DMARDs

	DMARDs	SECTION:
	Disease-Modifying Anti-Rhuematic Drugs	How to read this chart Close this window

DRUG

BRAND(S)

DOSAGE

SPECIAL
INSTRUCTIONS

POSSIBLE
SIDE EFFECTS

BE AWARE

DRUG	BRAND(S)	DOSAGE	SPECIAL INSTRUCTIONS	POSSIBLE SIDE EFFECTS	BE AWARE

Auranofin (oral gold)	Ridaura	6 to 9 mg per day in 1 or 2 doses	Take with a glass of milk or water. If stomach upset occurs, take with food.	Diarrhea, low blood counts, metallic taste in mouth, mouth ulcers, protein in urine, skin rash or itching	Before taking this drug, let your doctor know if you have or have had: adverse reaction to a gold-containing medication, a history of blood-cell abnormality, inflammatory bowel disease or kidney or liver disease. This drug can cause sun sensitivity, so minimize exposure to sunlight and wear sunscreen. Your doctor should order periodic blood and urine tests to check for effects on the blood and kidneys.

Azathioprine	Imuran	50 to 150 mg per day in 1 to 3 doses	Take with food.	Fever or chills; loss of appetite; liver problems; low blood counts; nausea or vomiting; unusual tiredness or weakness	Tell your doctor if you use allopurinol or have kidney or liver disease. This drug can be associated with development of certain cancers, such as lymphoma. Your doctor may order periodic blood tests to check for effects on the blood.

Chlorambucil	Leukeran	2 to 8 mg per day in 1 or 2 doses	Use only for life-threatening organ disease.	Hair loss, low blood counts, missing menstrual periods, nausea	Let your doctor know if you have an active infection. Use of this drug may make you more susceptible to infections and certain cancers.

Cyclophosphamide	Cytoxan	50 to 150 mg per day in a single dose orally(This drug may also be given intravenously.)	Take oral medication with breakfast. Drink lots of fluids throughout the day and empty bladder before bedtime. Use only for severe organ disease.	Blood in urine; darkening of skin and fingernails; hair loss; infertility; loss of appetite; low blood counts; missing menstrual periods; nausea or vomiting	Tell your doctor know if you have liver or kidney disease, an active infection or high blood pressure. Use of this drug may make you more susceptible to infection and certain cancers. Your doctor should order periodic tests to check for side effects of this drug on the blood and urinary tract.

Cyclosporine	Neoral	100 to 400 mg per day in 2 doses. Exact doses vary by weight.	Take at the same time every day, either with a meal or between meals.	Headache; high blood pressure; increase in hair growth; kidney problems; loss of appetite; nausea	Tell your doctor if you have liver or kidney disease, an active infection or high blood pressure. Because this drug's rate of absorption is unpredictable, your doctor should monitor it through blood tests. Use of this drug may make you more susceptible to infection and certain cancers. Do not take with St. John's wort, grapefruit or grapefruit juice.

Gold sodium thiomalate (injectable gold)	Myochrysine	10 mg the first week, 25 mg the following week, then 25 to 50 mg per week thereafter. Frequency may be reduced after several months.		Irritation and soreness of tongue; irritated or bleeding gums; metallic taste; skin rash or itching; ulcers or white spots on lips or in mouth or throat	Let your doctor know if you have any of the following: lupus, skin rash, kidney disease or colitis. Increased joint pain may occur for one or two days after injection, but it usually disappears after the first few injections. Your doctor should order periodic urine and blood tests to check for side effects.

Hydroxychloro- quine sulfate	Plaquenil	200 to 600 mg per day in 1 or 2 doses		Blurred vision; diarrhea; headache; increased sensitivity to sunlight; itching; loss of appetite; nausea or vomiting; rashes; abdominal cramps or pain	Let your doctor know if you have any eye problems, including a retinal abnormality. Because vision may be damaged with long-term therapy (given over several years) or high doses, you may need to have an eye exam when you start taking this drug and every 6 to 12 months thereafter to detect retinal changes.

Leflunomide	Arava	10 to 20 mg per day in a single dose		Dizziness; gastrointestinal problems; hair loss; headache; heartburn; high blood pressure; liver problems; low blood cell count; pain or burning in feet or hands (neuropathy); skin rash; stomach pain; sneezing; sore throat	Let your doctor know if you have active infection, liver or kidney disease or underlying cancer. Your doctor should order periodic tests to check for the drug's effect on the blood and liver. Either member of a couple who is taking leflunomide and is ready to conceive should go through an elimination process using the drug cholestyramine prior to conception.

Methotrexate	Rheumatrex, Trexall	7.5 to 20 mg per week in a single dose orally (This drug may also be given by injection.)		Abdominal discomfort; chills; dizziness; fever; general feeling of illness; hair loss; headache; increased sun sensitivity; itching; liver problems; low blood counts; mouth sores; nausea and stomach upset; rashes; shortness of breath; yeast infections	Let your doctor know if you have one of the following: abnormal blood count, liver or lung disease, alcoholism, active infection or hepatitis. Your doctor should order chest X-rays, liver tests and blood counts before you start this drug and throughout treatment to monitor for side effects. Alert your doctor immediately if you have a dry cough, fever or difficulty breathing. It rarely can be associated with increased risk of blood diseases, such as lymphoma.

Minocycline	Minocin	200 mg per day in 2 or 4 doses	Take on an empty stomach. Swallow whole with water. Drink plenty of fluids.	Cramps or burning of the stomach; diarrhea; darkening of the skin; dizziness; lightheadedness or unsteadiness; liver problems; sun sensitivity	This drug is not currently FDA-approved for arthritis. It is an antibiotic. Before taking this medication, let your doctor know if you have a sensitivity to tetracycline medications. In children, minocycline can cause permanent tooth discoloration.

Mycophenolate mofetil	CellCept	500 to 2,000 mg daily in one to two oral doses	Avoid taking antacids containing aluminum or magnesium at the same time.	Diarrhea, gastrointestinal ulcers or bleeding; nausea or vomiting; severe infections	Let your doctor know if you have an active infection before taking this drug. Your doctor should order periodic blood tests to check for unwanted effects. Do not take during pregnancy.

Sulfasalazine	Azulfidine, Azulfidine EN-Tabs	500 to 3,000 mg to 3 grams per day in 2 to 4 doses	Take after a meal and with water. Drink plenty of water to stay well hydrated.	Abdominal pain or upset; aching of joints; diarrhea; headache; increased sun sensitivity; itching; loss of appetite; nausea or vomiting; skin rash	Let your doctor know if you have any of the following: allergy to sulfa drugs or aspirin, kidney or liver disease or blood disease. Failure to drink adequate fluids while on this medication can lead to the formation of urine crystals. This drug can lower sperm counts and may interfere with conception. Your doctor should order periodic blood tests to check for side effects of this drug.