Understanding Rheumatoid Arthritis Medications (cont.)
Francisco Talavera, PharmD, PhD
IN THIS ARTICLE
- What Is Rheumatoid Arthritis?
- What Causes Rheumatoid Arthritis?
- What Are the Risks of Rheumatoid Arthritis?
- How Is Rheumatoid Arthritis Treated?
- Nonsteroidal anti-inflammatory drugs (NSAIDs), nonselective inhibitors of the cyclo-oxygenase (COX-1 and COX-2) enzymes
- NSAIDs, selective cyclo-oxygenase-2 (COX-2) inhibitors
- Disease-modifying antirheumatic drugs (DMARDs)
- Azathioprine (Imuran), Cyclosporine (Sandimmune, Neoral), Gold salts, and Hydroxychloroquine (Plaquenil)
- Leflunomide (Arava), Methotrexate (Rheumatrex, Trexall), Penicillamine (Cuprimine), and Sulfasalazine (Azulfidine)
- Biologic drugs
- Investigational drugs
- Synonyms and Keywords
- Authors and Editors
- Understanding Rheumatoid Arthritis Medications Topic Guide
Azathioprine (Imuran), Cyclosporine (Sandimmune, Neoral), Gold salts, and Hydroxychloroquine (Plaquenil)
- Who should not use this medication: Pregnant or breastfeeding women should not use azathioprine; additionally, people with the following conditions should not use this drug:
- Allergy to azathioprine
- Preexisting bone marrow or blood toxicities
- Use: Azathioprine is taken orally up to 3 times daily. If the response is inadequate, the dose may be gradually increased after 6-8 weeks. Take with food to decrease stomach irritation.
- Drug or food interactions: Use of other immunosuppressant drugs increases the risk for infection and increases toxicity to bone marrow or blood cells. Many drug interactions exist. Contact a doctor or pharmacist before beginning new prescription or over-the-counter medications.
- Side effects: Immunosuppressant drugs are not safe during pregnancy. They may also cause bone marrow or blood cell toxicity. People with impaired kidney or liver function may need lower doses.
Cyclosporine (Sandimmune, Neoral)
- Who should not use this medication: People receiving psoralen-PUV-A or UV-B radiation should not take cyclosporine because of an increased cancer risk. Additionally, persons with the following conditions should not take this drug:
- Allergy to cyclosporine
- Uncontrolled hypertension
- Use: Cyclosporine is taken orally in daily doses. Take it at the same time of day and with the same food. High-fat meals may decrease absorption, while milk may slightly increase absorption.
- Drug or food interactions: Patients must tell their doctor what medications they are currently taking, because many drugs interact with cyclosporine. Grapefruit juice may increase the level of cyclosporine in the blood, causing increased side effects. Cyclosporine may increase the risk of severe muscle and kidney toxicity of cholesterol-lowering medications known as statins (lovastatin [Mevacor], atorvastatin [Lipitor], simvastatin [Zocor], Pravastatin [Pravachol]).
- The following drugs may decrease the level of cyclosporine in the blood, thereby decreasing effectiveness:The following drugs increase cyclosporine side effects:
- Antibiotics - Azithromycin (Zithromax), clarithromycin (Biaxin), erythromycin (E.E.S., Ery-Tab, E-Mycin), gentamicin (Garamycin)
- Antifungals - Itraconazole (Sporanox), ketoconazole (Nizoral), fluconazole (Diflucan), voriconazole (VFEND), amphotericin B (Fungizone, Amphotec, Abelcet)
- Antivirals - Acyclovir (Zovirax)
- Cardiovascular medications - Nicardipine (Cardene), verapamil (Calan, Isoptin, Covera-HS)
- Side effects: To guard against problems, blood pressure and kidney and liver function are monitored on a regular basis, as is the level of cyclosporine in the blood. Cyclosporine may increase the risk of infection or lymphoma.
Gold salts (auranofin [Ridaura], aurothioglucose [Solganal], gold sodium thiomalate [Aurolate, Myochrysine])
- Who should not use this medication: Persons with the following conditions should not take gold salts:
- Allergy to gold products or other heavy metals
- Severe colitis
- Pulmonary fibrosis
- Exfoliative dermatitis
- Bone marrow disease resulting in low blood cell counts
- Blood cell disease
- Use: Gold pills are taken every day or every other day. The injectable forms may be taken by injection every 1-2 weeks for the first 5-6 months, and then decreased to monthly injections.
- Drug or food interactions: Gold salts may increase bone marrow toxicity when used with other drugs that depress bone marrow function. When used with penicillamine (Cuprimine), gold salts may increase the risk for skin rash, bone marrow toxicity, and decreased blood cell counts.
- Side effects: Gold salts must be used with caution in people with liver or kidney disease and in those with a history of bone marrow disease or severe hypertension. Skin rash and irritation are common side effects. Gold salts may cause the following:
- Decreased appetite
- Mouth soreness
- Eye infection
- Renal toxicity with edema
- Pulmonary toxicity
- Blood cell toxicity
- Bone marrow toxicity
- Who should not use this medication: People with allergy to hydroxychloroquine or related drugs (for example, chloroquine [Aralen]), and those with a history of vision changes caused by the drug or related drugs should not take them.
- Use: Hydroxychloroquine is taken orally in varying doses. Take with food or milk.
- Drug or food interactions: Hydroxychloroquine may increase the risk of liver toxicity when administered with other drugs toxic to the liver, such as acetaminophen (Tylenol). Hydroxychloroquine may increase levels of digoxin and metoprolol in the blood.
- Side effects: Annual eye examinations are required to monitor for possible vision changes. Hydroxychloroquine must be used with caution in individuals with the following conditions:
- Liver disease
- G-6-PD deficiency
- Kidney impairment
- Blood disorders
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