Psoriatic Arthritis treatments: Psoriatic arthritis treatments

Bimekizumab is a biologic medicine used to treat adults with active psoriatic arthritis when other disease-modifying antirheumatic drugs (DMARDs) have not worked well enough or cannot be tolerated. It can be used on its own or together with methotrexate. NICE recommends bimekizumab for certain adults with active psoriatic arthritis who have not responded adequately to previous DMARD treatment.

Bimekizumab is also used to treat moderate to severe plaque psoriasis and some other inflammatory conditions.

How does it work?

Bimekizumab is a biologic medicine called an interleukin-17 (IL-17) inhibitor. It blocks two inflammatory proteins, IL-17A and IL-17F, which play an important role in the inflammation associated with psoriatic arthritis and psoriasis.

By reducing the activity of these proteins, bimekizumab reduces inflammation. This can help improve joint pain, stiffness and swelling, as well as psoriasis affecting the skin and nails. It can also improve physical functioning and quality of life.

Who can get it?

Bimekizumab is available on prescription for adults with active psoriatic arthritis.

For NHS treatment, NICE recommends it for adults whose psoriatic arthritis has not responded well enough to DMARDs or who cannot tolerate them, and who have had two conventional DMARDs and at least one biological DMARD, or for whom TNF-alpha inhibitors are contraindicated.

It can be used on its own or with methotrexate.

How is it used?

Bimekizumab is given as an injection under the skin (subcutaneous injection).

For psoriatic arthritis, the usual dose is:

• 160 mg once every 4 weeks.

If you have psoriatic arthritis together with moderate to severe plaque psoriasis, the recommended dose is:

• 320 mg at weeks 0, 4, 8, 12 and 16, followed by 320 mg every 8 weeks.
• After week 16, if the joint response is not maintained, your doctor may consider changing the dose to 160 mg every 4 weeks.

Your doctor will assess how well the treatment is working and decide whether you should continue treatment.

What are the side effects?

Like all medicines, bimekizumab can cause side effects, although not everyone gets them.

Very common

• Upper respiratory tract infections, such as a sore throat or blocked nose.

Common

• Oral thrush (candidiasis)
• Fungal skin infections, such as athlete's foot
• Ear infections
• Cold sores (herpes simplex)
• Gastroenteritis
• Inflamed hair follicles (folliculitis)
• Headache
• Rash, dermatitis or eczema
• Acne
• Injection-site reactions, such as redness, swelling or pain
• Feeling tired (fatigue).

Uncommon

• Reduced levels of certain white blood cells (neutropenia)
• Fungal infections affecting the skin or mucous membranes, including the oesophagus
• Conjunctivitis
• Inflammatory bowel disease.

Serious allergic reactions, including anaphylaxis, have been reported with IL-17 inhibitors. Seek urgent medical attention if you develop symptoms of a serious allergic reaction, such as swelling of the face, lips, tongue or throat, difficulty breathing or severe dizziness.

Because bimekizumab affects part of the immune system, your doctor will check for infections and other relevant health problems before and during treatment.

How do I get bimekizumab?

Bimekizumab is available on prescription and is normally started and monitored by a healthcare professional experienced in treating psoriatic arthritis.

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Bimekizumab is known commercially as Bimzelx and is marketed in the UK by UCB Pharma Ltd

Reviewed: August 2026
Version ID: 2/BIM/PAT/08/26

Adalimumab is a biologic medicine used to treat psoriatic arthritis. It is also used to treat a number of other inflammatory conditions, including rheumatoid arthritis and plaque psoriasis.

It belongs to a group of medicines called TNF-alpha (TNF-α) inhibitors. Adalimumab is available in several biosimilar brands as well as the original brand, Humira.

How does it work?

Adalimumab blocks the action of a protein called tumour necrosis factor-alpha (TNF-α).

TNF-α is one of the chemical messengers involved in inflammation. Too much TNF-α can contribute to inflammation in the joints and skin in conditions such as psoriatic arthritis and psoriasis.

By blocking TNF-α, adalimumab reduces inflammation. This can help improve symptoms such as joint pain, swelling and stiffness and can also improve psoriasis affecting the skin

Who can get it?

Adalimumab is available on prescription for adults with active psoriatic arthritis. It can be used on its own or in combination with other medicines, including methotrexate. Adalimumab should not be used in people with an active tuberculosis infection or another serious infection, and it should not be used in people with moderate or severe heart failure. It is also contraindicated in people with hypersensitivity to adalimumab or any of the ingredients.

Your doctor will check for infections, including tuberculosis, before treatment and will consider your medical history before prescribing adalimumab.

People with certain neurological conditions, including multiple sclerosis or other demyelinating disorders, require particular caution when treatment with a TNF inhibitor is considered.

How is it used?

Adalimumab is given as an injection under the skin (subcutaneous injection). Many people can learn to administer the injection themselves at home.

For adults with psoriatic arthritis, the usual dose is:

40 mg every other week.

Adalimumab is normally continued for as long as it is controlling the condition and remains appropriate. Your doctor will regularly assess how well the treatment is working.

The dose used for plaque psoriasis is different from the dose used for psoriatic arthritis, so patients should follow the dosing instructions provided for their particular condition.

What are the side effects?

Because adalimumab affects part of the immune system, it can increase the risk of infections.

Common side effects include:

• respiratory tract infections
• headaches
• abdominal pain
• nausea
• diarrhoea
• rash
• itching
• injection-site reactions, such as redness, swelling or pain
• muscle or bone pain
• increased levels of liver enzymes seen in blood tests.

Other side effects can include changes in blood counts and allergic reactions.

Serious infections can occur, including tuberculosis and serious bacterial, fungal or viral infections. Patients should tell their doctor if they develop signs of a serious infection, such as persistent fever, feeling very unwell or a persistent cough.

Rarely, TNF inhibitors have been associated with neurological disorders, heart failure or certain cancers. Your doctor will discuss the risks and benefits of treatment with you.

Pregnancy and breastfeeding

If you are pregnant, planning to become pregnant or breastfeeding, tell your doctor.

Adalimumab can be used during pregnancy when clinically needed. It can also be used during breastfeeding. Your doctor will discuss whether treatment should be continued during pregnancy and whether any changes are needed around the time of delivery.

How do I get adalimumab?

Adalimumab is available on prescription and is generally initiated and monitored by a specialist.

NICE recommends adalimumab and other TNF inhibitors as treatment options for eligible people with active psoriatic arthritis. The choice of biologic depends on factors such as previous treatment, other conditions and whether psoriasis is also present.

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Adalimumab is known commercially as:

Reviewed: August 2026
Version ID: 2/ADA/PAT/08/26

Certolizumab pegol is a biologic medicine used to treat active psoriatic arthritis in adults when previous treatment with disease-modifying antirheumatic drugs (DMARDs) has not worked well enough. It can be used together with methotrexate or on its own when methotrexate is not appropriate or is not tolerated.

It belongs to a group of medicines called TNF-alpha (TNF-α) inhibitors.

How does it work?

Certolizumab pegol blocks the action of a protein called tumour necrosis factor-alpha (TNF-α).

TNF-α is a chemical messenger involved in inflammation. Excessive TNF-α activity contributes to inflammation in conditions such as psoriatic arthritis and psoriasis.

By blocking TNF-α, certolizumab pegol reduces inflammation. This can help reduce joint pain, swelling and stiffness and improve physical function and quality of life.

Who can get it?

Certolizumab pegol is available on prescription for adults with active psoriatic arthritis.

It is not licensed for the treatment of psoriatic arthritis in children.

The NHS use of certolizumab pegol is subject to clinical criteria and specialist assessment. NICE recommends certolizumab pegol as an option for eligible adults with active psoriatic arthritis.

How is it used?

Certolizumab pegol is given as an injection under the skin (subcutaneous injection).

For adults with psoriatic arthritis, the recommended starting treatment is:

• 400 mg (two 200 mg injections) at weeks 0, 2 and 4.
• This is followed by 200 mg every 2 weeks.

Alternatively, after the starting doses, 400 mg every 4 weeks can be considered as a maintenance treatment.

Your doctor will decide which dosing schedule is most appropriate for you. Treatment is normally started and monitored by a specialist.

What are the precautions and side effects?

Because certolizumab pegol affects part of the immune system, it can increase the risk of infections.

Before treatment, you will normally be assessed for tuberculosis (TB) and other infections. People with active TB or another serious infection should not normally start treatment until the infection has been treated.

Tell your doctor if you develop symptoms of an infection during treatment, such as persistent fever, cough or feeling unusually unwell. Treatment may need to be temporarily stopped if you develop a serious infection.

Your doctor may also check for hepatitis B before treatment where appropriate, as TNF inhibitors can cause hepatitis B to reactivate in people who have previously been infected.

Certolizumab pegol should not normally be used in people with moderate or severe heart failure. Tell your doctor if you have heart failure or develop new or worsening symptoms such as increasing breathlessness or swelling of the legs.

Other conditions may require particular caution, including certain neurological disorders, blood disorders, liver problems and a history of cancer. Your doctor will assess your individual risks before treatment.

Possible side effects include:

• infections, including respiratory infections
• headache
• nausea
• fever
• rash and other skin reactions
• itching
• injection-site reactions, such as pain, redness or swelling
• high blood pressure
• weakness or tiredness
• changes in blood cell counts
• changes in liver blood tests
• sensory disturbances, such as tingling or numbness.

Serious allergic reactions can occur but are uncommon. Seek medical attention if you develop swelling of the face, lips, tongue or throat, difficulty breathing or severe dizziness.

Rarely, TNF inhibitors can cause lupus-like reactions, serious infections, blood disorders or neurological problems. Tell your doctor about any new or unexplained symptoms.

Pregnancy and breastfeeding

Certolizumab pegol has an important advantage compared with some other biologic medicines because very little of the medicine crosses the placenta.

It can be used during pregnancy when clinically necessary, and it can also be used while breastfeeding. Your doctor will discuss whether treatment should be continued during pregnancy.

If certolizumab pegol is given during pregnancy, particularly later in pregnancy, tell the baby's healthcare professionals because this may affect the timing of certain live vaccines for the baby.

How do I get certolizumab pegol?

Certolizumab pegol is available on prescription and is normally started and monitored by a specialist.

NICE recommends certolizumab pegol as an option for eligible adults with active psoriatic arthritis when other treatments have not worked adequately or cannot be tolerated.

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Certolizumab pegol is known commercially as Cimzia® and is marketed in the UK by UCB Pharma Ltd.

Reviewed: August 2026
Version ID: 2/CER/PAT/08/26

Etanercept is a biologic medicine used to treat psoriatic arthritis and some other inflammatory conditions. It belongs to a group of medicines called tumour necrosis factor (TNF) inhibitors.

For adults with active and progressive psoriatic arthritis, etanercept may be considered when previous treatment with disease-modifying antirheumatic drugs (DMARDs) has not worked well enough. NICE recommends TNF inhibitors such as etanercept for people who have active peripheral arthritis and have not responded adequately to at least two standard DMARDs.

How does it work?

Etanercept blocks the action of a protein called tumour necrosis factor-alpha (TNF-α). TNF-α is one of the chemical messengers involved in inflammation.

By blocking TNF-α, etanercept reduces inflammation. This can help improve the pain, swelling and stiffness associated with psoriatic arthritis and can help reduce the progression of joint damage.

Who can get it?

Etanercept is available on prescription and treatment should be started and supervised by a specialist experienced in treating inflammatory diseases.

For adults with psoriatic arthritis, it is used when previous DMARD treatment has not worked adequately.

