Taking medications regularly and following correct instructions is very important for people with rheumatoid arthritis (RA). It is the responsibility of the patients to know their medications well and avoid making mistakes, which can have serious consequences.
Mistake
No. 1: You take Methotrexate daily instead of once a week
Methotrexate, the most
commonly prescribed drug for RA, is usually taken weekly. Sometimes, it
is prescribed twice a week. It should be taken one day a week - on the same day
each week (e.g., every Saturday). It is not taken daily like many medications.
Methotrexate tablets are available in different strengths like 2.5, 5, 7.5, 10,
15, 20 and 25 mg. The usual starting dose for adults with RA is 15 mg once a
week. The total dose of methotrexate can be increased to up to 25 mgs each
week, if needed.
Too often we come across
patients who mistakenly take methotrexate daily rather than weekly. That
specific mistake can result in serious side effects related to toxicity. Errors
can occur at the pharmacy, too, where mislabelling may direct a patient to take
methotrexate daily versus weekly. Know that methotrexate for RA is a weekly
drug.
Mistake No. 2: You forget to take folic acid
tablets
Taking folic acid regularly is important to prevent
side effects from methotrexate. Usually, folic acid is prescribed five days a
week. Please note folic acid and methotrexate are completely different drugs.
Brand name of these drugs could sound similar (e.g. Folvite/Folimax and
Folitrax)
Mistake No. 3: You continue medications even during
infection.
If you catch an infection which requires you to take
antibiotics it is advised to withhold medications like methotrexate for 2 weeks
and inform your rheumatologist.
Mistake No. 4: You stop medications abruptly
Keep taking your
medications for the full time of treatment, even if you begin to feel better
after a few days. Do not miss any doses. Sudden discontinuation of certain
medications may pose a life-threatening situation.
Common reasons to stop
medications –
1.
‘I was worried about side effects’
2.
‘My parents/relatives suggested me to switch
to alternative therapy’
3.
‘I thought my body will get addicted to
medications’
4.
‘I was feeling fine’
Mistake No. 5: You alter the dose or treatment
regime against medical advice.
It is important to follow
all the instruction of the doctor. Many patients try to minimize drug intake by
either taking tablets alternate days or half doses. Suboptimal treatment can
cause flare up of disease. You may not be aware that certain tablets like
sulfasalazine should not be broken. You should swallow Sulfasalazine
enteric-coated tablet whole. Do not crush, break, or chew it. This is because they are specially coated to pass
through your stomach before they are absorbed. Breaking the tablet could
interfere with the special coating.
Mistake No. 6: You don’t tell all your doctors about
everything you are taking
All your doctors should
know what medications and supplements you are taking. People with RA
typically have more than one doctor on their healthcare team. It is important
for each of your doctors to have a complete and current medication list for
you. Keeping all your doctors informed about your medications will help to
prevent drug interactions. Do not neglect to provide each doctor with your full
list. It’s your responsibility.
Mistake
No. 7: You don’t inform your rheumatologist information related to your pregnancy
or breastfeeding.
You should consult with your rheumatologist if you are
planning to get pregnant. Planning ahead is the key. Some of the drugs used to
treat RA can be continued while trying to conceive or even during the
pregnancy. Certain medications like methotrexate and
leflunomide should be stopped well in advance before you conceive.
Although you may be concerned about the possible harmful
effects of taking RA drugs while pregnant, it is important to remember that
uncontrolled arthritis during pregnancy can also have adverse effects on your
baby such as low birth weight.
My Takeaway Advice
·
Learn about each medication that you are taking.
·
Don’t deviate from the prescribed regimen.
·
Do not stop medications abruptly.
·
Share with rheumatologist if you are planning
to get pregnant or taking alternative therapy.
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