Biologics: Side Effects and Solutions
Here are the most common side effects associated with biologic drugs, with tips for lessening their effects.
If you’ve ever read the prescribing information for any medication, the side effects can be scary. The truth of the matter is that for most people the benefit of taking the drug outweighs its possible side effects.
Perspective About Side Effects
The Food and Drug Administration (FDA) instructs drug companies on what to include in their warnings section for prescription medications. Your biologic is FDA approved because it passed a series of trials to prove its safety and efficacy. You need to put these benefits in perspective when comparing potential risks, which include side effects labeled as “common” (occurring in ~1 in 10 who take a drug), “uncommon” (~1 in 100) or “rare” (~1 in 1000).
Let’s look at some of the most common side effects, and possible solutions, for the average person with inflammatory arthritis taking a biologic drug.
Injection Site Reactions
Injection site reactions – such as redness, swelling, itching or pain around the injection site – are fairly common, especially at the beginning of your treatment. Most reactions clear up without treatment, but you can use a cold compress, topical corticosteroids, oral antihistamines, or acetaminophen to ease discomfort. If symptoms persist past 5 days or get worse, call your doctor. The spot where you inject yourself should also be rotated.
If your biologic is given as an infusion, the clinic or facility will begin by getting your vital signs – temperature, blood pressure and pulse. A health professional will continue to monitor your vitals during and after the infusion until you leave the facility.
Before your scheduled biologic infusion (and sometimes given prior to injections), you may receive “pre-meds,” such as an antihistamine, antiemetic (for nausea) or an anti-inflammatory drug (NSAID). These will prevent any mild reactions, such as pain, swelling, redness at infusion site, headache, flushing, nausea or rash. If more serious reactions (such as difficulty breathing, chest pain or tightness, high or low blood pressure, swelling of face and hands, fever, chills or anaphylaxis) occur, the infusion can be stopped and the reaction will be treated on site.
Since biologic therapies suppress the immune system, treatment leaves you more susceptible to infection. The most common are colds, upper respiratory tract infection, sinus infection, sore throat/bronchitis or urinary tract infections.
The most effective way to prevent infection is frequent hand washing. Wash your hands any time you arrive somewhere, whether it be home, work, restaurant or a friend’s house. Be sure to wash before and after eating or preparing food. If soap and water are not available, use a commercial hand sanitizer.
Here are other suggestions for avoiding infections:
- Avoid crowded areas, enclosed spaces, public transportation and childcare facilities.
- Tell friends and family not to visit if they are sick.
- Talk to your doctor before scheduling vaccinations, dental appointments or manicures.
- Do not share cups, utensils or personal items.
- Do not swim in lakes, rivers, ponds or public pools; and avoid hot tubs.
- Ask your doctor about contact with your pets. It’s probably a good idea not to change cat litter or to clean up after the dog. Birds, fish, rodents, reptiles and farm animals should be avoided.
- Check with your doctor about whether it’s safe to work in the garden with soil or mulch.
- It’s a good idea to avoid unpasteurized food, raw eggs or fish, soft cheeses and shellfish.
Headaches occur more commonly in patients taking biologics than the general public. Try placing a cold pack on your forehead for 10 to 15 minutes. Or you can try lying down in a dim room for a few minutes, taking a warm shower, or massaging your head and neck. Avoid looking at a computer or smartphone screen for extended periods. It might also help to reduce the amount of caffeine you consume.
There are a number of non-drug remedies you can try to combat queasiness.
- Place a cold compress on your forehead.
- Lie down without moving in a dark, quiet room.
- Avoid heat, humidity and stuffy rooms.
- Breathe fresh air deeply through your nose; sometimes inhaling peppermint or drinking ginger tea helps.
- Suck on ice or sip cool water. Nibble on a saltine cracker if you think your stomach can handle it. Avoid sugary drinks or snacks.
Recognize New Symptoms Right Away
A key piece of advice is to listen to your body. The following symptoms are signs of an infection or a more serious condition and you should contact your doctor right away:
- Fever, sweat or chills
- Muscle aches, weakness/numbness or tingling
- Shortness of breath or chest pain
- Rash or painful sores; warm, red or painful skin
- Diarrhea or stomach pain
- Burning during urination or urinating more than normal
- Unusual fatigue
- Vision problems or dizziness
- Poor appetite or weight loss
- Bleeding or bruising easily
The good news is that most people feel a beneficial effect fairly soon after the first treatment with a biologic. And although side effects can develop within the first 6 to 9 months of treatment, the risk declines with continued use, especially if the drug is improving your condition.