purchased without a prescription, it is necessary
to see a physician for the injections. Speak to your doctor for more information on
viscosupplementation and which preparation might be best for you.
CORTICOSTEROIDS
See page 35 for extensive information.
MEDICATIONS FOR
SYMPTOMS AND
DISEASE CONTROL
These medications are only available for the treatment of inflammatory arthritis
because there are no known medications to slow down osteoarthritis. They work
to prevent joint damage and bone erosion in inflammatory arthritis. The goal is
to keep your joints healthy for years to come.
Anti-Rheumatic Drugs (DMARDs) and biologics fall into
Disease-Modifying
this category.
medications often take 6-12 weeks to begin to have an effect. They
These
work to address the root of the problem in inflammatory arthritis. Shutting
down the inflammatory processes can take a long time, but the result of
healthy joints will be worth it.
www.arthritis.ca
21
DISEASE-MODIFYING ANTI-RHEUMATIC
DRUGS (DMARDs)
22
Brand Names
Product
Common Dose
Myochrisine
Gold
(sodium aurothiomalate)
Plaquenil
Hydroxychloroquine
200-400 mg daily
1-2 tablets daily
Arava
Leflunomide
Methotrexate
Methotrexate
Salazopyrin
Sulfasalazine
Imuran
Azathioprine
www.arthritis.ca
23
Frequency
Call Doctor
Common
If severe
Skin rash
Rare
Yes
Liver problems
Rare
Blood counts
Rare
Infection
Rare
Malignancy
Very rare
GOLD
Brand Name: Myochrisine
Supplied: Vials of 10, 25 and 50 mg
What types of arthritis is gold used for?
Gold is a DMARD used to treat inflammatory types of
arthritis, such as rheumatoid and psoriatic arthritis.
What is the typical dose and when do I take it?
Gold is given as an injection usually once a week. A very small
test dose (10 mg ) is given on the first week to make sure you are not
overly sensitive. The second injection, a week later, builds up to 25 mg,
followed by 50 mg every week thereafter. If you respond very well to gold,
it may be possible to reduce the frequency of the injections to every 2 weeks
or every month.
How long will it take to work?
Unfortunately, like many of the DMARDs, you wont feel the effects of gold right
away. Most people notice the effects about 12 weeks after they start taking it.
Is there anybody who should not take gold?
It is generally advisable to avoid all medications, including gold, during pregnancy
and breastfeeding. Occasionally this medication may need to be continued during
pregnancy and/or breastfeeding, but only after discussion between you and your
doctor. Please discuss all treatments with your doctor if you are planning a pregnancy
or if pregnancy is a possibility. Anyone who has had a prior allergic reaction to gold
should avoid it. People with certain kidney or blood diseases may not be able to
use gold and should discuss their situation with their doctor.
www.arthritis.ca
25
Frequency
Call Doctor
Common
Mouth sores
Rare
Metallic taste
Rare
No
Aching in muscles
and joints
Rare
No
Allergic reaction
Rare
Blood counts
Rare
Kidney problems
Rare
Lung problems
Very rare
Bowel problems
Very rare
HYDROXYCHLOROQUINE (HCQ)
Brand Name: Plaquenil
Supplied: 200 mg tablets
What types of arthritis is hydroxychloroquine used for?
HCQ is a DMARD used to treat inflammatory types of arthritis, such as rheumatoid
and psoriatic arthritis.
What is the typical dose and when do I take it?
HCQ is taken as a tablet once or twice a day and the dose is based on your body
weight. Each tablet contains 200 mg of HCQ. The most common dose is 1-2 tablets
per day or 200-400 mg. If you require 300 mg per day, your doctor may ask you to
take 2 tablets one day and 1 the next. If you are taking 2 tablets a day, you can take
them both at once or divide them up one in the morning and one in the evening.
How long will it take to work?
Like many of the DMARDs, you wont feel the effects of HCQ right away.
Most people start noticing the effects about 6-8 weeks after they start to take it,
but the benefit may not occur for 3 months.
Is there anybody who should not take hydroxychloroquine?
It is generally advisable to avoid all medications, including HCQ, during pregnancy and
breastfeeding. Occasionally this medication may need to be continued during pregnancy
and/or breastfeeding, but only after discussion between you and your doctor. Please
discuss all treatments with your doctor if you are planning a pregnancy or if pregnancy
is a possibility. Anybody who has had a previous reaction to HCQ or has had eye problems
as a result of hydroxychloroquine should avoid it. Anyone with problems in the retina
of the eye should discuss this treatment with their rheumatologist.
