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Taking Your Medicines Safely

by Linda Richards, RD, MS

DMARDs. Disease-modifying antirheumatic drugs (DMARDs) are often prescribed to treat inflammatory types of arthritis, such as rheumatoid arthritis (RA), lupus, and scleroderma. Methotrexate (Rheumatrex, Trexall) is the most commonly used DMARD; among others are hydroxychloroquine (Plaquenil), sulfasalazine (Azulfidine), leflunomide (Arava), azathioprine (Imuran), and gold injections.

With some of the DMARDs, the most serious potential side effect is infection. Individual DMARDs also have additional potential side effects. For example, hydroxychloroquine can cause eye problems (although this is rare), and methotrexate and leflunomide can irritate the liver. If you take a DMARD, your doctor will run tests from time to time to check for side effects.

Examples of interactions are that taking azathioprine and the gout medicine allopurinol increases the risk of liver problems, and that taking sulfasalazine with blood-thinning medicines increases the risk of bleeding.

Biologic response modifiers. Biologic response modifiers include etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), anakinra (Kineret), abatacept (Orencia), and rituximab (Rituxan). The biologics target specific parts of the immune system known to be involved in the inflammation of inflammatory types of arthritis. Side effects include a risk of serious infection and a rash at the injection site.

Analgesics. Analgesics are designed for pain relief, with acetaminophen (Tylenol) being the most widely used. Some doctors prescribe stronger analgesics, such as codeine, for severe pain. These stronger analgesics, or narcotics, may be combined with acetaminophen. Examples are acetaminophen with codeine (Tylenol No. 2) and hydrocodone with acetaminophen (Vicodin). Acetaminophen can have serious effects on the liver if you take higher doses than recommended or if you drink alcohol while you’re on the drug. Acetaminophen overdose is easier than you might think because acetaminophen is an ingredient in many over-the-counter cold medicines. People may take more than one drug containing acetaminophen without realizing it. (That’s why checking labels is important.) Narcotic analgesics may cause physical and psychological dependence over time.

An example of an interaction is that taking analgesics and tricyclic antidepressants, such as amitriptyline or doxepin, increases the risk of side effects from both types of drugs, including drowsiness and weakness.

Corticosteroids. Many people with inflammatory types of arthritis take corticosteroids such as prednisone, which are among the most effective and fast-working drugs. Because they can cause some very serious side effects, including bone loss, cataracts, and high levels of blood glucose, the lowest possible dose for as short a time as possible is advised, although doses may be increased if arthritis flares are particularly severe.

Examples of interactions are that if you take corticosteroids and insulin or oral diabetes medicines, you may decrease the effectiveness of the diabetes drugs.

Supplements and foods. While most adults consult their doctors about prescription drugs, less than half tell their physicians about their supplement use. This is unfortunate since attitudes about alternative medicine have shifted over the last decade. Today your physician is likely more open to discussing supplement use. It’s also important because supplements sometimes have a positive and sometimes a negative effect on your other medicines.

For example, glucosamine and chondroitin sulfate can cause stomach upset, bloating, and other GI side effects in some people, and it’s possible that glucosamine can increase blood glucose levels, although the research on this is mixed. Ginger and devil’s claw may increase the risk of bleeding if you’re taking NSAIDs or corticosteroids.

If you do use supplements, which are not regulated the way drugs are, buy supplements with a United States Pharmacopeia (USP) seal or an endorsement from ConsumerLab on the label. These seals/endorsements don’t speak to the health claims of the supplements, but they do ensure that you are getting a quality product. Occasionally, regular foods may enhance or interfere with certain medicines. One well-known example of this is grapefruit or grapefruit juice, which can affect how much of certain drugs gets into your bloodstream. These drugs include cyclosporine, certain lipid-lowering and heart medicines, certain blood pressure medicines, and some anti-anxiety drugs.

Safety first

Taking a drug safely may require a little extra effort, but the added security is well worth it. The lessons of drug safety can be boiled down to a few simple rules: know what you are taking and why; follow directions; look after your drugs properly; and be alert to any possible side effects or interactions.

Last Reviewed on June 15, 2011

Linda Richards is a freelance health writer based in Alpine, California.

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