A joint decision between patient and doctor about how to manage a chronic disease is essential. Often, prescription medications are the core of traditional treatment for most, if not all, chronic diseases. Many diseases are managed with medication from more than one drug class, meaning, patients take more than one drug.
Common Rheumatoid Arthritis Medications
People with rheumatoid arthritis (RA) are prescribed medications from five main drug classes, which include NSAIDs (nonsteroidal anti-inflammatory drugs), analgesics (pain medications), DMARDs (disease-modifying antirheumatic drugs), biologics, and corticosteroids. Based on their preferences and recommendations from their doctors, RA patients typically go through periods of trial and error to find the most effective combination of drugs. Once that is determined, adherence with the treatment plan is important, as is an awareness of potential side effects and adverse events.
Side Effects Are Possible
Rheumatoid arthritis medications are associated with potential side effects that can be severe and possibly even fatal. It is the responsibility of the person living with RA to know what those side effects are and to avoid making mistakes, which can have serious consequences.
7 Common Mistakes Associated With RA Drugs
Let’s consider some of the common mistakes made by people who take rheumatoid arthritis drugs, starting with one of the most serious:
Mistake No. 1: You Take Methotrexate Once a Day Instead of Once a Week
Methotrexate, the most commonly prescribed DMARD for RA, is taken weekly. The oral formulation of methotrexate is taken one day a week for RA on the same day each week (e.g., every Saturday). It is not taken daily like many medications. Methotrexate is available in 2.5 milligram (mg) tablets. The usual starting dose for adults with RA is 7.5 mgs — that's three 2.5 mg tablets taken together once a week. The total dose of methotrexate can be increased to up to 25 mgs each week, if needed, per doctor’s orders. Too often we hear reports of people who mistakenly take methotrexate daily rather than weekly. That specific mistake can result in serious side effects related to toxicity and possibly even death. Errors can occur at the pharmacy, too, where mislabeling may direct a patient to take methotrexate daily versus weekly. Know that methotrexate for RA is a weekly drug. Call the pharmacy and your doctor if directions are confusing or contradictory.
Mistake No. 2: You Use More Than One Type of NSAID at a Time
Different NSAIDs should not be combined. NSAIDs are popular, commonly prescribed anti-inflammatory medications. A handful of NSAIDs are familiar by their brand names and even their generic names. For example, most people have heard of or have used Motrin or Advil (ibuprofen) or Naprosyn (naproxen).
There are numerous NSAIDs available that are less familiar. Ibuprofen is also sold without a prescription under the brand names Addaprin and I-Prin, while naproxen sodium is available as Aleve. What’s more, some over-the-counter (OTC) products are marketed to treat more than one symptom so they contain more than one type of drug. Why is that important to know? You should take only one NSAID at a time. You cannot take two or more different NSAIDs without increasing the risk of side effects, especially gastrointestinal side effects (e.g., bleeding ulcers) and the risk of heart attack or stroke. People who take an oral NSAID must be aware of this because NSAIDs come in various formulations (such as topical creams and patches) and as OTC products, too. People must read the label on every product they use and consider the cumulative effect of the listed NSAIDs.
Mistake No. 3: You Combine OTC and Prescription NSAIDs
Rules for the safe use of NSAIDS pertain to over-the-counter versions, too. Advil and Aleve are commonly used over-the-counter NSAIDs. They contain ibuprofen and naproxen, respectively, but not at prescription strength. Because Advil and Aleve are readily available on drugstore shelves, people sometimes pick up the products and use them without being aware that they are NSAIDs and should not be combined with other NSAIDs.
Mistake No. 4: You Don’t Store Biologic Drugs Properly
Most biologic drugs must be kept refrigerated. It is important for people to adhere to that instruction so that the quality of the product is preserved and the biologic drug is kept at the appropriate temperature. People who travel with biologic drugs sometimes neglect or forget to make preparations to keep them refrigerated. Also, sometimes people pick up their biologic drug from the pharmacy and fail to get it into the refrigerator at home as quickly as possible. Most, if not all, of the biologic drug manufacturers provide travel kits to keep your medication cold. Check out the drug manufacturer’s website for your particular biologic drug and follow its instructions for maintaining the proper temperature, whether storing it at home or traveling.
Mistake No. 5: You Stop Prednisone Cold Turkey
Discontinuation of prednisone should involve tapering the dose. People who take prednisone or other oral corticosteroids — especially those who take high doses or who have taken the drug for a long period of time — are warned about the need to taper the dose when stopping the drug to avoid withdrawal symptoms. The symptoms of withdrawal may include joint pain, muscle pain, fatigue, headache, fever, low blood pressure, nausea, and vomiting. Sudden discontinuation may cause severe withdrawal symptoms in people who have taken corticosteroids for a prolonged period because the normal production of steroids by the body is essentially turned off during that time and needs to reboot. Despite this well-known warning, some people with RA mistakenly take a chance and stop prednisone cold turkey, risking a life-threatening situation.
Mistake No. 6: You Don’t Follow the Directions Exactly
Read the prescribing information for your drug and follow the directions precisely. Check the label on your prescription bottles, as well as the small stickers that the pharmacist adds when filling your prescription. Make sure that the label matches what your doctor told you in person. Too often people pay no attention to prescribing information beyond how many pills to take. Do not disregard directions, such as if you need to take the medication with food or on an empty stomach. There is a good reason for those directives.
Mistake No. 7: You Don’t Tell All of Your Doctors About Everything You Are Taking
All of your doctors should know what medications and supplements you are taking. People with RA typically have more than one doctor on their healthcare team. It is important for each of your doctors to have a complete and current medication list for you. Keeping all of your doctors on the same page will help prevent prescribing errors related to drug interactions. Do not neglect to provide each doctor with your full list. It’s your responsibility.
My Takeaway Advice
Some medication mistakes made by people with RA are related to negligence. Other mistakes occur because of a lack of awareness. Some are simply accidental. Regardless, the consequences can be dire.
Be sure to learn about each medication that you are prescribed. Be aware of what is required for the proper and safe use of each drug that you take. Don’t deviate from the prescribed regimen. Take it seriously. Safe use of medication is your responsibility.