Etanercept can also be prescribed for some children and young people with inflammatory conditions, including juvenile idiopathic arthritis, psoriatic arthritis and severe plaque psoriasis, depending on their age and circumstances.

How is it used?

Etanercept is given as an injection under the skin (subcutaneous injection). Some people can be taught to inject themselves at home.

Psoriatic arthritis

The recommended dose is:

• 25 mg twice a week, or
• 50 mg once a week.

Treatment should be reviewed if there is no adequate response after about 12 weeks. NICE recommends discontinuing treatment if an adequate response to PsA treatment criteria has not been achieved at 12 weeks.

Plaque psoriasis
For adults, the recommended dose is 25 mg twice a week or 50 mg once a week. In some circumstances, 50 mg twice a week can be used for up to 12 weeks before reducing the dose. Treatment should normally be stopped if there is no response after 12 weeks.

Like all medicines that affect the immune system, etanercept can increase the risk of infections.

Common side effects can include:

• infections, including upper respiratory tract infections
• headache
• itching or rash
• injection-site reactions such as redness, itching, pain or swelling
• fever
• nausea
• dizziness
• cough or other respiratory symptoms.

More serious infections can occasionally occur. Before and during treatment, patients may need monitoring for infections such as tuberculosis and hepatitis B.

Rarely, serious allergic reactions, blood disorders, demyelinating disorders, heart failure or certain cancers can occur. Patients should seek medical advice if they develop symptoms of a serious infection or other concerning symptoms.

How do I get etanercept?

Etanercept is available on prescription and is normally initiated and supervised by a specialist.

Etanercept is available in the UK under several brand names, including:

Reviewed: August 2026
Version ID: 2/ETA/PAT/08/26

Golimumab is a biologic medicine used to treat active and progressive psoriatic arthritis in adults when previous treatment with DMARDs has not worked well enough. It belongs to a group of medicines called TNF inhibitors (TNF blockers). It can be used on its own or together with methotrexate.

How does it work?

Golimumab blocks the action of a protein called tumour necrosis factor-alpha (TNF-α). TNF-α is one of the chemical messengers involved in inflammation.

By blocking TNF-α, golimumab reduces inflammation. This can help reduce the pain, swelling and stiffness associated with psoriatic arthritis and can help reduce progression of joint damage.

Who can get it?

Golimumab is available on prescription and treatment should be started and supervised by a specialist experienced in treating inflammatory diseases.

For psoriatic arthritis, it is used in adults with active and progressive disease when previous DMARD treatment has not worked well enough. NICE recommends golimumab as an option for active and progressive psoriatic arthritis when the relevant criteria for TNF-inhibitor treatment are met.

How is it used?

Golimumab is given as an injection under the skin (subcutaneous injection). After appropriate training, some people can give themselves the injection at home.

For psoriatic arthritis, the usual dose is:

50 mg once a month, on the same date each month.

If you weigh more than 100 kg and have not had an adequate response after three or four doses, your doctor may consider increasing the dose to 100 mg once a month. The increased dose is associated with a higher risk of some serious adverse reactions.

Treatment should be reviewed if there is no evidence of benefit after approximately 12–14 weeks (3–4 doses).

What are the side effects?

Like other medicines that block TNF, golimumab can increase the risk of infections.

Very common side effects may include:

• upper respiratory tract infections, such as sore throat, runny nose and hoarseness.

Common side effects may include:

• bacterial infections
• viral infections, including influenza and cold sores
• superficial fungal infections
• bronchitis
• sinusitis
• anaemia
• dizziness
• headache
• high blood pressure
• abnormal liver-function blood tests
• depression
• difficulty sleeping
• stomach pain or indigestion
• constipation
• rash and itching
• hair loss
• weakness
• numbness or tingling
• injection-site reactions, such as redness, itching, pain, bruising or swelling.

More serious but less common effects include serious infections, tuberculosis, pneumonia, hepatitis B reactivation, serious allergic reactions, blood disorders, heart failure, demyelinating disorders and certain cancers. Patients should seek medical advice promptly if they develop symptoms of a serious infection or other concerning symptoms.

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Golimumab is available on prescription and is known commercially as Simponi. It is manufactured in the UK by Janssen-Cilag Ltd (a Johnson & Johnson company).

Reviewed: August 2026
Version ID: 2/GOL/PAT/08/26

Infliximab is a biologic medication for the treatment of psoriatic arthritis in adult patients when the response to DMARD therapy has been inadequate. This biologic medication is a chimeric human murine IgG1 monoclonal antibody.

How does it work?

Infliximab blocks tumour necrosis factor-alpha (TNF-α), a chemical "messenger" in the immune system that signals other cells to cause inflammation. There is too much TNF-α in the skin of people with psoriasis and the joints of people with certain types of arthritis, such as psoriatic arthritis.

Who can get it?

Infliximab is prescribed (in combination with methotrexate) for adult patients with active and progressive psoriatic arthritis.

How is it used?

5 mg/kg given as an intravenous infusion over a 2-hour period followed by additional 5 mg/kg infusion doses at 2 and 6 weeks after the first infusion, then every 8 weeks thereafter.

What are the side effects?

In studies of rheumatoid arthritis and Crohn's disease patients, the most common side effects reported were:

• infusion reactions (fever, chills, rash)
• respiratory infections
• headache,
• vertigo/dizziness
• stomach pain
• itching
• viral infections
• fatigue
• flushing
• fever
• nausea
• diarrhoea
• dyspepsia
   

These side effects are generally mild and did not cause most patients to stop taking Infliximab. These events happened most often after the first Infliximab infusion and may decrease after additional infusions.

How do I get infliximab?

Infliximab is available by prescription, primarily from rheumatologists and gastroenterologists. Some dermatologists are prescribing it for psoriasis.

Available Guidance

National Institute for Health and Care Excellence (NICE) guidance

Scottish Medicine Consortium guidance

All Wales Medicines Strategy Group

For Northern Ireland, the Department of Health, Social Services and Public Safety (DHSSPS) provide reviews and advice.

Read reviews or write your own

If you would like to read other people’s experience of this treatment, or have any comments to share, good or bad, you might like to go to iWantGreatCare for Infliximab, iWantGreatCare for Remicade,   iWantGreatCare for Flixabi, iWantGreatCare for Inflectra and iWantGreatCare for Resima.

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Infliximab is known commercially as:

Ustekinumab is a biological therapy used either alone or with methotrexate for the treatment of active psoriatic arthritis in adult patients who did not respond to other disease modifying drugs. It belongs to the group of treatments known as immunosuppresants (medicines that inhibit your immune system).

How does it work?

Ustekinumab blocks tumour necrosis factor-alpha (TNF-α), a chemical "messenger" in the immune system that signals other cells to cause inflammation. There is too much TNF-α in the skin of people with psoriasis and the joints of people with certain types of arthritis, such as psoriatic arthritis.

Who can get it?

Available to adults who have not responded to other disease modifying drugs.

How is it used?

For adults over 18 years of age with a body weight of less than 100kg, initially 45mg by subcutaneous injection.  If body weight is more than 100kg initially 90mg by subcutaneous injection.  Repeat the dose after 4 weeks, then every 12 weeks.  Consider discontinuation if no response after 28 weeks. 

What are the side effects?

Common side effects (may affect up to 1 in 10 people):

• Diarrhoea
• Nausea
• Feeling tired
• Feeling dizzy
• Headache
• Itching (‘pruritus’)
• Back, muscle or joint pain
• Sore throat
• Tooth infections
• Redness and pain where the injection is given.

Uncommon side effects (may affect up to 1 in 100 people):

• Depression
• Blocked or stuffy nose
• Bleeding, bruising, hardness, swelling and itching where the injection is given
• Drooping eyelid and sagging muscles on one side of the face (‘facial palsy’ or ‘Bell’s palsy’), which is usually temporary
• A change in psoriasis with redness and new tiny, yellow or white skin blisters, sometimes accompanied by fever (pustular psoriasis).

In patients with psoriasis, exfoliative dermatitis has been reported following ustekinumab treatment. Patients with plaque psoriasis may develop erythrodermic psoriasis, with symptoms that may be clinically indistinguishable from exfoliative dermatitis, as part of the natural course of their disease. As part of the monitoring of the patient’s psoriasis, physicians should be alert for symptoms of erythrodermic psoriasis or exfoliative dermatitis. If these symptoms occur, appropriate therapy should be instituted. Ustekinumab should be discontinued if a drug reaction is suspected.

How do I get ustekinumab?

Ustekinumab is available by prescription, primarily from rheumatologists. It is also prescribed by dermatologists for psoriasis.

Available Guidance

National Institute for Health and Care Excellence (NICE) guidance

Scottish Medicine Consortium guidance for ustekinumab

All Wales Medicines Strategy Group advice on ustekinumab

For Northern Ireland, the Department of Health, Social Services and Public Safety (DHSSPS) provide reviews and advice.

Read reviews or write your own

If you would like to read other people’s experience of this treatment, or have any comments to share, good or bad, you might like to go to iWantGreatCare for Ustekinumab or iWantGreatCare for Stelara.

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Ustekinumab is known commercially as Stelara and is marketed in the UK by Janssen Ltd

Adcortyl contains triamcinolone acetonide which belongs to a group of medicines, which are known as corticosteroids, that are used for joint pain, swelling and stiffness associated with rheumatoid arthritis and osteoarthrosis.

How does it work?

Inflammation occurs as a result of allergy or irritation and is caused by the release of substances that are important in the immune system. These substances cause blood vessels to widen, resulting in the affected area becoming red, swollen, itchy and painful. Corticosteroids work by acting within cells to decrease the release of these substances in a particular area, thereby reducing swelling, redness and itch.

Who can get it?

Available on prescription for adults and children over the age of 6 years.

How is it used?

Use in inflammatory joint disorders:
The dose of injection to be given into a joint or into a tendon sheath depends upon the size of the joint to be treated and the severity of the condition. Doses of 2.5 - 5mg (0.25-0.5ml) for smaller joints and 5-15mg (0.5-1.5ml) for larger joints usually give relief of symptoms. This medicine should not be used for injection into the Achilles tendon.

What are the side effects?

All medicines may cause some unwanted or “side” effects. Some which can occur with steroid treatment are as follows. Tell your doctor immediately if you get ulcer pains in your stomach or severe pain in your abdomen, facial swelling or an unexpected rash. Patients have reported increased appetite, weight gain, indigestion, sickness, feeling tired or weak. Steroid treatment may cause increased risk of infection, thinning of bones or tendons causing fractures or torn muscles, water retention, irregular heart beat, high blood pressure or blood clots. Skin disorders or eye problems, including glaucoma and cataracts, may occur and wounds or broken bones may be slow to heal. Treatment with steroids can stop the body from producing some hormones and may slow or stop children’s growth rate. If you are female, your periods may become irregular. Elevation or depression of mood, sleeplessness and severe headaches have been reported. Very rare instances of blindness have been reported following injection to the face.
In particular, when Adcortyl IA/ID is injected into a joint you may notice some indentation appearing after a while in the surrounding area. There may also be some temporary worsening of the pain and discomfort after the injection. Similarly, injections given under the skin may cause slight changes in skin colour around the site of injection. These changes should disappear in time.

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Adcortyl is marketed in the UK by Bristol Myers Squibb Pharmaceuticals Ltd

Betamethasone is a type of medicine which is known as a corticosteroid. Corticosteroids are hormones produced naturally by the adrenal glands which have many important functions, including control of inflammatory responses.

How does it work?

