Drug Side Effects in Rheumatoid Arthritis: Helpful Strategies

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Medication side effects are highly individual

Side effects of medications are a reality for people with Rheumatoid Disease (PRD), ranging from a minor nuisance to serious health dangers. Be careful to not prejudge the way side effects may affect people. Side effects, like medication benefits, are extremely individual because of genetics; don’t assume that because your sister-in-law took a certain drug without complaint that all of your patients should be able to tolerate it.

Honest discussions about side effects will increase the likelihood that your patients will make good decisions about medications. Drug inserts published by pharmaceutical companies may not reflect every possible side effect, and your patients may experience side effects at a higher rate than was reported in clinical trials. Side effects in clinical trials are quantified by clinician reports. Patients do not directly report side effects in clinical trials in spite of the fact that that can have direct input on the way drug benefits are reported.[1]

Other factors can impact side effects or perceptions about side effects; and sincere communication will promote better outcomes. Failing to be straightforward about side effects can erode trust or contribute to the high levels of discordance and non-adherence in Rheumatoid Disease.

Consider the following best practices, and some alternatives for managing side effects before stopping a drug.

Best practices related to drug side effects

  • Be honest with patients about possible side effects; people cope better when they have more accurate expectations.
  • Record patients’ complaints of side effects in medical chart.
  • Do not dismiss side effects as imaginary or insignificant.
  • Become aware of particular side effect risks to PRD such as risk of tendon rupture with fluoroquinolones.
  • Pursue options to manage side effects (see below), as long as the side effects do not put the patient’s health at risk.
  • Ask patients whether the side effects they experience are outweighed by the benefits of the drug. Encourage patients to think this through before quitting a medication.
  • Do not expect drug “reps” or drug package inserts to inform you of a complete representation of all possible side effects.

Unfortunately, side effects are frequently dismissed without considering alternatives. Doctors can be allies in helping people determine whether a medication must be discontinued, or what options could be explored. If side effects do not represent a danger to the patient’s health, consider ways to manage them.

Ways side effects can be managed

1. Explore options for taking the medication at a different time of day and with or without food, including particular foods.

2. Ask the patient to journal medication doses, side effects, and other symptoms or events. A careful examination will sometimes indicate that disease symptoms are mistaken for side effects.

3. Try splitting doses of the medication. A weekly dose can be split and taken over two days.

4. Suggest smaller initial doses to build up a tolerance. Even a smaller than therapeutic dose may enable a patient to eventually tolerate a drug.

5. Encourage patients to consult with other patients who take this medication successfully, through an online forum or local support group.

6. Encourage patients to ask a pharmacist for input about side effects. Pharmacists are trained to discuss medications with consumers.

7. Offer a supplement or another medication that may moderate side effects.

8. Explore whether medication combinations may cause side effects, and which drug would be better to discontinue.

9. Consider whether blood tests may indicate ways the patient is being affected by the drug (such as tests for liver and kidney function, or iron or vitamin deficiencies).

10. Discuss alternative medications with the patient.

MORE INFORMATION ON SIDE EFFECTS

FOOTNOTES
1 Basch E. The missing voice of patients in drug safety reporting. N Eng J [Internet]. 2010 Mar 11[cited 2013 May 31] 362:865-869. Available from: http://www.nejm.org/doi/full/10.1056/NEJMp0911494
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