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Arthritis Today

Scared by Side Effects

Advice for reducing the risk of medication side effects.

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Q: After reading the pharmacy sheets listing side effects of the medications I take for rheumatoid arthritis (RA), I can't help but wonder if the "cure" is worse than the disease. Is it possible I'd be better off skipping the medications and taking my chances with the RA?

A: For those with arthritis, side effects of medication are an understandable worry. But I would hate to see fear cause you to give up medications completely. True, no medication is completely safe, and the potential risk of side effects can be frightening. Anytime you interfere with one bodily process you may interfere with others – sometimes in undesirable ways. But the dangers of untreated RA, in most cases, far outweigh the risks of the drugs used to treat it. Each day, medications ease pain, prevent joint destruction and improve the lives of countless people with arthritis and related conditions. In some cases, medications can literally save lives.

The pharmacy sheets are provided as a service to make you aware of side effects that can occur with a certain medication. Keep in mind that the key word here is "can." You shouldn't assume that the listed side effects will necessarily occur in you. Even if you do experience one or more side effects, you may be able to reverse or halt them by stopping or changing medications. In most cases, no action is needed; the side effects resolve on their own.

Many factors can influence how your body reacts to a drug. Some are largely controllable – such as when and how you take your medicine. Factors that can't be changed, such as your age and other health problems, may be compensated for with choice of medication or a dosage adjustment. Life is full of risks. Sometimes we have to risk experiencing a side effect to gain a medication's benefits. The key is weighing risks against potential gain. Your doctor can help you weigh those risks and choose the drugs that provide the most help and do the least possible harm.

There are also several things you can do to reduce your risk of drug side effects. Here are a few:

Let your doctor know about any other medications you are taking – even over-the-counter (OTC) ones – because some can add to the side effects of others. For example, taking aspirin along with a prescription nonsteroidal anti-inflammatory drug (NSAID) can increase your risk of stomach ulcers and other side effects.

Don't underestimate the power of nutritional supplements. Nutritional supplements, too, can affect the way a drug works. In some cases – such as taking folic acid along with methotrexate – vitamin supplements can reduce the risk of certain side effects. In other cases, taking nutritional supplements or herbs in addition to prescribed medications can interfere with the action of the medication or even enhance its potential side effects.

Find out if there are certain foods you should eat or avoid while taking a medication. Most drugs, including NSAIDs, should be taken with food to reduce the risk of stomach upset. For others – such as minocycline, an antibiotic that is being used increasingly to treat RA – taking with food can decrease the drug's absorption.

Forgo alcohol – it can add to the side effects of most drugs, from analgesics to antidepressants. If you can't or don't want to give up alcohol altogether, set a limit of two drinks (including beer) per week.

Ask your doctor to prescribe the lowest beneficial dose of a drug and never take more than the prescribed amount. Many side effects are related to dosage. High doses of glucocorticoids such as prednisone, for example, can cause a wide range of side effects, including fluid retention, fragile bones and increased susceptibility to infections. Low doses, which are often effective in managing inflammatory arthritis, have a low risk of side effects.

Take the drug at the time designated by your doctor. Timing, in some cases, can influence a drug's side effects. For example, taking the osteoporosis drug alendronate when you get up in the morning, rather than before lying down at night, can cut the risk of esophageal ulcers. Timing can also influence some drugs' wanted effects. By taking a drug at the optimum time, you may actually be able to reduce the dose and, thus, the risk of side effects.

Never stop taking any medication without consulting your doctor. A drug can't help you if you don't take it, but abruptly stopping a drug can hurt you. The dosage of drugs such as prednisone, for example, must be tapered to avoid serious adverse effects.

Let your doctor know if you suspect a side effect. He can determine whether the side effect requires treatment or if discontinuing a drug or perhaps educing its dose is in order.

Leonard H. Calabrese, DO
Rheumatologist

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