Betamethasone is a synthetic corticosteroid and is used to decrease inflammation. It works by acting within cells to prevent the release of certain chemicals that are important in the immune system. These chemicals are normally involved in producing immune and allergic responses, resulting in inflammation. By decreasing the release of these chemicals in a particular area, inflammation is reduced. This can help control a wide number of disease states, characterised by excessive inflammation. They include severe allergic reactions, inflammation of the lungs in asthma and inflammation of the joints in arthritis.

Betamethasone also decreases the numbers of white blood cells circulating in the blood. This, along with the decrease in inflammatory chemicals, can prevent the rejection of organ transplants, as it prevents the body from attacking foreign tissue. It is useful for the treatment of certain types of leukaemia, where there is an abnormally large production of certain white blood cells. It is also used to treat some diseases which are caused by the immune system attacking itself (auto immune diseases).

Betamethasone is used in much higher doses than the levels of corticosteroids produced naturally by the body, and as such, the usual actions of corticosteroids become exaggerated and can be observed as side effects of this medicine.

Who can get it?

Available on prescription for adults and children over the age of 1 year.

How is it used?

The dose used will depend upon the disease, its severity, and how quickly you get better. The following are for guidance only.
Adults:
Short term treatment: 2000 - 3000 micrograms (4-6 tablets) daily for the first few days, then reducing the daily dose by 250 - 500 micrograms (1/2 or 1 tablet) every two to five days, depending upon the response.
Rheumatoid arthritis: 500 - 2000 micrograms (1-4 tablets) daily. For long-term treatment the lowest effective dosage is used.
Most other conditions: 1500 - 5000 micrograms (3-10 tablets) daily for one to three weeks, then gradually reducing to the minimum effective dosage. Larger doses may be needed for mixed connective tissue diseases and ulcerative colitis.
Children:
A proportion of the adult dosage may be used (e.g. 75% at 12 years, 50% at 7 years and 25% at 1 year).

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

• Depression
• Thinning of the skin
• Increased pressure inside the eye (glaucoma)
• Decreased functioning of the adrenal gland (adrenal suppression)
• Thinning of the bones (osteoporosis)
• Ulceration of the stomach or intestine
• Increased susceptibility to infections
• Increased risk of fractures of the bones
• Increased hair growth (hirsutism)
• Yeast infection of the moist areas of the body, especially the vagina (candidiasis)
• Suppression of growth in children and adolescents
• Muscle weakness
• Weight gain
• Acne

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Betamethasone is marketed in the UK by Focus Pharmaceuticals Ltd.

Deflazacort is a type of medicine known as a corticosteroid. Corticosteroids are hormones produced naturally by the adrenal glands which have many important functions, including control of inflammatory responses.

How does it work?

Deflazacort is a synthetic corticosteroid and is used to decrease inflammation. Deflazacort works by acting within cells to prevent the release of certain chemicals that are important in the immune system. These chemicals are normally involved in producing immune and allergic responses, resulting in inflammation. By decreasing the release of these chemicals in a particular area, inflammation is reduced. This can help control a wide number of disease states which are characterised by excessive inflammation. They include severe allergic reactions, inflammation of the lungs in asthma and inflammation of the joints in arthritis.

Deflazacort also decreases the numbers of white blood cells circulating in the blood. This, along with the decrease in inflammatory chemicals, can prevent the rejection of organ transplants, as it prevents the body from attacking foreign tissue. It is also useful for the treatment of certain types of leukaemia, where there is an abnormally large number of certain white blood cells in the tissues or blood. It is also used to treat some diseases which are caused by the immune system attacking itself (autoimmune diseases).

Deflazacort is used in much higher doses than the levels of corticosteroids produced naturally by the body, and as such, the usual actions of corticosteroids become exaggerated and can be observed as side effects of this medicine.

Who can get it?

Available on prescription for adults and children

How is it used?

Adults
The usual maintenance dose in adults for most conditions, including rheumatoid arthritis, is in the range of 3 – 18mg taken orally each day.
In some instances, an initial dose of up to 120mg each day may be needed.
The dose in adults with severe asthma may be up to 48 to 72mg each day to begin with.
This dose may be gradually reduced once the asthma attack has been controlled.

Children
Doses in children are given according to the child’s bodyweight. Your doctor or
pharmacist will be able to advise you on the number of tablets needed in each case.
The usual dose in children with chronic arthritis is between 0.25 – 1.0mg/kg bodyweight each day.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.
• problems with your digestive system – indigestion, ulcer, bleeding, inflamed
• pancreas, nausea
• water retention, salt retention, high blood pressure, heart failure
• muscle weakness, bone thinning, impaired healing and thinning of the skin,
• bruising, acne
• headaches, vertigo, dizziness, difficulty in sleeping and restlessness,
• emotional problems, depression, over-excitement, aggravation of epilepsy and of schizophrenia
• allergies (rash, itching and sometimes shortness of breath)
• hormonal disorders (in particular effects on the adrenal gland), including excess hair growth, weight gain, increased appetite, diabetes, menstrual disorders

Read reviews or write your own

If you would like to read other people’s experience of this treatment, or have any comments to share, good or bad, you might like to go to iWantGreatCare for Deflazacort or iWantGreatCare for Calcort.

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Deflazacort is known commercially as Calcort and is marketed in the UK by Sanofi-Aventis Ltd.

Hydrocortisone acetate is a type of medicine known as a corticosteroid. Corticosteroids are hormones produced naturally by the adrenal glands which have many important functions, including control of inflammatory responses.

How does it work?

Hydrocortisone acetate is used to decrease inflammation. It works by acting within cells to prevent the release of certain chemicals that are important in the immune system. These chemicals are normally involved in producing immune and allergic responses, resulting in inflammation. By decreasing the release of these chemicals in a particular area, inflammation is reduced. This can help control a wide number of disease states, characterised by excessive inflammation. These include inflammation of the joints in arthritis.

Hydrocortisone acetate is given by injection directly into a joint or the tissue around a joint, to relieve inflammation and pain and increase mobility of the affected joint, in conditions such as arthritis or inflamed tissue surrounding a tendon.

Although hydrocortisone acetate is given as a local injection, if injections are given at high doses for a prolonged period, they can be absorbed into the bloodstream. Such high doses can result in the usual actions of corticosteroids becoming exaggerated and being observed as side effects of this medicine.

Who can get it?

Available on prescription as an injection.

How is it used?

Adult dose 5—50 mg daily according to joint size. No more than 3 joints to be treated daily
Child dose 5—30 mg daily in divided doses. No more than 3 joints to be treated daily.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

• Difficulty in sleeping (insomnia)
• Depression
• Increased pressure inside the eye (glaucoma)
• Weight gain
• Decreased functioning of the adrenal gland (adrenal suppression)
• Thinning of the bones (osteoporosis)
• Ulceration of the stomach or intestine
• Increased susceptibility to infections
• Acne
• Increased risk of fractures of the bones
• Increased hair growth (hirsutism)
• Skin thinning
• Suppression of growth in children and adolescents
• Local pain and swelling at the site of injection

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Hydrocortisone is marketed in the UK by Sovereign Medical Ltd and is known commercially as Hydrocortistab

Kenalog contains the active ingredient triamcinolone, which belongs to the group of medicines known as corticosteroids and is given by injection for those suffering joint pain, swelling and stiffness of rheumatoid arthritis and osteoarthrosis.

How does it work?

Triamcinolone works by preventing or reducing inflammation. It is used to treat a number of conditions that are characterised by excessive inflammation.

Triamcinolone suppresses the immune system and so can be used to treat autoimmune diseases. It can also be used in the treatment of certain types of cancers

Who can get it?

It is prescribed for adults and children over 6 years of age suffering from rheumatoid arthritis.

How is it used?

Triamcinolone is an injection that is usually given by a healthcare professional. The person responsible for giving you your medicine will make sure that you get the appropriate dose.

What are the side effects?

Reactions following injection into a joint have been rare, howevr the following side effects have been reported

• dizziness
• flushing
• injection site problems such as abscesses, pain, skin colour changes, irritation or Charcot-like arthropathy
• post-injection flare
• temporary worsening of joint discomfort

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Triamcinolone is only available on prescription and is commercially known as Kenalog® Intra-articular/Intramuscular and is marketed in the UK by Bristol-Myers Squibb Pharmaceuticals Ltd

Methylprednisolone is a corticosteroid based injection used for the local inflammation of joints due to rheumatoid arthritis.

How does it work?

Methylprednisolone works by preventing or reducing inflammation.
It is used to treat a number of conditions that are characterised by excessive inflammation.
Methylprednisolone suppresses the immune system and so can be used to treat autoimmune diseases.
The time that a joint injection takes to work varies between patients. However an improvement in the joint is usually noticed 1 to 2 days after the injection.

Who can get it?

Available on prescription for adults and children
You should only have this medicine during pregnancy if your doctor thinks that you need it

How is it used?

This medicine will be given to you as an injection.
If you have any concerns about this medicine or how this will be given to you, talk to someone who is involved in your medical care.
You should usually try and rest the affected joint for 2 days after an injection. However you should follow your doctor’s advice as he or she may tell you to rest for longer.

What are the side effects?

As with all steroids withdrawal symptoms can occur when this medicine is stopped.
These include:

• fever,
• muscle pain,
• joint pain,
• rhinitis,
• conjunctivitis
• weight loss
• painful, itchy skin.

If the dose of Methylprednisolone is reduced too rapidly serious problems can occur including adrenal problems, lowered blood pressure or death

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Methylprednisolone is known commercially as Depo-Medrone and is marketed in the UK by Pfizer Ltd

Prednisolone is given as in injection for the local treatment, by intra-articular or peri-articular injection, of the following conditions: rheumatoid arthritis; osteoarthritis; synovitis not associated with infection; tennis elbow (Lateral Epicondylitis) ; golfer's elbow, and housemaids knee - bursitis.

The Injection is also suitable for administration by the intramuscular route in conditions requiring systemic corticosteroids, e.g. suppression of inflammatory and allergic disorders such as bronchial asthma, anaphylaxis, ulcerative colitis and Crohn's disease. It belongs to a group of medicines known as corticosteroids.

How does it work?

Prednisolone suppresses the immune system and so can be used to treat autoimmune diseases. Prednisolone can help to prevent and to treat the rejection of transplanted organs. It can also be used in the treatment of certain types of cancers.
People who take corticosteroids for a long period of time are prone to infections as their immune system can become weak. These infections may be much more severe than they usually would be and the symptoms that would usually be used to identify such infections can be hidden. For this reason people who take Prednisolone must be careful to avoid exposure to infections such as chickenpox and measles whenever possible. If you have been exposed to chickenpox or measles, you must get immediate medical advice. You should continue to take your medicine unless your prescriber advises you to stop taking it.

How is it used?

For articular use: 5-25 mg depending upon the size of the joint. The injections may be repeated when relapse occurs. No more than three joints should be treated in one day.

For intramuscular use: Dosage will depend upon the clinical circumstances and the judgement of the physician. The suggested dose is 25-100 mg once or twice weekly.

Elderly. Steroids should be used cautiously in the elderly since adverse effects are enhanced by old age
Undesirable effects may be minimised by using the lowest effective dose for the minimum period, and by administering the daily requirement as a single morning dose or whenever possible, as a single morning dose on alternate days. Frequent patient review is required to titrate the dose against disease activity.

What are the side effects?

