Taking your medication
How long before my new medication takes effect?
Most disease-modifying medications (DMARDs) take 8-12 weeks to be effective, particularly if they require a gradual dose increase. Some people notice an improvement earlier than this.
When should I take my medication?
Some medications need to be taken on an empty stomach or separately from other drugs. If this is the case we will tell you when the treatment is first prescribed. Full instructions are clearly stated on the packaging or accompanying leaflet.
Some medication such as anti-inflammatory (NSAID) drugs should always be taken with or immediately after food. Again, this should be clearly stated on the drug packaging.
Methotrexate is only to be taken once weekly, on the same day each week.
It is important to take all medication at the correct dose and at regular intervals as recommended.
If you are taking a bisphosphonate tablet for osteoporosis ( eg. Alendronic acid or risedronate) then this should be taken once you are fully upright on an empty stomach with a glass of water. No other food or drink or medication should be taken for at least 30 minutes after swallowing.
Should I stop any of my medications before going into hospital for surgery?
Depending upon the reason for your admission, we may advise you to temporarily stop some or all of your treatment. However, you should continue to take all prescribed medication unless specifically advised to do otherwise.
Biologic treatment may need to be stopped for one to two weeks before surgery, and can usually restart one to two weeks after surgery, once the wound is healed and you are free of infections. You should contact your Rheumatology Nurse Specialist using the number on your alert card to discuss this further.
Do I need to stop any of my medications for dental treatment?
You may need to withhold your drug depending on what type of dental treatment is being carried out. Ensure that your dentist is aware of what treatment you are on.
For how long do I have to continue my medication and can I ever stop it?
Most patients stay on their medications for a number of years. The aim of treatment is to get the condition into remission, which means a significant reduction in the symptoms of inflammation, but it doesn’t necessarily mean that the condition has gone.
The more aggressively we treat inflammatory arthritis at presentation, the more likely we are to achieve and maintain remission.
Not everyone will be able to stop their medications, but most should be able to reduce the dose and number of medications they take once their disease is under control. We will aim to ultimately get you on the minimum amount of medication to keep you well.
With any chronic inflammatory condition flares may occur and should not be seen as a sign of treatment failure, though if your flares increase in frequency or severity we will need to adjust or escalate your treatment.
Can I drink alcohol whilst on these medications?
Some medicines used to treat your arthritis are processed by your liver, and when taken with alcohol can increase the risk of liver side-effects.
We recommend that you have no more than 10 units of alcohol a week.
Is it OK to continue to take anti-inflammatory drugs (NSAIDs) and aspirin whilst on Methotrexate?
Methotrexate can theoretically interact with anti-inflammatory drugs including aspirin.
This is not a concern with the dosages of Methotrexate prescribed for the treatment of arthritis. However, long-term anti-inflammatory use is associated with an increased risk of gastric, kidney and cardiovascular problems and if at all possible should be avoided.
Why do I need to take folic acid after Methotrexate each week?
Methotrexate may be associated with side-effects such as mouth ulcers and these can be reduced or improved with folic acid.
What should I do about my medication if I have diarrhoea and vomiting?
If you are vomiting and unable to keep food down, it is sensible to omit your rheumatology medication while symptoms persist. When things have settled, start taking your medication again: however, if symptoms come back, then the symptoms may be due to the treatment. Please call/email our Rheumatology Advice Line to discuss this.
If you are taking Methotrexate in tablet form, it may be possible to change this to the injectable preparation. This is given under the skin, bypassing the gastrointestinal system, so less likely to cause side-effects such as nausea, vomiting and diarrhoea. If you would prefer this, please discuss with the Rheumatology team at your next appointment.
I feel sick after taking my methotrexate, should I stop taking the medication?
Feeling sick (nausea) is a common side-effect of methotrexate, especially when treatment starts. This normally gets better, but for some people it may continue.
This feeling may be helped by:
- taking the methotrexate with or after food
- taking the methotrexate just before you go to bed; you may be able to sleep through the feeling of sickness
- making sure you take your folic acid
- switching to injectable methotrexate.
Sometimes the dose of folic acid can be changed, but this should only be done after speaking to a doctor. Your doctor may tell you to take another tablet to reduce the feeling of sickness. The Rheumatology team may also change your methotrexate tablets to an injection once a week.
It is important that you take your methotrexate regularly so do not stop the drug without discussing it with the Rheumatology team or your doctor first.
What should I do if I have side-effects from my treatment?
Unfortunately some of the medications that are used to treat rheumatic diseases can cause side effects such as:
- mouth ulcers
- sore throats
Rarely, patients can develop shortness of breath and/or a dry cough, which may require further investigation.
It is important to report any side-effects, even if not listed above, and seek advice from your GP or the Rheumatology team about continuing treatment.
What can I do about injection site reactions?
Injection site reactions include redness, itching, pain or swelling at the injection site. They mostly occur one to two days after an injection and go away within three to five days. They are most common during the first few months of treatment.
It may help to apply a cold compress to the site. Anti-histamine tablets or creams available from your chemist can help.
Injection site reactions can be due to the way an injection has been given. Try changing where you give the injection each time: you can inject into the front of the thigh and abdomen.
If you have pain, redness, or swelling around the injection site that doesn’t go away, or gets worse, call the Rheumatology Advice Line or email the Rheumatology Advice Email..