Is there anything I should avoid when taking hydroxychloroquine?
No, in general most things are very safe when taking HCQ.
26
www.arthritis.ca
27
Symptom
Frequency
Call Doctor
Rare
If severe
Skin rash
Rare
Yes
Blurry vision
Rare
If severe
Headaches or dizziness
Rare
If severe
Rare
If severe
Rare
Yes
Rare
Yes
28
LEFLUNOMIDE (LEF)
Brand Name: Arava
Supplied: 10 and 20 mg tablets
What types of arthritis is leflunomide used for?
Leflunomide (LEF) is a DMARD used to treat inflammatory types of arthritis,
such as rheumatoid and psoriatic arthritis.
What is the typical dose and when do I take it?
LEF is taken as a tablet every day or every other day. The usual dose is 10-20 mg
per day. With this medication, taking 20 mg every other day is very similar to
taking 10 mg daily and is cheaper.
How long will it take to work?
Like many of the DMARDs, you wont feel the effects of LEF right away. Most
people notice the effects about 6-8 weeks after they start taking it.
Is there anybody who should not take leflunomide?
Any woman who is pregnant or may become pregnant should not take LEF.
LEF taken during pregnancy can cause birth defects in the unborn child and
should be avoided at all cost. Any woman who is breastfeeding should also avoid
LEF. People with active infections or liver, kidney or blood diseases may not be
able to use LEF and should discuss this situation with their doctor.
Is there anything I should avoid when taking leflunomide?
Yes, avoid alcohol. LEF has the potential to affect the liver (rarely), so your alcohol
use must be severely restricted. Talk to your doctor.
www.arthritis.ca
29
Common
If severe
Skin rash
Rare
Yes
Thinning hair
Rare
If severe
Rare
Rare
Yes always
Liver problems
Rare
Monitored by regular
blood tests
Blood counts
Rare
Monitored by regular
blood tests
Infection
Rare
30
METHOTREXATE (MTX)
Brand Name: Methotrexate
Supplied: 2.5 mg tablets, 50 mg/2ml vials for injection
What types of arthritis is methotrexate used for?
MTX is a DMARD used to treat inflammatory types of arthritis, such as rheumatoid
and psoriatic arthritis.
What is the typical dose and when do I take it?
MTX is given either as tablets or injection; the choice will be up to you and your
doctor.The most important thing to remember is that MTX is only taken once a
week. Choose a day that places the least demands on you, since some people feel
unwell (tired, sick to the stomach, loss of appetite or headache) for a day or two
after they take MTX. If you are taking the tablets, each tablet contains 2.5 mg of
MTX, with the most common dose ranging from 3-10 tablets per week or 7.5-25 mg.
If you are taking 6 or more tablets a week, the dose can be split to take half in the
morning and half at night (e.g. if you are taking 6 tablets a week, you take 3 with
breakfast and 3 with dinner). If you are taking the injection, MTX is supplied in 2 ml
vials containing a total of 50 mg. The most common dose with injections ranges
from 0.3-1.0 ml per week or 7.5-25 mg.
How long will it take to work?
Like many of the DMARDs, you wont feel the effects of MTX right away. Most people
notice the effects about 6-8 weeks after they start taking it.
Is there anybody who should not take methotrexate?
Any woman who is pregnant or may become pregnant should not take MTX.
MTX taken during pregnancy can cause birth defects in the unborn child or even
a miscarriage, and should be avoided at all cost. Any woman who is breastfeeding
should also avoid MTX. People with active infections or liver, kidney or blood diseases
may not be able to use MTX and should discuss this situation with their doctor.
Is there anything I should avoid when taking methotrexate?
Yes, avoid alcohol. MTX has the potential to affect the liver, so your alcohol use
must be restricted. Talk to your doctor. The antibiotic trimethoprim should not be
used with MTX. Trimethoprim is often combined with sulfa antibiotics. If you need
an antibiotic for bladder, ear or chest infection, make sure that any doctor who
treats you is aware of this restriction.
Do I need any monitoring while taking methotrexate?