Side-effects can be minimised by using lowest effective dose for minimum period possible; gastro-intestinal effects include dyspepsia, peptic ulceration (with perforation), abdominal distension, acute pancreatitis, oesophageal ulceration and candidiasis; musculoskeletal effects include proximal myopathy, osteoporosis, vertebral and long bone fractures, avascular osteonecrosis, tendon rupture; endocrine effects include adrenal suppression, menstrual irregularities and amenorrhoea, Cushing's syndrome (with high doses, usually reversible on withdrawal), hirsutism, weight gain, negative nitrogen and calcium balance, increased appetite; increased susceptibility to and severity of infection; neuropsychiatric effects include euphoria, psychological dependence, depression, insomnia, increased intracranial pressure with papilloedema in children (usually after withdrawal), psychosis and aggravation of schizophrenia, aggravation of epilepsy; ophthalmic effects include glaucoma, papilloedema, posterior subcapsular cataracts, corneal or scleral thinning and exacerbation of ophthalmic viral or fungal disease; other side-effects include impaired healing, skin atrophy, bruising, striae, telangiectasia, acne, myocardial rupture following recent myocardial infarction, fluid and electrolyte disturbance, leucocytosis, hypersensitivity reactions (including anaphylaxis), thromboembolism, nausea, malaise, hiccups

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Prednisolone is available on prescription. It is known commercially as Deltastab and is marketed in the UK by Amdipharm Plc

Anakinra is a Disease modifying antirheumatic drug that belongs to the group of medicines which are known as Interleukin-1 antagonists.

How does it work?

Normally, your body produces a protein that blocks the harmful effects of interleukin-1. In rheumatoid arthritis your body does not produce enough of this blocking protein. The active anakinra is produced by DNA technology using the micro-organism E coli and works in the same way as your natural blocking protein. By blocking IL-1, Kineret inhibits the inflammatory response in RA including pain.

How is it used?

Kineret is given by injection at the same time every day. This is usually done by the patient in the same way that a diabetic patient treats themselves.

The most suitable places to inject yourself are:
• the top of thighs; and
• the abdomen, except for the area around the navel.
Change the place that you inject each time so you don't become sore in one area. If someone else is injecting for you, they can also use the back of your arms.

What are the side effects?

Very common side effects are:
Injection site reactions
The most common and consistently reported treatment-related adverse event associated with Kineret were ISRs. The majority (95%) of ISRs were reported as mild to moderate. These were typically characterised by 1 or more of the following: erythema, ecchymoses, inflammation, and pain. At a dose of 100 mg/day, 71% of patients developed an ISR compared to 28% of the placebo treated patients, which was typically reported within the first 4 weeks of therapy. The median duration of the above mentioned typical symptoms was 14 to 28 days. The development of ISRs in patients who had not previously experienced ISRs was uncommon after the first month of therapy.
Serious infections
The incidence of serious infections in the studies conducted at the recommended dose (100 mg/day) was 1.8% in Kineret-treated patients and 0.7% in placebo-treated patients. These infections consisted primarily of bacterial events such as cellulitis, pneumonia, and bone and joint infections, rather than unusual, opportunistic, fungal, or viral infections. Most patients continued on study drug after the infection resolved. There were no on-study deaths due to serious infectious episodes.
In clinical studies and post-marketing experience, rare cases of opportunistic infections have been observed and included fungal, mycobacterial, bacterial, and viral pathogens. Infections have been noted in all organ systems and have been reported in patients receiving Kineret alone or in combination with immunosuppressive agents.
Neutropenia
In placebo-controlled studies with Kineret, treatment was associated with small reductions in the mean values for total white blood count and absolute neutrophil count (ANC). Neutropenia (ANC < 1.5 x 109/l) was reported in 2.4% patients receiving Kineret compared with 0.4% of placebo patients.
Kineret treatment should not be initiated in patients with neutropenia (ANC < 1.5 x 109/l). It is recommended that neutrophil counts be assessed prior to initiating Kineret treatment, and while receiving Kineret, monthly during the first 6 months of treatment and quarterly hereafter. In patients who become neutropenic (ANC < 1.5 x 109/l) the ANC should be monitored closely and Kineret treatment should be discontinued
Malignancies
Rheumatoid arthritis (RA) patients may be at a higher risk (on average 2-3 fold) for the development of lymphoma. In clinical trials, whilst patients treated with Kineret had a higher incidence of lymphoma than the expected rate in the general population, this rate is consistent with rates reported in general for RA patients.
In clinical trials, the crude incidence rate of malignancy was the same in the Kineret-treated patients and the placebo-treated patients and did not differ from that in the general population. Furthermore, the overall incidence of malignancies was not increased during 3 years of patient exposure to Kineret.
Immunogenicity
In clinical trials, up to 3% of patients tested seropositive at least once during the study for antibodies capable of neutralising the biologic effects of anakinra. The occurrence of antibodies was typically transient and not associated with clinical adverse reactions or diminished efficacy.

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Anakinra is known commercially as Kineret and is marketed in the UK by Swedish Orphan Biovitrum Ltd

Azathioprine is a type of medicine called an immunosuppressant which belongs to the group of drugs known as disease modifying antirheumatic drugs. It is used to treat severe rheumatoid arthritis

How does it work?

The immune system normally recognises and protects the body from foreign substances such as bacteria and viruses. It also recognises and attacks transplanted tissue and cells that have become cancerous. Sometimes however, the immune system can react excessively, or mount an attack against normal healthy tissues. This can result in various disorders known as autoimmune diseases. For example, in rheumatoid arthritis the immune system attacks the joints, causing pain and inflammation. In systemic lupus erythematosus the immune system attacks the skin and internal organs. The activity of the immune system can also be a problem following organ transplants, because it recognises the transplanted tissue as foreign and attacks it, causing the organ to be rejected. In situations such as these it is useful to suppress the activity of the immune system.

The immune system relies on different types of white blood cells that are produced in the bone marrow and lymph glands. Azathioprine works by decreasing the production of these white blood cells. It does this by interfering with the production of the cells genetic material, DNA, which stops the cells from dividing and multiplying. The decrease in the numbers of white blood cells reduces the ability of the immune system to reject organ transplants. In autoimmune diseases it reduces the immune system attack on normal tissues and so reduces the severity of the symptoms, and in many cases halts the progress of the disease. However, it can take weeks to months of treatment for the full effect of the medicine to become apparent.
Unfortunately white blood cells are needed to fight invading micro-organisms, so during treatment the body becomes more susceptible to infections. Azathioprine also interferes with the growth and division of other types of blood cells in the bone marrow. Reduced production of red blood cells can cause anaemia and reduced production of platelets can cause problems with blood clotting. For this reason, your doctor will monitor the levels of all your blood cells.
Azathioprine is often used in combination with other immunosuppressants such as corticosteroids. When combined with corticosteroids it can often allow a reduced dose of corticosteroid to be used.

Who can get it?

This medicine is available on prescription for adults and children

How is it used?

The dosage is very variable and it may be changed from time to time by your doctor. The usual daily dosage of Imuran is from 1 - 3 mg per kilogram body weight for adults and children. The usual dosage for elderly patients and those with liver or kidney disease should be at the lower end of the dosage range for adults. Imuran Injection may only be given intravenously (into a vein) as an injection or an infusion. Your doctor will discuss the best method of treatment for you. While you are on Imuran, your doctor will want you to have a blood test from time to time to check the blood cell count and to adjust the dosage if necessary.

What are the side effects?

See your doctor immediately if any of the following occur:

• if you feel sick, dizzy, lose your appetite, vomit or develop bad diarrhoea or jaundice (yellowing of the skin or eyes)
• if you start feeling more tired than usual, or if you notice any signs of a fever (chills), rash, muscle or joint pain, or an infection
• if you have any unexpected bruising or bleeding
• if you start feeling more ill while taking Imuran
• if you develop lumps on the body or patches on the skin.

You may notice some hair loss while taking Imuran. This is a rare side effect of Imuran that could happen in less than 1 in 1,000 patients. Often hair does grow again, even if you carry on taking Imuran. If you are worried ask your doctor.
Imuran can cause kidney problems (symptoms may include changes in the amount of urine passed and changes in the colour of the urine) or a drop in blood pressure.
Very rarely, liver or lung problems may occur.

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Azathioprine is known commercially as Imuran and is marketed in the UK by Aspen.

Chloroquine belongs to the group of drugs known as disease modifying antirheumatic drugs and it is used in the treatment of rheumatoid arthritis.

How does it work?

Chloroquine has anti-inflammatory activity and is sometimes used in high doses to treat the autoimmune diseases rheumatoid arthritis, juvenile rheumatoid arthritis, systemic lupus erythematosus, and discoid lupus erythematosus.

In these diseases, the body's immune system is overactive and causes inflammation that results in the disease symptoms. Chloroquine suppresses the inflammation and the disease process.

It doesn't have an immediate effect, but requires four to six months of treatment for a full response.

If there is no real benefit on the disease after taking this medicine for six months, your doctor will usually ask you to stop taking it and try a different DMARD.

Who can get it?

This medicine is available on prescription for adults and children.

How is it used?

15 ml should be taken daily.

What are the side effects?

• Headache,
• GI upset,
• hair loss,
• skin eruptions,
• depigmentation,
• blurred vision,
• corneal opacities,
• retinal damage.
• Blood disorders.
• Allergy,
• anaphylaxis

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Chloroquine is known commercially as Nivaquine Syrup and is marketed in the UK by Sanofi Aventis.

Ciclosporin belongs to the group of drugs known as disease modifying antirheumatic drugs and it is a type of medicine called a cytotoxic antimetabolite. Methotrexate is used to treat three different conditions: rheumatoid arthritis, psoriasis and cancer of various types.

How does it work?

Ciclosporin suppresses the immune system by preventing white blood cells called T lymphocytes from producing substances called lymphokines. Lymphokines normally stimulate the growth of T and B lymphocytes, which are white blood cells responsible for regulating and triggering immune responses. They provide defence against infection and foreign cells.

By preventing the production of lymphokines, ciclosporin suppresses the action of T and B lymphocytes. This prevents certain immune responses from occurring – the immune system is suppressed.

The skin conditions psoriasis and dermatitis are also affected by the immune system. It is thought that T cells over-react to a stimulus in these conditions, causing the scaling and inflammation of the skin. Ciclosporin can be used in severely disabling and resistant forms of these conditions to suppress the action of the T cells and therefore improve the scaling of the skin.

Rheumatoid arthritis, and a syndrome involving the kidneys called nephrotic syndrome, are also treated with ciclosporin in certain cases. These conditions are thought to be caused by inappropriate activity of the immune system towards the body’s own cells. T cells are involved in producing inflammation as part of their immune function, thus suppressing their action can help to reduce the inflammation in the joints seen in arthritis, and the inflammation in the kidneys seen in the nephrotic syndrome

Who can get it?

This medicine is available on prescription for adults over the age of 18.

How is it used?

For the treatment of severe rheumatoid arthritis, the total daily dose is usually within the range of 2.5 mg/kg body weight per day and 4 mg/kg body weight per day.

What are the side effects?

Many side effects associated with ciclosporin therapy are dose-dependent and responsive to dose reduction. In the various indications the overall spectrum of side effects is essentially the same; there are, however, differences in incidence and severity. As a consequence of the higher initial doses and longer maintenance therapy required after transplantation, side effects are more frequent and usually more severe in transplant patients than in patients treated for other indications.
Frequency estimate: very common 10%, common 1% to <10%,
Uncommon 0.1% to <1%, rare 0.01% to <0.1%, very rare <0.01%.

