To minimize the risk of side effects, your doctor should prescribe the lowest dose of a medication that helps, and you should let your doctor know of any medical problems you have or medications you are already taking. Keep in mind that some potentially serious problems can be detected only by regular lab tests ordered by your doctor.

If you experience serious side effects, your doctor may decide to stop a drug. In other cases, you and your doctor can try to relieve side effects as you continue to take the drug and gain its benefits by trying the following:

SIDE EFFECT: STOMACH UPSET and NAUSEA
CULPRITS: NSAIDs, DMARDs
POSSIBLE SOLUTIONS:

• Take the medication with food.
• Take a once-daily NSAID in the afternoon or evening, instead of the morning.
• Take NSAIDs with a drug that reduces stomach acid. These come in two types and include cimetidine (Tagamet), ranitidine hydrochloride (Zantac), esomeprazole (Nexium), lansoprazole (Prevacid) and omeprazole (Prilosec).
• Switch from an oral DMARD to an injected form. For severe problems, ask about anti-nausea and vomiting drugs such as granisetron (Kytril) or metoclopramide (Reglan).

SIDE EFFECT: STOMACH ULCERS
CULPRITS: NSAIDs
POSSIBLE SOLUTIONS:

• Add misoprostal (Cytotec) to reduce the risk of stomach ulcers and promote healing of existing ulcers. Misoprostol comes in a combination product called Arthrotec, which also contains the NSAID diclofenac sodium.
• Switch to celecoxib (Celebrex), a type of NSAID called a COX-2 that has less risk of stomach ulcers.
• Avoid alcohol. Alcohol mixed with NSAIDs can increase gastric bleeding.
• Avoid taking an NSAID with another medication, such as an OTC cold remedy, which could also contain an NSAID and increase your risk of ulcers.

SIDE EFFECT: INSOMNIA
CULPRITS: CORTICOSTEROIDS
POSSIBLE SOLUTIONS:

• Take a once-daily dose in the morning.
• Avoid stimulants such as caffeine that exacerbate sleeplessness.

SIDE EFFECT: DRY MOUTH
CULPRITS: ANTIDEPRESSANTS, NARCOTIC ANALGESICS
POSSIBLE SOLUTIONS:

• Moisten your mouth with sugar-free gum or hard candies, or by sucking on ice chips.
• Try saliva substitutes, such as Salivart, Xerolube or Glandosan.
• Avoid alcohol or alcohol-containing mouthwashes that can make dry mouth worse.

SIDE EFFECT: MOUTH ULCERS
CULPRITS: METHOTREXATE
POSSIBLE SOLUTIONS:

• Avoid salty or spicy foods or excess citrus fruits that can irritate ulcers
• Try topical pain relievers such as Oragel or Zilactin or ask your doctor or dentist about a prescription rinse or mouthwash to help ulcers heal.

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