You will need regular blood tests to monitor your liver and blood counts for
side effects.
www.arthritis.ca
31
Common
If severe
Rare
Headaches
Rare
If severe
Hair loss
Rare
Mouth sores
Rare
Rare
Yes always
Liver problems
Rare
Monitored by regular
blood tests
Blood counts
Rare
Monitored by regular
blood tests
Infection
Rare
SULFASALAZINE (SSZ)
Brand Name: Salazopyrin
Supplied: 500 mg tablets; 500 mg EC tablets
What types of arthritis is sulfasalazine used for?
SSZ is a DMARD used to treat inflammatory types of arthritis, such as rheumatoid
and psoriatic arthritis.
What is the typical dose and when do I take it?
SSZ is taken as tablets, usually twice a day. Each tablet contains 500 mg of SSZ.
The most common dose is 2 tablets (1000 mg) twice a day; however, your doctor
may increase the dose to 3 tablets twice a day. As SSZ can upset the stomach,
it is important to start the medication gradually and build up as directed by
your doctor.
How long will it take to work?
Like many of the DMARDs, you wont feel the effects of SSZ right away.
Most people notice the effects about 6-8 weeks after they start taking it.
Is there anybody who should not take sulfasalazine?
It is generally advisable to avoid all medications, including SSZ, during pregnancy
and breastfeeding. Occasionally this medication may need to be continued during
pregnancy and/or breastfeeding, but only after discussion between you and
your doctor. Please discuss all treatments with your doctor if you are planning a
pregnancy or if pregnancy is a possibility. Anyone who has had a prior allergic
reaction to medications containing sulfa should avoid SSZ. Patients who have
had an allergy to ASA (Aspirin) should also avoid SSZ.
32
www.arthritis.ca
33
CORTICOSTEROIDS
Symptom
Common
If severe
Common
If severe
Rash
Common
Yes
Common
Blood counts
Rare
Monitored by regular
blood tests
Liver problems
Very rare
Monitored by regular
blood tests
Kidney problems
Very rare
Monitored by regular
blood tests
Infertility
Very rare
Route
Deltasone
Prednisone
Solumedrol
Methylprednisolone
100-1000 mg
Intravenous (IV)
Celestone
Soluspan
Betamethasone
1-12 mg
Intra-articular
(joint injection)
Kenalog
Aristospan
Triamcinolone
Hexacetonide
10-80 mg
Depomedrol
Methylprednisolone
40-120 mg
Intra-muscular
(muscle injection)
34
www.arthritis.ca
35
STEROID INJECTIONS
Brand Names: Depomedrol, Kenalog, Aristospan, Celestone Soluspan
What types of arthritis are steroid injections used for?
Steroid injections, also referred to as cortisone injections, are used to help relieve
the pain and swelling associated with many types of arthritic conditions, including
both inflammatory arthritis and osteoarthritis. Injecting a steroid in or around the
joint is an effective way to locally reduce pain and swelling.
How long will it take for the injection to work and how long will it last?
Most injections typically take 24-48 hours to take full effect. If local anesthetic
(freezing) is given with the injection, you may feel improvement quite quickly.
After the injection, it is normal to feel a temporary increase in discomfort in the joint
that should be resolved within 24 hours. You can treat this discomfort by applying
a cold pack or by using medications, such as acetaminophen or non-steroidal
anti-inflammatory drugs (check with your doctor). If possible, it is best to rest the
joint for 24-48 hours after an injection, as studies have shown this may improve
the effect of the injection. However, the length of time an injection will last is variable.
Some patients report months of relief while others find only a few days of relief.
Is there anybody who should not be given an injection?
For the most part, steroid injections are very safe and suitable for most people.
Anyone who has had a serious allergic reaction to steroids and those with an
infection in the joint or in the skin or soft tissues overlying the joint should not
be given injections.
36
Infection
Rare
Rare
Yes
No
Rare
No
Rare
No
PREDNISONE
Brand Name: Prednisone
Supplied: 1, 5 and 50 mg tablets
What types of arthritis is prednisone used for?
Prednisone is a steroid used to treat inflammatory types of arthritis, such as
rheumatoid and psoriatic arthritis, lupus and polymyalgia rheumatica.