If you keep having problems with reaction, we may need to check the way you are doing the injection.
Can I have a steroid injection before my holiday / wedding / special occasion?
If your arthritis is particularly active we may consider giving you a steroid injection to settle your symptoms, especially if you are waiting for new treatments to start working.
However, regular use of steroids can be harmful, so we do not routinely offer this before holidays or other special occasions. If you require this, please discuss it with your GP or the Rheumatology nurses, who will decide if it is appropriate.
How many times can I have a steroid injection?
There is no rule about the number of steroid injections a person can have, but long-term continued steroid use is associated with significant side-effects, so repeated injections are best avoided and should only be used if your condition has flared.
This is the reason many doctors limit the number of injections they offer to patients. If a steroid injection wears off quickly, or does not improve things, then repeating it may not help either.
If you need steroid injections often, it may be a sign that your disease is not well-controlled, and we may need to think about making changes to your medication.
Holidays / travel
I am going on holiday; what about my medication, do I need a travel letter?
You need to take your medication with you, including any injections you need, when you go on holiday.
If you get your prescription from your GP, please get in touch with them in good time to request extra medication for when you are on holiday.
If we supply your medication, please contact us for a travel letter if you are taking injections with you on a plane.
Keep your medication in your hand luggage if you are flying.
Methotrexate injections cannot be taken on board your flight and we would recommend that you take a prescription of oral Methotrexate for your holiday. This can be prescribed by your GP.
Is it OK to miss one or more injections (Methotrexate or biologic therapies) while I am away on holiday?
Ideally your medication schedule should not be interrupted as this increases the risk of your condition flaring.
If you have weekly Methotrexate injections, it may be possible to have a small supply of tablets prescribed for you to use instead during your holiday, but this is not an option if you have previously been intolerant of these.
People who regularly self-inject biologics drugs such as Etanercept (Enbrel) or Adalimumab (Imraldi) may continue while away, but ensure that refrigeration facilities are available.
Before you go, make sure you have sufficient supplies of your medication and ‘sharps’ bins for disposal of used syringes. Request a holiday letter from the delivery company or Rheumatology team to have with you when taking injectable medication through customs.
Does it matter if I miss one or more routine blood monitoring tests whilst I am away on holiday?
Obviously it may not be practical for you to arrange blood monitoring tests if you are away from home. Where possible, schedule tests for a week or so before your departure and as soon as possible after your return.
If you are planning an extended trip please discuss this with your GP, as alternative arrangements may need to be made.
Interactions with other medications
Can I take over-the-counter pain medications as well as my prescribed drugs?
Always check over-the-counter medications for possible interactions with prescribed drugs.
Simple painkillers such as paracetamol are usually safe, providing you do not exceed the maximum recommended dose and ensure that none of your prescribed drugs also contain paracetamol, since this could result in accidental overdose.
Do not take over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) such as Nurofen if you are already taking prescribed NSAIDs. Avoid NSAIDs if you have previously suffered any adverse effects or have a history of gastritis or stomach ulcers. Also avoid NSAIDs if you are asthmatic or have high blood pressure unless your GP advises you to take them.
Will my arthritis medications interfere with my other prescribed medications?
Bring a list of all your medications with you to every appointment: we take all your medications into account when making prescribing decisions.
Can I use complementary or herbal remedies?
Complementary or herbal medicines may interact with prescribed drugs. If you wish to use these therapies, please discuss this with us at your appointment. For more information please visit Arthritis Research UK and Arthritis Care.
Prescription and delivery
My prescription has expired – can my own doctor (GP) renew this for me?
Yes, your doctor will receive a letter regarding any changes to your treatment made in clinic and will renew your prescription.
Biologic drugs are the exception and are only prescribed via the rheumatology department. You will need to attend your clinic appointments for us to be able to do this. The prescription is then managed with the homecare delivery company.
The delivery company says my prescription has run out – what should I do?
Your prescription is managed by the rheumatology nurses in conjunction with the delivery company. Usually the delivery company asks the nurses for your repeat prescription to be renewed well before it is going to expire but occasionally this does not happen in time.
The rheumatology nurses will renew your repeat prescription if you have attended your scheduled clinic appointments and had any relevant bloods or tests that have been asked for.
If you do not attend your appointments, your prescription for biologic drugs will be stopped. You may need to phone the rheumatology nurses to discuss your repeat prescription.
My drugs have not been delivered – what should I do?
Please contact the company that delivers your medications to reorganise the delivery.
Health Care at Home 03331039499
Lloyds Pharmacy 03452636135/ 01417662575
If you have ongoing delivery problems cannot solve yourself with the company, please contact the rheumatology nurses using the contact numbers on your biologic alert card.
We monitor bloods when DMARDs and biologic medicines are used. This is to ensure that the drugs are being used safely and not causing any harmful effects. For patients on a DMARD such as Methotrexate your bloods will be monitored by your GP.
Should there be any cause for concern, the GP who reviews all blood tests as a part of blood monitoring will contact you with appropriate advice. The GP will contact the Rheumatology team if they have ongoing concerns.
Patients on biologics will have their bloods monitored by the Rheumatology Department. We will not inform you of your blood results however occasionally we may contact you to hold medication as there has been an issue with your results.