DMARDs: Safety

Reduce the risks of these arthritis-fighting drugs by using them safely.


DMARDs are a class of drugs often prescribed for inflammatory forms of arthritis. While they are most commonly used for rheumatoid arthritis, many are also used for juvenile arthritis, psoriatic arthritis, ankylosing spondylitis and lupus. The drugs work in different ways to prevent the immune system from damaging the joints and, in some cases, internal organs. By doing so, DMARDs can help people with inflammatory arthritis live more active lives with less pain and less risk of joint destruction. But the drugs are not without risks.

Because all DMARDs work differently, it is important to read about and speak with your doctor about the benefits and risks of the one(s) you are prescribed. Follow these general tips to reduce your risks and use DMARDs safely.

Discuss Preexisting Medical Conditions

Medical conditions you have before you start a DMARD may increase your risk of side effects from certain DMARDs. Let your doctor know if you have an active infection, kidney or liver disease, cardiovascular disease or a history of cancer. Also, let your doctor know if you have allergies to other drugs. If you are allergic to aspirin or sulfa drugs, for example, you should not take sulfasalazine.

Disclose Other Medicines You Take

Let your doctor know all of the drugs and supplements you are taking. Often drugs interact with one another. Some drugs may interfere with the effectiveness of your DMARD, while others may increase your risk of a potentially serious side effect. In some cases starting a DMARD will mean you have to stop another drug or switch to a different one.

Take with Food – If Advised

Some medicines can cause stomach upset if taken on an empty stomach. Others – such as minocycline, an antibiotic that may be used as a DMARD – work best on an empty stomach.

Get Checkups

Regular monitoring is the key to identifying potential problems so they don’t become serious problems. Your doctor may recommend you have periodic checkups or lab tests to determine if the drugs are affecting your blood, internal organs or eyes. These tests can help your doctor decide if you need a change in dose or a different medication.

Avoid Infections

Because DMARDs suppress the immune system, be careful of activities or situations that are likely to introduce germs to your body. Wash your hands frequently, avoid touching your eyes and nose, try to stay away from people who are sick, and wear gloves when working in the yard to avoid getting pricked or cut. Let your doctor know if you are on a DMARD and scheduling a surgical or dental procedure. Get all the immunizations recommended by your doctor. If you notice signs of infection – fever, cough or painful urination, for example – let your doctor know right away.

Become Familiar with Side Effects

Speak with your doctor about side effects to watch for and what to do if you experience them. Report any health problems to your doctor.

Understand Dosing Directions

DMARDs can be given in different ways (oral or injected), on different schedules (daily, weekly) and in many different amounts. Be sure you understand exactly how much you need to take and how often. Never increase your dose unless your doctor advises.

Ask About Foods and Supplements

Ask your doctor if you need – or should avoid – any particular foods or supplements while taking a DMARD. Taking a folic acid supplement with methotrexate, for example, can reduce the drug’s side effects.  Taking cyclosporine with grapefruit juice can make it difficult to regulate levels of the drug in your body.

Limit or Avoid Alcohol

DMARDs and alcohol don’t always mix. Methotrexate, leflunomide and cyclosporine can affect the liver. Drinking alcohol while taking those drugs can increase the risk of liver damage.

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