www.arthritis.ca
37
Frequency
Call Doctor
Low Dose
High Dose
If Severe
Always
Increased appetite
Emotional sensitivity
Difficulty sleeping
Restlessness / tremor
Nausea or indigestion
Blurry vision
Fluid retention
Acne
Hair growth
Frequency
Increased appetite
and weight gain
Infection
Osteoporosis
Avascular necrosis
38
Frequency
Call Doctor
Low Dose
High Dose
If Severe
Always
Muscle weakness
Cataracts or glaucoma
Monitored by MD
Osteoporosis
Monitored by MD
Avascular necrosis
www.arthritis.ca
39
1 Take it as directed
Actemra
Tocilizumab
Cimzia
Certolizumab
Pegol
Enbrel
Etanercept
Humira
Adalimumab
Kineret
Anakinra
Orencia
Abatacept
Remicade
Infliximab
Rituxan
Rituximab
Simponi
Golimumab
BIOLOGICS
Your doctor will recommend a therapy that is best suited to your type of arthritis,
other medical problems and other medications. Your doctor will discuss the benefits
of each biologic, how the medication is given and its potential side effects.
www.arthritis.ca
41
Biologics are administered in two ways: infusion and injection. Your doctor
can provide you with information on the way in which different medications
are administered and help make the right choice for you.
Infusion
This means the medicine will be given to you
through a needle placed in a vein in your arm.
Each infusion will be carried out by a health-care
professional. The length of the infusion will range
from 30 minutes to two hours, depending on the
specific medication that you are taking, the period
that your doctor feels is best for you and, in some
cases, the length of time that you have been
receiving the medication.
The infusion may take place in a number of settings. One product is infused
only in clinics specifically set up to administer this drug. Others are administered
in other clinical settings. All clinics are staffed by health-care professionals. Some
medications may be administered in your home with the assistance of a healthcare professional. You will be monitored throughout the infusion and, in some
cases, for a period of time after the infusion.
The frequency of administration will vary by product, the length of time you have
been taking the product and how you respond to the medication. Your infusion
will be pre-scheduled with the clinic or health-care professional in accordance
with the frequency decided by your doctor.
Injection
This means that the medication will be given by a needle under the skin of your
abdomen or thigh. The medication is dispensed by the pharmacist in a single-use
pre-filled syringe containing the dose decided by your physician. The pharmacist
will advise you on how to store the medication until it is injected.
You can administer the injection yourself or a family member or friend can
do this for you. Training will be provided by your doctor or another health
professional. Detailed instructions will be provided to you. If you prefer, you can
make arrangements for a health professional to administer the medication.
42
ABATACEPT
Brand Name: Orencia
Supplied: An intravenous infusion given by a health-care professional once a month,
either at home or in an infusion clinic
What types of arthritis is abatacept used for?
Abatacept is a biologic used to treat inflammatory types of arthritis, such as
rheumatoid arthritis.
What is the typical dose and when do I take it?
Abatacept infusion is given every month. The dose given depends on your
body weight, but typical doses range from 500-1000 mg.
www.arthritis.ca
43
Action
Fever
Prescribed an antibiotic
Become pregnant
44
Infusion reaction
Rare
Rare
If severe
Rare
If severe
Rare
If severe
Rash or flushing
Rare
If severe
Rare
Yes always
Rare
Very rare
ADALIMUMAB
Brand Name: Humira
Supplied: 40 mg pre-filled syringes and 40 mg pre-filled pens
What types of arthritis is adalimumab used for?
Adalimumab is a biologic used to treat inflammatory types of arthritis, such as
rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis, as well as other
diseases, such as Crohns disease and psoriasis.
What is the typical dose and when do I take it?
Adalimumab is given by an injection under the skin. The usual dose is 40 mg
given once every 2 weeks. In some cases, it may be given once a week.
How long will it take to work?
Some people begin to feel the effects of adalimumab within a few weeks;
however, it may take months to feel the full effect. Some people respond a little
slower, taking up to 6 months until the maximum benefit is felt.
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Frequency
Call Doctor
Common
If severe
Action
Fever
Rare
If severe
Headaches
Rare
If severe
Prescribed an antibiotic
Rare
Yes always
Become pregnant
Very rare
Monitored by doctor
Very rare
Monitored by doctor
Very rare
Monitored by doctor
Very rare
Monitored by doctor
ANAKINRA
Brand Name: Kineret
Supplied: 100 mg pre-filled syringes
What types of arthritis is anakinra used for?
Anakinra is a biologic used to treat inflammatory types of arthritis,
such as rheumatoid arthritis.
What is the typical dose and when do I take it?
Anakinra is given by an injection under the skin every day. The dose given
with each injection is 100 mg.
How long will it take to work?
Most people begin to feel the effects of anakinra after 2-4 weeks; however, it
may take months to feel the full effect. Some people respond a little slower,
taking 3-6 months until the maximum benefit is felt.