Blood and the lymphatic system disorders:
Uncommon: anaemia, thrombocytopenia
Rare: micro-angiopathic haemolytic anaemia, haemolytic uraemic syndrome

Endocrine disorders:
Rare: menstrual disturbances, gynaecomastia

Metabolism and nutrition disorders:
Very common : hyperlipidaemia
Common: hyperuricaemia, hyperkalaemia, hypomagnesaemia
Rare: hyperglycaemia

Nervous system disorders:
Very common: tremor, headache
Common: paraesthesia
Uncommon: signs of encephalopathy or demyelination, especially in liver transplant patients, such as convulsions, confusion, disorientation, decreased responsiveness, agitation, insomnia, visual disturbances, cortical blindness, coma, paresis, cerebellar ataxia.
Rare: motor polyneuropathy
Very rare: optic disc oedema including papilloedema with possible visual impairment secondary to Benign Intracranial Hypertension.

Cardiovascular disorders:
Very common: hypertension

Gastrointestinal disorders:
Common: anorexia, nausea, vomiting, abdominal pain, diarrhoea,
gingival hyperplasia,

Hepato-biliary disorders:
Common: hepatic dysfunction
Rare: pancreatitis.

Skin and subcutaneous tissue disorders:
Common: hypertrichosis
Uncommon: allergic rashes

Musculoskeletal, connective tissue and bone disorders:
Common: muscle cramps, myalgia
Rare: muscle weakness, myopathy

Renal and urinary disorders:
Very common: renal dysfunction (see 4.4 'Special Warnings and special precautions for use')

General disorders and administration site conditions:

Common: fatigue
Uncommon: oedema, weight increase
The increased risk of developing malignancies and lymphoproliferative disorders appears to be related to the degree and duration of immunosuppression rather than to the use of specific agents.

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Ciclosporin is known commercially as Neoral oral solution and is marketed in the UK by Novartis Pharmaceuticals ltd.

Hydroxychloroquine belongs to the group of medicines known as disease modifying antirheumatic drugs and is for the treatment of rheumatoid arthritis, juvenile rheumatoid arthritis, and lupus erythematosus.

How does it work?

Hydroxychloroquine is thought to act by interfering with the production and release of blood cells that are involved in the body's immune defence system. Hence the autoimmune response of the antibodies against its own body is reduced and as result the amount of damage to the cells is minimized and prevented. As it has the potential to prevent progression of the disease, by limiting the damage caused, it is often referred to as a disease-modifying antirheumatic drug (DMARDS) and is commonly used very early in the treatment of rheumatoid arthritis.

Hydroxychloroquine is also used in treating skin conditions that are caused or aggravated by sunlight

Who can get it?

Available on prescription

How is it used?

Initially 2 daily in divided doses with meals,
Discontinue after six months if no improvement.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

• Retinal changes,
• corneal opacity,
• impaired visual accommodation (discontinue if occur).
• Skin reactions,
• bleaching of hair,
• alopecia,
• GI upset

Hydroxychloroquine may increase the blood levels of digoxin, resulting in an increased risk of side-effects or toxicity. Therefore close monitoring is required.

The absorption of hydroxychloroquine may be reduced by antacids (indigestion remedies). It is advisable to leave a 4-hour interval between the two doses.

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Hydroxychloroquine is marketed in the UK by Sanofi Aventis and is known commercially as Plaquenil

Leflunomide is a disease modifying antirheumatic drug used in the treatment of moderate to severe active rheumatoid arthritis and active psoriatic arthritis

How does it work?

Leflunomide is an immunosuppressive medicine. It helps to suppress overactivity of the immune system in rheumatoid arthritis and psoriatic arthritis. It can help to reduce pain and swelling by limiting inflammation.
Due to the effects on the immune system, people who take Leflunomide are prone to getting infections. This includes serious infections such as tuberculosis and sepsis. It is for this reason that people who have Leflunomide are monitored for infections.
Leflunomide stays in the body for several months so the effects of this medicine will persist for some time after you take your last dose.
The effects of Leflunomide are not usually seen or felt until it has been taken for several weeks

Who can get it?

Suitable for adults only.

How is it used?

• swallow whole with a glass of water
• this medicine can be taken with or without food

What are the side effects?

Clinical studies have shown the following side effects when taking Leflunomide

• Increased Blood Pressure
• GI upset
• oral mucosal disorders
• abdominal pain
• altered liver function
• leucopoenia
• tenosynovitis
• headache
• dizziness
• asthenia
• paraesthesia
• weight loss
• allergy
• hair loss
• dry skin.

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Leflunomide is known commercially as Arava and is marketed in the UK by Sanofi-Aventis Ltd.

Methotrexate  belongs to the group of drugs known as disease modifying anti-rheumatic drugs and it is a type of medicine called a cytotoxic antimetabolite. Methotrexate is used to treat three different conditions: rheumatoid arthritis, psoriasis and cancer of various types.

How does it work?

In rheumatoid arthritis methotrexate is thought to work by suppressing the excessive activity of the immune system that causes the inflammation in this condition, though the exact mechanism of action is not fully understood. It is used when the arthritis does not improve sufficiently with conventional treatment, or for people who cannot tolerate conventional treatments. In arthritis methotrexate is sometimes referred to as a disease-modifying antirheumatic drug (DMARD), because it suppresses the disease process.

In low doses methotrexate can also affect the division of normal, healthy cells, and it has the potential to produce serious side effects. For this reason, treatment with methotrexate is usually only initiated by hospital specialists, and regular blood tests are needed to monitor for potential side effects.

Who can get it?

This medicine is available on prescription for adults over the age of 18.

How is it used?

Dosage

Jylamvo oral solution

For the treatment of severe psoriasis  take 2.5-5mg test dose one week prior to therapy.  Then 7.5mg once weekly, increasing gradually as necessary; maximum 25mg weekly.  After desired response reduce gradually to lowest effective dose.

Maxtrex
7.5mg to be taken once weekly or 2.5mg at 12 hour intervals for 3 doses as a course once weekly.  Adjust dose according to response: use lowest effective dose.  Max 20mg weekly.

Methofill

7.5mg by subcutaneous injection, increasing gradually depending on individual tolerance and disease activity up to a maximum weekly dose of 25mg  After desired response reduce gradually to lowest effective dose.

Methotrexate

7.5mg to be taken once weekly or 2.5mg at 12 hour intervals for 3 doses as a course once weekly.  Adjust dose according to response: use lowest effective dose.  Max 20mg weekly.

Methotrexate oral solution
7.5mg to be taken once weekly or 2.5mg at 12 hour intervals for 3 doses as a course once weekly.  Adjust dose according to response: use lowest effective dose.  Max 20mg weekly.

Metoject
7.5mg by subcutaneous injection once weekly, increasing gradually depending on individual tolerance and disease activity.  Max weekly dose 25mg.  After desired response gradually reduce to lowest effective dose.

Nordimet

7.5mg by subcutaneous injection, increasing gradually depending on individual tolerance and disease activity up to a maximum weekly dose of 25mg  After desired response reduce gradually to lowest effective dose.

Ziatal
7.5mg by subcutaneous or intramuscular injection once weekly, then adjust according to indvidiaul tolerance and disease activity.  Maximum weekly dose of 25mg.  After desired response gradually reduce to lowest effective dose.

What are the side effects?

The most common unwanted effects are nausea, stomach pains and soreness of the mouth and lips,

Methotrexate can make you more likely to catch infections. If you think you have an infection, a sore throat, fever, chills, or achiness during treatment you should tell your doctor immediately. Methotrexate can cause inflammation of the lung with breathlessness. If you develop a persistent cough, experience pain or difficulty breathing, or become breathless, you should seek medical attention.

Less common unwanted effects include vomiting, diarrhoea, loss of appetite, tiredness, drowsiness, feeling weak, dizziness, eye irritation, mood changes, loss of interest in, or inability to have sex, fever, chills, pain in joints or muscles, acne, boils, rash itchiness, vaginal ulcers.

In a small number of patients methotrexate may cause serious unwanted effects, and on rare occasions, death. You should contact your doctor immediately if you notice any of the following:

• Unusual bleeding (including vomiting blood) or bruising
• Blood in urine or stools
• A discoloration or yellowing of the skin
• A serious skin rash with reddening of the skin
• A painless lump in your neck, groin or armpits with associated backache fever or night sweats
• Pain or difficulty in passing urine
• The need to drink much more than usual
• A dry cough
• A numb or tingling feeling
• Fits (convulsions)
• Unusual body movements or a lack of balance
• Hair loss
• Loss of consciousness
• Black or tarry stools
• Tiny red spots on the skin
• Pain in the shoulders or back
• The need to pass urine more often than usual
• Constipation
• Pain or difficulty in breathing or shortness of breath
• Confusion
• An inability to move
• Difficulty with speech
• An allergic reaction which may cause a skin rash or swelling of your lips or tongue
• Thickening of the skin
• Photosensitivity (reaction to UV and sun light).

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Methotrexate is known commercially as Jylamvo which is marketed in the UK by Intrapharm, Maxtrex which is marketed in the UK by Pfizer Ltd, Methofill which is marketed in the UK by Accord,  Methotrexate oral solution which is marketed in the UK by Rosemont Pharmaceuticals Limited,  Metoject which is marketed in the UK by Medac, Nordimet which is marketed in the UK by Nordic and Ziatal which is marketed in the UK by Nordic.

Penicillamine is one of a group of drugs called disease-modifying antirheumatic drugs (DMARDS) used to treat serious, active rheumatoid arthritis.

How does it work?

Penicillamine is a chelating agent. This means that it binds to certain metals, including lead and copper, to help remove them from your body if necessary. Distamine also helps to relieve the pain and stiffness of rheumatoid arthritis if other medicines and rest have not worked.

Who can get it?

Available for adults and children over 8 years of age.

How is it used?

Rheumatoid arthritis: take 125mg to 250mg a day for the first month. (1) Your doctor will then tell you how to increase the dose gradually over several months until you are feeling better. He or she may then change your dose to keep you well. This new dose is usually 500mg to 750mg a day, but it can be as high as 1500mg. It may be several months before you feel better. If there is no improvement you should stop taking the tablets after a year. If you stay well for six months your doctor may reduce your dose. If you are elderly, you may be given a smaller dose. Do not take more than 1000mg a day.

What are the side effects?

When you start taking the tablets you may feel sick or even be sick. You may lose your appetite or notice that food tastes different. These side effects usually wear off, but tell your doctor if they trouble you.
You will have regular blood and urine tests, especially when you start taking the tablets and when you increase the dose. These are to check for changes in your blood cell counts and to look for protein or blood in your urine.

Other known side effects include the following:

Very common side effects (more than 1 in 10 patients) of Distamine include:

• protein in your urine (this is detected by a urine test).

Rare side effects (more than 1 in 10,000 patients) of Distamine include:

• sore mouth
• swollen breast tissue
• lung problems (e.g. wheezing, coughing or difficulty breathing)
• hair loss
• wrinkly skin.

Other side effects of Distamine include:

• loss of taste
• feeling or being sick (especially at the start of treatment)
• loss of appetite (especially at the start of treatment)
• severe stomach and back pain
• jaundice which is the yellowing of the skin or eyes as a result of liver or blood problems (this may include changes in lood tests which show how your liver is working)
• redness, a rash or itching
• fever or frequent infections
• blistering, swollen skin
• muscle weakness
• worsening of the pain and swelling in your joints

How do I get Penicillamine?

Penicillamine is available on prescription.

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Penicillamine is known commercially as Distamine and is marketed in the UK by Alliance Pharmaceuticals Ltd.

Sodium aurothiomalate belongs to a group of medicines known as disease modifying antirheumatic drug and is used for the treatment of Rheumatoid arthritis and juvenile chronic arthritis.

How does it work?

