What Are Potential Side Effects from DMARDS?

* denotes most common side effect if one were to have a side effect

All medications have potential side effects. Most people do not suffer from these side effects. A random few people do and unfortunately, there is no way to predict it. This can be said regarding naproxen and ibuprofen.

I tend to lean towards methotrexate if you are a young woman who wants kids in the future.

I tend to lean towards leflunomide if you have chronic kidney disease.

Most of my patients do well on either medication.

METHOTREXATE

Methotrexate is a weekly regimen that is supplemented with daily folic acid to help counteract potential side effects. Methotrexate may take 6 to 12 weeks to be effective.

Potential Adverse Affects

Nausea*
Vomiting
Upset stomach
Oral ulcers
Hair thinning
Infection
Liver function abnormalities
Blood count abnormalities
Rarely pneumonitis
Rarely melanoma and non-melanoma skin cancer

Medication Monitoring

You will need routine CBC and CMP as a measure for long term use of immunosuppressants.

Things You Should Do

You should avoid sick people and be vaccinated with the Flu and Pneumonia vaccines (Prevnar-13 and Pneumovax-23)

You should get annual influenza vaccines and the pneumonia vaccines.

You should apply SPF 50 sunscreen when out in the sun.

You should avoid alcohol as it may hasten irritation.

FOR WOMEN: You should avoid pregnancy due to risk for birth defects.

If you have any problems or side effects with this medication, please call your prescribing provider immediately.

ARAVA (leflunomide)

I usually start with half a tablet (10 mg) daily for 7 days and then ask the patient to increase to one full tablet daily (20 mg) if they have no side effects, such as diarrhea or upset stomach. Leflunomide may take 4 to 8 weeks to be effective.