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Action
Fever
Prescribed an antibiotic
Become pregnant
Common
If severe
Common
If severe
Headaches
Common
If severe
Rare
Yes - always
Rare
Monitored by MD
CERTOLIZUMAB PEGOL
Brand Name: Cimzia
Supplied: 200 mg pre-filled syringes
What types of arthritis is certolizumab used for?
Certolizumab is a biologic used to treat inflammatory types of arthritis,
such as rheumatoid arthritis.
What is the typical dose and when do I take it?
Certolizumab is given by an injection under the skin. The starting dose is
400 mg given at week 0, 2 and 4. This is followed by a maintenance dose of
200 mg given once every 2 weeks. In some cases, a 400 mg dose may be
prescribed once a month.
How long will it take to work?
Some people begin to feel the effects of certolizumab within a few weeks;
however, it may take months to feel the full effect. Some people respond a little
slower, taking up to 6 months until the maximum benefit is felt.
Action
Fever
Prescribed an antibiotic
Become pregnant
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Any woman who is pregnant or may become pregnant should not take
certolizumab, as it has not been studied in pregnant women. Women taking
certolizumab should use birth control, such as the oral contraceptive pill.
Any woman who is breastfeeding should also avoid certolizumab.
ETANERCEPT
Brand Name: Enbrel
Supplied: 50 mg pre-filled syringes & 25 mg vials of powder for reconstitution
You should discuss all vaccinations with your doctor and notify your doctor of
any scheduled surgeries.
Frequency
Call Doctor
Common
If severe
Rare
If severe
Headaches
Rare
If severe
Rare
Yes always
Very rare
Monitored by doctor
Very rare
Very rare
Very rare
Monitored by doctor
Monitored by doctor
Action
Fever
Prescribed an antibiotic
Become pregnant
Monitored by doctor
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Any woman who is pregnant or may become pregnant should not take
etanercept, as it has not been studied in pregnant women. Women taking
etanercept should use birth control, such as the oral contraceptive pill.
Any woman who is breastfeeding should also avoid etanercept.
GOLIMUMAB
Brand Name: Simponi
Supplied: 50 mg pre-filled syringes and 50 mg pre-filled autoinjector
Anyone with a history of cancer, congestive heart failure or nervous system problems
(like multiple sclerosis) should discuss the use of etanercept with their doctor.
You should discuss all vaccinations with your doctor and notify your doctor of
any scheduled surgeries.
Frequency
Call Doctor
Common
If severe
Rare
If severe
Headaches
Rare
If severe
Rare
Yes always
Very rare
Monitored by doctor
Very rare
Very rare
Very rare
Monitored by doctor
Monitored by doctor
Action
Fever
Prescribed an antibiotic
Become pregnant
Monitored by doctor
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Any woman who is pregnant or may become pregnant should not take
golimumab, as it has not been studied in pregnant women. Women taking
golimumab should use birth control, such as the oral contraceptive pill.
Any woman who is breastfeeding should also avoid golimumab.
INFLIXIMAB
Brand Name: Remicade
Supplied: Given by intravenous infusion
You should discuss all vaccinations with your doctor and notify your doctor of
any scheduled surgeries.
Frequency
Call Doctor
Common
If severe
Abdominal pain
Rare
If severe
Headaches
Rare
If severe
Rare
Yes always
Very rare
Monitored by doctor
Very rare
Very rare
Very rare
Monitored by doctor
Monitored by doctor
Action
Fever
Prescribed an antibiotic
Become pregnant
Monitored by doctor
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55
Frequency
Call Doctor
Infusion reaction
Common
If severe
Rare
If severe
Headaches
Rare
If severe
Rare
If severe
Rash or flushing
Rare
If severe
Rare
Yes always
Very rare
Monitored by doctor
Very rare
Very rare
Very rare
Very rare
Monitored by doctor
Monitored by doctor
Concern
Action
Fever
Prescribed an antibiotic
Become pregnant
Monitored by doctor
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RITUXIMAB
Brand Name: Rituxan
Supplied: Given by intravenous infusion
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Any woman who is pregnant or may become pregnant should not take
rituximab, as it has not been studied in pregnant women. Women taking
rituximab should use birth control, such as the oral contraceptive pill.
Any woman who is breastfeeding should also avoid rituximab.
TOCILIZUMAB
Brand Name: Actemra
Supplied: Given by intravenous infusion
You should discuss all vaccinations with your doctor and notify your doctor of
any scheduled surgeries.