Sodium aurothiomalate in the treatment of rheumatoid arthritis limits inflammation which helps to reduce signs and symptoms of the disease such as pain and swelling. It has to be taken for a few months before you feel or notice an improvement in your symptoms.
Myocrisin is an injection that is usually given by a healthcare professional. The person responsible for giving you your medicine will make sure that you get the appropriate dose. A small dose of medicine may be given initially as a test dose the first time that you have Myocrisin. You will be under medical observation for about half an hour after Myocrisin has been given to you. If you feel that the medicine is making you feel unwell or you think it is not working, you should talk to someone who is involved in your care.

Who can get it?

Not recommended for the elderly or for those with a history of urticaria, eczema or colitis.
Blood, skin and urine should be checked before each injection.

How is it used?

This medicine will be given to you as an injection. If you have any concerns about this medicine or how this will be given to you, talk to someone who is involved in your medical care.

What are the side effects?

Albuminuria, rash, eosinophilia. These may lead to a temporary suspension of treatment for 1 or 2 weeks.

Pruritus, metallic taste, oropharyngeal disorders, bruising, unexpected bleeding, menorrhagia, or diarrhoea can be experienced and should be reported to someone who is involved in the patient’s medical care

How do I get Sodium aurothiomalate?

Sodium aurothiomalate is available on prescription.

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It is known commercially as Myocrisin and is marketed in the UK by Sanofi Aventis.

Sulfasalazine is disease modifying antirheumatic drug used in cases of Rheumatoid arthritis that are not responding to NSAIDs

How does it work?

Sulfasalazine is an immunosuppressive medicine. It helps to suppress over-activity of the immune system in rheumatoid arthritis. It can help to reduce pain and swelling by limiting inflammation.
Sulfasalazine needs to be taken for at least six weeks before any improvement is noticed.
Other information about Sulfasalazine:
people starting treatment with this form of medicine will normally be prescribed a low dose. The dose will then be gradually increased as necessary. This is to reduce the chances of getting side-effects

Who can get it?

Not recommended for children

How is it used?

Initially 1 daily for one week after meals, increasing by 1 each week to max. 6 daily in divided doses.

What are the side effects?

This medicine may cause side-effects in some people. The most common side effects are nausea, headache, rash, loss of appetite and raised temperature. These usually settle down during treatment as the body adjusts to the medicine.
Salazopyrin may cause temporary infertility in men. Fertility returns when treatment is stopped. Normal contraception should still be used.
Occasionally the drug causes a reduction in the number of cells in the blood. In about 1 in 700 patients there is a serious fall in the number of white cells, the majority of such patients suffering from rheumatoid arthritis. This is why blood tests are made during the first three months of treatment. If you do not have these tests there is the possibility of a very serious reaction being missed. A fall in your white cell count may be noticed as tiredness, sore throat or difficulty in getting over an infection. If you have these or feel generally unwell or if you find that you are bruising easily, tell your doctor straight away.
Very infrequently a serious skin condition may occur, with rash (sometimes confined to the cheeks and bridge of the nose) peeling skin or blistering. It may be triggered or aggravated by sunlight. Should this occur, stop taking the tablets, avoid strong sunlight and contact your doctor promptly. Hair loss or thinning may occur.
Other rare side-effects which have been noted are:
allergic reactions {rash, itching}, nervous reactions {vertigo (dizziness), tinnitus (ringing in the ears), tingling in hands and feet, loss of control over movements, fitting, depression, hallucinations, difficulty in sleeping}, breathlessness, mouth ulcers, stomach pain, swollen face or neck, kidney pain, blood in urine, anaemia, bloodshot eyes, cough, joint pain, heart muscle inflammation, sore or swollen glands, hepatitis or jaundice
If you notice any of these or anything else you are concerned about, please tell your doctor or pharmacist.

How do I get Sulfasalazine?

Sulfasalazine is available on prescription.

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It is known commercially as Salazopyrin EN-Tabs and is marketed in the UK by Pfizer Ltd

Aceclofenac belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs) and it is used in the treatment of osteoarthritis, rheumatoid arthritis and ankylosing spondylitis.

How does it work?

It works by blocking the action of a substance in the body called cyclo-oxygenase. Cyclo-oxygenase is involved in the production of various chemicals in the body, some of which are known as prostaglandins. Prostaglandins are produced in response to injury or certain diseases and would otherwise go on to cause pain, swelling and inflammation. Arthritic conditions are one example of this. Aceclofenac is used to relieve pain and inflammation in arthritic conditions. All the medicines in this group reduce inflammation caused by the body's own immune system and are effective pain killers.

Who can get it?

Aceclofenac is a prescription only medicine (POM) and is not suitable for children. It should be used with caution in patients who are allergic to aspirin or any other NSAIDs (such as ibuprofen, naproxen or diclofenac), who have a history of stomach ulcers or intestinal bleeding, who have moderate to severe kidney disease, who have suspected liver failure, or who are pregnant.

How is it used?

The recommended dose in adults is 200 mg per day, taken as one tablet in the morning and one in the evening.

Tables should be swallowed whole with a drink of water. The tables should not be crushed or chewed the tablets.

Take preferably with or after food.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

Common side effects (occur in more than 1 in 100 patients but in less than 1 in 10 patients):

• dizziness
• nausea (feeling sick)
• diarrhoea
• increased liver enzymes in the blood

Uncommon (occur in more than 1 in 1,000 patients but in less than 1 in 100 patients):

• wind (flatulence)
• inflammation or irritation of the lining of the stomach (gastritis)
• constipation
• vomiting
• mouth ulcers
• itching
• rash
• inflammation of the skin (dermatitis)
• raised circular red itchy, stinging or burning patches on the skin (hives)
• increase in blood urea levels
• increase in blood creatinine levels

Rare (occur in more than 1 in 10,000 patients but in less than 1 in 1,000 patients):

• low levels of iron in the blood
• hypersensitivity (allergic reaction)
• visual disturbance
• shortness of breath

Very Rare (occur in less than 1 in 10,000 patients):

• low white blood cells levels
• low platelets levels in the blood
• abnormal breakdown of red blood cells (anemia)
• high potassium levels in the blood
• depression
• strange dreams
• inability to sleep
• tingling, pricking or numbness of skin
• uncontrollable shaking (tremor)
• drowsiness
• headaches
• abnormal taste in the mouth
• sensation of spinning when standing still
• heart pounding or racing (palpitations)
• hot flushes
• difficulty breathing
• high pitched noise when breathing
• inflammation of the mouth
• stomach ulcer
• inflammation of the pancreas (pancreatitis)
• inflammation of the liver (hepatitis)
• yellowing of the skin (jaundice)
• spontaneous bleeding into the skin (appears as a rash)
• blisters
• water retention and swelling
• tiredness
• leg cramps
• increased blood alkaline phosphatase levels
• weight gain

Aceclofenac should not be taken with any other NSAID, due to an increased risk of side effects.

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Aceclofenac is available on prescription. Aceclofenac is known commercially as Preservex and is marketed in the UK by Almirall Ltd

Arthrotec belongs to the group of medicines which are known as non-steroidal anti-inflammatory drugs (NSAIDs) and is made up from the active ingredients of Diclofenac and Misoprostol. It is used for the relief of pain caused by Rheumatoid arthritis & osteoarthritis.

How does it work?

It works by blocking the production of a group of chemicals (prostaglandins) that are normally produced by the body in response to injury or certain diseases. These prostaglandins would otherwise go on to cause swelling, pain and inflammation. By blocking prostaglandins, diclofenac relieves swelling, pain and inflammation.
However, prostaglandins also play a role in protecting the stomach lining. They reduce the amount of acid produced by the stomach, and increase bicarbonate and mucus secretion in the gut. This promotes protection of the lining of the gut and relief of symptoms due to excess acid in the gut. Therefore, the reduction of prostaglandin levels by diclofenac may result in excess gut acid and may damage the gut lining (ulcers).

Misoprostol works by mimicking the action of prostaglandin and so counteracts the adverse effects on the gut, which could be caused by use of diclofenac.

The combination is particularly useful for individuals requiring diclofenac, who also have a special need to prevent the associated adverse effect on the gut.

Who can get it?

This medicine is only suitable for those over the age of 18.

How is it used?

Take 50 mg tablets two to three times daily or 75 mg tablet twice daily, both taken with food.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

• Headache
• Dizziness or loss of balance
• Tiredness
• Blood disorders
• Skin rashes
• Decreased kidney function
• Retention of water in the body tissues (fluid retention)
• Alteration in results of liver function tests
• Vaginal bleeding
• Gastric disturbances including nausea, vomiting, gastric discomfort, constipation, diarrhoea
• Hypersensitivity reactions such as narrowing of the airways (bronchospasm), swelling of the lips, throat and tongue (angioedema) or severe skin reaction (toxic epidermal necrolysis)
• Change in menstrual bleeding

This medicine may cause dizziness and so may affect your ability to drive or operate machinery safely. Do not drive or operate machinery until you know how this medicine affects you and you are sure it won't affect your performance.
This medicine should not be used by pre-menopausal women unless they are using effective contraception.
It is recommended that people taking this medicine for long periods of time have regular blood tests to monitor the levels of the different types of blood cells in the blood.

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Arthrotec is marketed in the UK by Pfizer Ltd

Aspirin belongs to the group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs) and is used for the treatment of Rheumatism, rheumatoid arthritis, prolonged pain.

How does it work?

It works by blocking the action of a substance in the body called cyclo-oxygenase.

Cyclo-oxygenase is involved in the production of various chemicals in the body. These are known as prostaglandins, prostacyclins and thromboxane.

With high doses of aspirin, e.g. 300mg, the blocking of cyclo-oxygenase prevents the production of prostaglandins. Prostaglandins are produced in response to injury or certain diseases and would otherwise go on to cause pain, swelling and inflammation. High doses of aspirin are therefore used to relieve pain and inflammation.

Who can get it?

Children under 16 years of age should not take aspirin, unless on the advice of a doctor. This is because aspirin use in children has been associated with a rare condition called Reye's syndrome. This condition affects the brain and liver and though extremely rare, can be fatal. The causes of Reye's syndrome are not fully understood, but use of aspirin to treat fever in children with a virus has been implicated.

How is it used?

The recommended dose in adults is 300—900 mg three or four times daily; maximum dose is 4 g daily.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

• Nausea
• Blood disorders
• Sensation of ringing, or other noise in the ears (tinnitus)
• Allergic reactions such as skin rash, swelling of the lips, tongue and throat (angioedema) or narrowing of the airways (bronchospasm)
• Increased bleeding time
• Ulceration or bleeding of the stomach or intestines
• Stomach or intestinal discomfort
• Worsening of asthma
• Indigestion (dyspepsia)

Aspirin reduces the rate at which the body can remove the medicine methotrexate. The two should not usually be used together.

There is an increased risk of side effects if aspirin is taken with other non-steroidal anti-inflammatory drugs (NSAIDs), e.g. ibuprofen, diclofenac, indomethacin. For this reason, aspirin should not be taken with any other NSAID. Low-dose aspirin used for anti-blood-clotting purposes is an exception to this, but should only be used with other NSAIDs on the instruction of a doctor.

There may be an increased risk of bleeding or ulceration of the stomach or intestines if aspirin is taken with corticosteroids, e.g. prednisolone, dexamethasone.

There may be an increased risk of side effects if aspirin is taken with acetazolamide.

Antacids (indigestion remedies) should not be taken at the same time as enteric-coated aspirin.

How do I get Aspirin?

Aspirin is available over the counter from your local pharmacy under various names.

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Axorid modified release capsules contain the active ingredient ketoprofen, which is a type of medicine called a non-steroidal anti-inflammatory drug (NSAIDs) and is used to treat pain caused by rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis in patients with a previous history or who are at risk of developing NSAID associated gastric ulcers and duodenal ulcers.

