Frequently Asked Questions - About Your Medication

These questions have been compiled from frequent queries we get to the advice line.  Please click on the question to reveal the answer.

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 this feeling of sickness
- making sure you take your folic acid the day after you have taken the 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.

Does the body get used to drugs and begin to have less side effects?

Unfortunately there is no way to know if a medicine will cause side effects.  It may depend on how much of the medicine you take, how old you are, how much you weigh, whether you are male or female, and if you have other health problems.

Patients over 65 are more likely to have side effects than younger patients.

Usually the benefits you get from taking the medicine are more important than minor side effects.   Some side effects may go away after a while but it is difficult to know how long this may take. If you struggle with any side effects of your medications please discuss this with your doctor or specialist nurse.

How long do I have to continue my medication for 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.  To most doctors remission means there has been a big reduction in the signs and symptoms of inflammation but it doesn’t mean that the arthritis has gone.

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. Even in the best of cases, flares may occur and should not be seen as a sign of treatment failure. Most patients will continue to have symptom flares at some point. Even if you are able to stop your medication for a year or two, the joint pain and swelling will often reappear and treatment will need to be started again.  Remission on medication is an outcome that we often see, however long-standing remission off medication is not that common.

If your medication dose has been lowered or stopped, it is important that you get in touch with your doctor if your symptoms reoccur.  Being able to spot if your symptoms are returning is very important and gives your doctor chance to consider restarting your treatment before damage can occur.

I am on antibiotics, should I stop taking my medication?

If you get an infection that needs antibiotics, then you should stop the following medication until you have finished your course and feel well again:

- methotrexate
- leflunomide
- mycophenolate
- ciclosporin
- azathioprine
- gold
- etanercept (Enbrel)
- adalimumab (Humira)
- certolizumab (Cimzia)
- golimumab (Simponi)
- tocilizumab (RoActemra)
- abatacept (Orencia)

What can I do about injection site reactions?

Injection site reactions include redness, itching, pain or swelling at the injection site.  They mostly occur 1 to 2 days after an injection and usually go away within 3 to 5 days.  They are most common during the first few months of treatment.  Sometimes injection site reactions can be due to the way that the injection has been given.

To help stop injection site reactions we advise changing where you give the injection each time. You can inject into the front of the thigh, outer upper arms and abdomen.  If you develop an injection site reaction it may help if you apply a cold compress to the site. 

If you have pain, redness, or swelling around the injection site that doesn't go away or gets worse, call the advice line.  If you keep having problems with reactions, again contact the advice line as we may need to check the way that you are doing the injection.

I am due to have surgery should I stop taking my DMARD medication?

DMARDs (or disease modifying anti-rheumatic drugs) are medications that are given to reduce inflammation and prevent damage to the joints.  DMARDs include drugs such as methotrexate, sulfasalazine, hydroxychloroquine, leflunomide, azathioprine, ciclosporin and gold.

There is no clear evidence that taking these medications affects surgery, in fact coming off them can cause a flare of your arthritis, which can be more of a problem. We therefore usually recommend that you stay on your medicines but let your surgeon know what you have been prescribed.

You may be asked to stop your medication for a while before and after surgery, but this depends on the medication being taken, the type of operation and the views of the surgeon.

I am due to have surgery what should I do about my biologic medication?

Biologic treatments include the following drugs:

- Certolizumab (Cimzia)
- Etanercept (Enbrel)
- Adalimumab (Humira)
- Golimumab (Simponi)
- Infliximab (Remicade)
- Rituximab (MabThera)
- Tocilizumab (RoActemra)
- Abatacept (Orencia)

General advice is to stop treatment 2 weeks before any surgery and for up to 6 weeks afterwards. Once your wound is completely healed you may start your treatment again. If you are on an intravenous biologic (eg infliximab, rituximab, tocilizumab) please let us know if you are having surgery by contacting the advice line so that we can advise you about what needs to be done.

I am going on holiday, what about my medication?

If going on holiday, medication needs to be taken with you including any injections you need for your condition.  If you get your prescription from your GP, please make sure that you get in touch with them in good time if you need more medication for when you are on holiday  If you are prescribed medication by the rheumatology team please contact the advice line (01772 777981).

We would advise you to keep your medication in your hand luggage if you are flying.  We can give you a letter showing what medications you are prescribed by the rheumatology team. You will need this if you are taking injections with you on a plane. 

When you come to blood monitoring clinic for your blood test please let us know if you are going away on holiday so we can tell you when your blood tests should be done.

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