Infusion reaction
Common
Rare
If severe
Rare
If severe
Rare
If severe
Rash or flushing
Rare
If severe
Rare
Yes always
Very rare
Monitored by doctor
Very rare
Monitored by doctor
Action
Fever
Become pregnant
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Any woman who is pregnant or may become pregnant should not take
tocilizumab, as it has not been studied in pregnant women. Women taking
tocilizumab should use birth control, such as the oral contraceptive pill.
Any woman who is breastfeeding should also avoid tocilizumab.
Anyone with a history of cancer, congestive heart failure or nervous system problems
(like multiple sclerosis) should discuss the use of tocilizumab with their doctor.
INDEX
Abatacept pg 43-45
Celebrex pg 15
You should discuss all vaccinations with your doctor and notify your doctor of
any scheduled surgeries.
Celecoxib pg 14, 15
Acetic acids pg 15
Actemra pg 59, 60
Cimzia pg 49, 50
Clinoril pg 15
Codeine pg 12, 13
Allopurinol pg 24
Symptom
Rare
If severe
Rare
If severe
Rare
If severe
Anacin pg 11
COXIBs pg 14-18
Blisters, shingles
Rare
If severe
Cytotec pg 19
Rare
Yes always
Ansaid pg 15
Daypro pg 15
Stomach pain
Rare
If severe
Demerol pg 13
Headache, dizziness
Rare
If severe
Depomedrol pg 35, 36
Rare
Aristospan pg 35, 36
Diflunisal pg 15
Rare
ArthriCare pg 12
Dilaudid pg 13
Rare
Arthrotec-50 pg 15
DMARDs (Disease-Modifying
Rare
Arthrotec-75 pg 15
Very rare
If severe
Aspercreme pg 12
Dolobid pg 15
Very rare
If severe
Duragesic Patches pg 13
Very rare
Azathioprine pg 23-25
Very rare
Yes always
BenGay pg 12
Entrophen pg 11, 14
Betamethasone pg 35
Esomeprazole pg 20
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Etodolac pg 15
Methotrexate pg 31, 32
Oxycodone pg 13
Steroids pg 8, 35, 40
Eucalyptamint pg 12
Meloxicam pg 15
Oxicams pg 15
Feldene pg 15
M-Eslon pg 13
Oxycontin pg 13
Fentanyl pg 13
Meperidine pg 13
Pantoloc pg 20
Sulindac pg 15
Flexall pg 12
Methylprednisolone pg 35, 36
Pantoprazole pg 20
Surgam pg 15
Flurbiprofen pg 15
Pariet pg 20
Surgam-SR pg 15
Froben pg 15
Mobicox pg 15
Pennsaid pg 17
Tenoxicam pg 15
Froben-SR pg 15
Morphine pg 12, 13
Percocet pg 13
Tiaprofenic Acid pg 15
Percodan pg 13
MS-Contin pg 13
Topical Medications pg 12
Piroxicam pg 15
Toradol pg 15
Myoflex pg 12
Plaquenil pg 22
Tramadol pg 13
Hydromorph-Contin pg 13
Nabumetone pg 15
Tramacet pg 13
Hydromorphone pg 13
Naphthylalkanones pg 15
Prevacid pg 20
Triamcinolone Acetonide pg 35
Naprosyn pg 15
Propionic Acids pg 15
Triamcinolone Hexacetonide pg 35
Naprosyn-SR pg 15
Tridural pg 13
Imuran pg 22-25
Naproxen pg 15
Rabeprazole pg 20
Tylenol pg 11, 13
Indocid pg 15
Nexium pg 20
Ralivia pg 13
Ultradol pg 15
Inflammatory arthritis pg 7, 8
Non-Medical Techniques pg 10
Relafen pg 15
Viscosupplementation pg 8, 20, 21
Non-Prescription Medications pg 11
Voltaren pg 15
Kenalog pg 35, 36
Novasen pg 11, 14
Rhodis pg 15
Voltaren-SR pg 15
Ketoprofen pg 15
NSAIDs (Non-Steroidal
Rituxan pg 56, 57
Zostrix pg 12
Ketorolac pg 15
Rituximab pg 57, 58
Orencia pg 43-45
Lansoprazole pg 20
Orudis pg 15
Salicylates pg 12, 15
Oruvail pg 15
Losec pg 20
Oxaprozin pg 15
Solumedrol pg 35, 57
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NOTES
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NOTES
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