How does it work?

Axorid includes a sustained release form of ketoprofen and a gastroresistant form of omeprazole, both suitable for once daily administration which works by blocking the action of a substance in the body called cyclo-oxygenase (COX). Cyclo-oxygenase is involved in the production of various chemicals in the body, some of which are known as prostaglandins. Prostaglandins are produced by the body in response to injury and certain diseases and conditions, and cause pain, swelling and inflammation. Ketoprofen blocks the production of these prostaglandins and is therefore effective at reducing inflammation and pain.

Ketocid modified release capsules are designed to release the ketoprofen slowly and continuously over several hours. This provides prolonged pain relief, so these capsules are taken once a day. The capsules must be swallowed whole to avoid damaging the modified release action.

Who can get it?

It is available on prescription for adults and children over the age of 15.

How is it used?

Take one tablet daily with or just after food. It is also recommend that a proton pump inhibitor should be also used in patients with rheumatoid arthritis or osteoarthritis

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

• GI intolerance,
• ulcerative stomatitis,
• CNS effects,
• malaise,
• fatigue,
• paraesthesia,
• hypersensitivity reactions,
• nephrotoxicity,
• abnormal liver function,
• neurological and haematological reactions.

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Axorid is marketed in the UK by and is marketed in the UK by Meda Pharmaceuticals Ltd

Brufen contains the active ingredient ibroprofen which is a type of medicine called a non-steroidal anti-inflammatory drug NSAID. Ibuprofen is a simple painkilling medicine used to relieve mild to moderate pain, inflammation and fever. It can relieve symptoms from rheumatoid arthritis, juvenile rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, seronegative arthropathies, peri-articular disorders, soft tissue injuries.

How does it work?

Ibuprofen works by blocking the action of a substance in the body called cyclo-oxygenase (COX). Cyclo-oxygenase is involved in the production of various chemicals in the body, some of which are known as prostaglandins. Prostaglandins are produced in response to injury and certain diseases and conditions, and cause pain, swelling and inflammation. NSAIDs block the production of these prostaglandins and are therefore effective at reducing inflammation and pain.

Ibuprofen also reduces fever by reducing the production of prostaglandins. Fever is associated with an increase in prostaglandins in the brain, and these prostaglandins cause the body temperature to increase. By reducing prostaglandins in the brain, ibuprofen lowers body temperature and hence reduces fever.

Ibuprofen reduces inflammation and related pain and so can be used to relieve muscular and rheumatic aches and pains. It can also be used to relieve other painful conditions such as headaches, migraine, toothache, nerve pain (neuralgia) and period pain. It is also useful for reducing fever, and Brufen syrup can be used for reducing fever in children.

Brufen retard tablets are sustained-release tablets. They are designed to release the ibuprofen slowly and continuously over a few hours to provide prolonged pain relief. These tablets must be swallowed whole to avoid damaging the sustained-release action.

Brufen should preferably be taken with food to avoid irritating the stomach.

Who can get it?

Available on prescription for adults and children (not recommended for children weighing less than 7kg).

How is it used?

Dosage for adults: Take 2 tablets in the early evening. For severe or acute conditions, take 3 tablets daily in two divided doses.

Dosage for children: 20mg/kg of body weight in divided doses or up to 40mg/kg for juvenile RA.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the more common side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

• GI upset or haemorrhage,
• rash,
• thrombocytopenia

Please read the patient information leaflet for further details.

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Ibuprofen is marketed in the UK by Abbott Laboratories Ltd and is known commercially as Brufen and Brufen Retard. Unbranded versions are also available.

Celecoxib helps to reduce inflammation and to reduce pain. Celecoxib works by blocking the production of some of the body chemicals that cause inflammation, pain, stiffness, tenderness, swelling and increased temperature.
By reducing inflammation in conditions affecting muscles and joints Celecoxib helps to improve movement.
Celecoxib can take a few weeks to help improve inflammation but can start to relieve pain after the first few doses.

Who can get it?

Celecoxib is available on prescription although you should speak to your doctor if you:

• are a child
• are a woman who could become pregnant and who is not using an effective method of birth control
• are allergic to any of the ingredients in the medicine
• are breast-feeding
• are elderly
• are pregnant
• are prone to gastrointestinal problems
• are suffering from dehydration
• have had an allergy to any medicine in the past
• have heart problems
• have high blood pressure or other risk factors for heart problems such as high levels of cholesterol, diabetes or smoking
• have inflammatory bowel disease
• have kidney problems
• have liver problems

How is it used?

swallow the medicine whole with a glass of water
this medicine can be taken with or without food. If taken with food, it may delay the effects of Celecoxib by up to an hour

What are the side effects?

In studies the most common reported side effects are:

• diarrhoea
• dizziness
• flatulence
• fluid retention
• indigestion
• oedema of the extremities
• pharyngitis
• rhinitis
• sinusitis
• skin or hypersensitivity reactions
• sleeping problems
• stomach pain
• upper respiratory tract infections

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Celecoxib is known commercially as Celebrex and is marketed in the UK by Pfizer Ltd

Dexibuprofen is for the treatment of pain and inflammation associated with osteoarthritis and other musculoskeletal disorders. It belongs to the group of drugs known as non-steroidal anti inflammatory drugs. (NSAIDS)

How does it work?

Dexibuprofen helps to reduce inflammation and to reduce pain. Dexibuprofen works by blocking the production of some of the body chemicals that cause inflammation, pain, stiffness, tenderness, swelling and increased temperature.
By reducing inflammation in conditions affecting muscles and joints Dexibuprofen helps to improve movement.
Dexibuprofen can take a few weeks to help improve inflammation but can start to relieve pain after the first few doses.

Who can get it?

Dexibuprofen must not be administered in the following cases:

• Patients previously sensitive to dexibuprofen, to any other NSAID, or to any of the excipients of the product.
• Patients in whom substances with a similar action (e.g. aspirin or other NSAIDs) precipitate attacks of asthma, ronchospasm, acute rhinitis, or cause nasal polyps, urticaria or angioneurotic oedema.
• Patients with active or suspected gastrointestinal ulcer or history of recurrent gastrointestinal ulcer.
• Patients who have gastrointestinal bleeding or other active bleedings or bleeding disorders.
• Patients with active Crohn's disease or active ulcerative colitis.
• Patients with severe heart failure.
• Patients with severe renal dysfunction (GFR < 30ml/min).
• Patients with severely impaired hepatic function.
• Patients with haemorrhagic diathesis and other coagulation disorders, or patients receiving anticoagulant therapy.
• From the beginning of 6th month of pregnancy

How is it used?

The normal dose is 300 mg up to three times a day. Your doctor may also prescribe tablets with higher or lower strength.
400 mg tablets may be prescribed in acute situations or during the start of therapy.
200 mg tablets may be used in special patient groups, such as the elderly, or in the treatment of mild to moderate pain.
For the treatment of mild to moderate pain, initially single doses of 200 mg dexibuprofen and daily doses of 600 mg dexibuprofen are recommended.
Do not take more than 1200 mg a day. The maximum single dose is 400 mg.

What are the side effects?

In clinical studies the most common side effects are:
Nausea, vomiting, abdominal pain, skin rash, fatigue or drowsiness, dizziness or giddiness, headache.

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Dexibuprofen is available on prescription and is commercially known as Seractil and is marketed in the UK by Genus Pharmaceuticals.

Dexketoprofen belongs to the group of medicines known as non-steroidal anti-inflammatory drugs (NSAIDs).
Dexketoprofen can be used short-term to relieve mild to moderate pain caused by rheumatic and muscular disorders and period (menstrual) pain.

How does it work?

Dexketoprofen works by preventing the production of irritant chemicals that cause pain and inflammation in the body

Who can get it?

Care should be taken if you have a history of bronchial asthma or allergic disease, SLE, mixed connective tissue disease, cardiac impairment, mild to moderate hepatic impairment, mild renal impairment. Not recommended for children
Care should also be taken if:

• if you are pregnant, trying for a baby or breast-feeding
• if you suffer from liver, kidney or heart problems
• if you suffer from hypertension (high blood pressure) or systemic lupus erythematosus
• if you suffer from rhinitis, asthma or breathing problems
• if you have ever had an unusual reaction from taking aspirin or NSAIDs
• if you get indigestion, heart burn or any other digestive or bowel problems
• if you have ever suffered from peptic (stomach) ulcer
• if you have ever had blood clotting problems
• if you have ever had an allergic reaction to this or any other medicine
• if you are taking any other medicines, including those available to buy without a prescription, herbal and complementary medicines

How is it used?

The recommended dose is 12•5 mg every 4—6 hours. or 25 mg every 8 hours. In acute pain, take 30 minutes before meals; maximum dosage 75 mg daily. (1)

What are the side effects?

In studies the most common reported side effects are:

• GI intolerance
• Headache
• Dizziness
• haematological effects

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Dexketoprofen is known commercially as Keral and is marketed in the UK by A. Menarini Pharma UK SRL.

Diclomax SR capsules and Diclomax Retard capsules contain the active ingredient diclofenac sodium, which is a type of medicine called a non-steroidal anti-inflammatory drug (NSAID). NSAIDs are used to relieve pain and inflammation caused by musculo-skeletal disorders, sprains, strains, back pain, rheumatoid arthritis, osteoarthritis and ankylosing spondylitis.

How does it work?

Diclofenac works by blocking the action of a substance in the body called cyclo-oxygenase (COX). Cyclo-oxygenase is involved in the production of various chemicals in the body, some of which are known as prostaglandins. Prostaglandins are produced by the body in response to injury and certain diseases and conditions, and cause pain, swelling and inflammation. Diclofenac blocks the production of these prostaglandins and is therefore effective at reducing inflammation and pain.

Diclofenac is used to relieve pain and inflammation in a wide range of musculoskeletal conditions, including various forms of arthritis, gout, sprains, fractures, dislocations, back pain, tendonitis, tenosynovitis, bursitis? and frozen shoulder. It is also used to relieve pain and inflammation following dental, orthopaedic (joints/bone) and other minor surgery.

Diclomax SR capsules and Diclomax Retard capsules are sustained-release capsules. They are designed to release the diclofenac slowly and continuously over a few hours. This provides prolonged pain relief, so the capsules are usually taken once (Retard) or twice (SR) a day. These capsules must be swallowed whole to avoid damaging the sustained-release action.

Both types of capsule should preferably be taken with food to help avoid irritating the stomach.

Who can get it?

Available on prescription for those over the age of 18.

How is Diclomax taken?

Diclomax SR

Adults: The normal dose is one or two 75mg capsules daily with or after food.
Children: Diclomax SR is not recommended for children.

Diclomax Retard

Adults: The normal dose is one capsule daily with or after food.
Children: Diclomax Retard is not recommended for children.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with NSAIDs. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

• Disturbances of the gut such as diarrhoea, constipation, nausea, vomiting or abdominal pain
• Indigestion (dyspepsia)
• Excess gas in the stomach and intestines (flatulence)
• Loss of appetite
• Headache
• Dizziness
• Balance disorders involving the inner ear (vertigo)
• Skin rashes
• Ulceration of the stomach or intestine
• Bleeding from the stomach or intestine
• Allergic reactions such as skin rashes, swelling of the lips, tongue and throat (angioedema) or narrowing of the airways (bronchospasm)
• Drowsiness
• Fluid retention (oedema)
• Kidney, liver or blood disorders

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Diclomax is marketed in the UK by Galen Ltd.

Difflam contains the active ingredient benzydamine hydrochoride which belongs to the group of medicines known as non-steroidal anti-inflammatory drug (NSAID). It is used to treat pain caused by backache, rheumatic and muscular pain, sprains, strains, and neuralgia.

How does it work?

Benzydamine works by preventing the formation of prostaglandins. Prostaglandins are produced by the body and are responsible for inflammation features, such as swelling, pain, stiffness, redness and warmth.
 
Benzydamine also acts as a local anaesthetic, causing numbness and so pain relief at the site of application.

Who can get it?

Available for both adults and children from a pharmacy.

How is it used?

1-2 g of difflam should be massaged in lightly three times daily.  In severe cases up to six times daily.  The cream should not be used for more than 10 days

What are the side effects?

Like all medicines Difflam Cream can cause side effects, although not everybody will get them.  

You may experience any of the following
•    Itching
•    Skin rash
•    Skin redness or swelling
•    Difficulty breathing and wheezing
Some people become more sensitive to the effects of sunlight after using this cream.  This means that the skin may become red and painful after only a few minutes in the sun.  These side effects should disappear if you stop using the cream.

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Difflam is marketed in the UK by Meda

Eccoxolac contains the active ingredient etodolac which is a type of medicine known as a non-steroidal anti-inflammatory drug (NSAID) used to relieve pain and inflammation as seen in rheumatoid arthritis and osteoarthritis.

How does it work?

NSAIDs work by blocking the action of a substance in the body called cyclo-oxygenase. Cyclo-oxygenase is involved in producing prostaglandins, in response to injury or certain diseases. These prostaglandins cause pain, swelling and inflammation. Because NSAIDs block the production of these prostaglandins, they are effective at relieving pain and inflammation.

Cyclo-oxygenase does not only produce prostaglandins that cause inflammation. It also produces prostaglandins that have useful roles in the body. There are two different forms of cyclo-oxygenase, COX-1 and COX-2. COX-2 is the form that (among other things) produces prostaglandins that cause inflammation. COX-1 does not produce inflammatory prostaglandins, but does produce others that have useful effects, including some that are involved in maintaining a healthy stomach and intestinal lining.

Traditional NSAIDs, such as ibuprofen or diclofenac, block the action of both COX-1 and COX-2, and this is why they can sometimes cause side effects such as stomach irritation and peptic ulcers. Etodolac belongs to a new generation of NSAIDs that selectively block the action of COX-2. This means that it stops the production of inflammatory prostaglandins, without stopping the production of prostaglandins that protect the stomach and intestines. It therefore reduces pain and inflammation, but is less likely than traditional NSAIDs to cause side effects on the stomach and intestines (although such side effects are still possible).

Etodolac is used to relieve the pain of osteoarthritis and rheumatoid arthritis, which is caused by inflammation of the joints.

Who can get it?

This medicine is available on prescription for adults. Not recommended for children.

How is it used?

400-600 mg daily in two divided doses or as a single daily dose.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

• Epigastric pain,
• GI upset or bleeding,
• headache,
• dizziness,
• tinnitus,
• rash,
• angioedema.

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Eccoxolac  is marketed in the UK by Meda Pharmaceuticals Ltd.

Felbinac is a type of medicine known as a non-steroidal anti-inflammatory drug (NSAID) used for the treatment of rheumatic and mild arthritic pain, sprains, strains and other soft tissue injuries

How does it work?

It works by blocking the production of a chemical (prostaglandin) which the body produces in response to injury or certain diseases. This prostaglandin would otherwise go on to cause swelling, pain and inflammation.

All the medicines in this group reduce inflammation caused by the body's own immune system and are effective pain killers.

Felbinac is applied to the skin surface (topically) for the relief of local pain and inflammation. It is used in many muscular and joint conditions such as in sprains, strains, rheumatism, and mild arthritic conditions.

The gel form of this medicine may be used in ultrasound as a coupling agent.

Who can get it?

Available on prescription for those over the age of 18.

How is it used?

Gently rub 1 g of gel or golf ball sized quantity of foam into affected area 2—4 times daily; maximum 25 g daily.
You should not cover the area being treated with airtight dressings such as bandages or other dressings, including nappies, as these will enhance the absorption of the medicine into the body and may increase the risk of adverse effects.
Avoid contact of this medicine with the eyes and the moist membranes lining the inside of certain parts of the body, e.g. mouth, nasal passages (mucous membranes). Rinse with cold water if accidental contact occurs.
Wash your hands thoroughly after applying this medicine, unless the hands are the area being treated.
The foam preparation is inflammable. Keep away from naked flames.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

• Mild local erythema,
• dermatitis,
• pruritus,
• paraesthesia

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Felbinac is marketed in the UK by Goldshield Pharmaceuticals Ltd and is known commercially as Traxam.

Feldene contains the active ingredient piroxicam, which is a type of medicine called a non-steroidal anti-inflammatory drug (NSAID). NSAIDs are used to relieve pain and inflammation as seen in rheumatoid arthritis and osteoarthritis.

How does it work?

Piroxicam works by blocking the action of a substance in the body called cyclo-oxygenase (COX). Cyclo-oxygenase is involved in the production of various chemicals in the body, some of which are known as prostaglandins. Prostaglandins are produced by the body in response to injury and certain diseases and conditions, and cause pain, swelling and inflammation. Piroxicam blocks the production of these prostaglandins and is therefore effective at reducing inflammation and pain.
Piroxicam is used to relieve pain and inflammation in a wide range of musculoskeletal conditions, including various forms of arthritis, gout and muscle sprains and strains. It is also used to relieve pain and inflammation following orthopaedic (bone), dental and other minor surgery.

Piroxicam has a prolonged duration of action which means that one dose can provide pain relief throughout the day. You should try and take your dose at the same time each day.
Feldene capsules should be swallowed with a drink. Feldene dispersible tablets are designed to be dissolved in water before taking, but can also be swallowed whole with a drink. Feldene melt tablets are designed to dissolve quickly on the tongue and be swallowed with your saliva. These are convenient to take if you don't have a drink handy. They can also be swallowed whole with a drink. All these dose forms should preferably be taken with food to help reduce irritation to the stomach.
Feldene injection may be given for the initial relief of pain, but you will be switched onto oral treatment as soon as possible. The injection is given into the muscle of the buttock.

Who can get it?

This medicine is available on prescription for adults.

How is it used?

20mg each day. This dose may be decreased to 10mg each day (especially for elderly patients) or increased to 30mg each day. See the label on the pack to find out what dose you should take.
As your medicine helps to relieve the painful symptoms of arthritis it is usual for it to be taken for long periods of time. (Doses above 20mg daily for more than several days carry an increased risk of effects on the digestive system).

What are the side effects?

Effects on digestive system including:

• diarrhoea or constipation, wind.
• nausea, vomiting, loss of appetite.
• sore mouth and/or lips.
• stomach ache, indigestion, abdominal pain/discomfort.
• stomach (peptic) ulcers.

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Feldene is marketed in the UK by Pfizer Ltd.

Fenbid Gel contains the active ingredient ibuprofen which belongs to the group of medicines known as non-steroidal anti-inflammatory drug (NSAID). It is used to treat pain caused by backache, rheumatic and muscular pain, sprains, strains, and neuralgia.

How does it work?

Ibuprofen works by blocking the action of a substance in the body called cyclo-oxygenase (COX). Cyclo-oxygenase is involved in the production of various chemicals in the body, some of which are known as prostaglandins. Prostaglandins are produced in response to injury and certain diseases and conditions, and cause pain, swelling and inflammation. NSAIDs block the production of these prostaglandins and are therefore effective at reducing inflammation and pain.

When ibuprofen is applied to the skin (topical application) it is absorbed through the skin into the underlying tissues, where it reduces pain and inflammation in the local area.

Fenbid gel and Fenbid forte gel can be used to relieve the pain of muscular and joint conditions such as sprains, strains, backache, rheumatism and minor arthritic conditions. They should be massaged gently into the affected area.

Ibuprofen is absorbed less into the bloodstream from preparations that are applied to the skin than from preparations that are taken by mouth (see end of factsheet), however absorption can still occur, particularly if large amounts are used on large areas.

Who can get it?

Available over the counter from most good chemists for adults and children over the age of 14.

How is it used?

For topical application over the affected area.
Massage in three to four times each day.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

• Skin rashes
• Abdominal pain
• Indigestion (dyspepsia)
• Allergic reactions such as asthma, narrowing of the airways (bronchospasm), swelling of the lips, throat and tongue (angioedema), itchy blistering rash or anaphylactic shock

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Fenbid Gel is marketed in the UK by Goldshield Pharmaceuticals Ltd

Fenbid contains the active ingredient ibroprofen which is a type of medicine called a non-steroidal anti-inflammatory drug (NSAID). Ibuprofen is a simple painkilling medicine used to relieve mild to moderate pain, inflammation and fever. It can relieve symptoms from rheumatoid arthritis, juvenile rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, seronegative arthropathies, peri-articular disorders, soft tissue injuries.

How does it work?

Ibuprofen works by blocking the action of a substance in the body called cyclo-oxygenase (COX). Cyclo-oxygenase is involved in the production of various chemicals in the body, some of which are known as prostaglandins. Prostaglandins are produced in response to injury and certain diseases and conditions, and cause pain, swelling and inflammation. NSAIDs block the production of these prostaglandins and are therefore effective at reducing inflammation and pain.

Ibuprofen also reduces fever by reducing the production of prostaglandins. Fever is associated with an increase in prostaglandins in the brain, and these prostaglandins cause the body temperature to increase. By reducing prostaglandins in the brain, ibuprofen lowers body temperature and hence reduces fever.

Ibuprofen reduces inflammation and related pain and so can be used to relieve muscular and rheumatic aches and pains. It can also be used to relieve other painful conditions such as headaches, migraine, toothache, nerve pain (neuralgia) and period pain. It is also useful for reducing fever.

Fenbid spansules are sustained-release capsules. They are designed to release the ibuprofen slowly and continuously over a few hours to provide prolonged pain relief. These capsules must be swallowed whole to avoid damaging the sustained-release action.

Who can get it?

Available on prescription for adults.

How is it used?

Initially take 2 tablets twice daily increasing to 3 tablets twice daily if necessary

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

• GI upset or haemorrhage,
• rash,
• thrombocytopenia

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Fenbid is marketed in the UK by Goldshield Pharmaceuticals Ltd

Fenoprofen is a type of medicine called a non-steroidal anti-inflammatory drug (NSAID). NSAIDs are used to relieve pain and inflammation. Fenoprofen is used to relieve mild to moderate pain in conditions such as rheumatoid arthritis, osteoarthritis, ankylosing spondylitis.

How does it work?

It works by blocking the production of a chemical (prostaglandin) which the body produces in response to injury or certain diseases. This prostaglandin would otherwise go on to cause swelling, pain and inflammation pain.

Who can get it?

Available on prescription for those over the age of 18.

How is it used?

300—600 mg three or four times daily with a maximum of 3 g daily
Take this medication with or after food

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

• GI intolerance,
• allergies,
• hepatic and renal disorders,
• blood dyscrasias

Fenoprofen may enhance the effect of the following medicines, resulting in an increased risk of side-effects or toxicity: baclofen, ciclosporin, digoxin, lithium, methotrexate, phenytoin, quinolone antibiotics, zidovudine and blood-thinning or anti-clotting medicines.

Fenoprofen may also enhance the effect of antidiabetic tablets (belonging to the sulphonylurea group), which could lead to low blood sugar levels.

The effect of fenoprofen may be enhanced by the following medicines, resulting in an increased risk of side-effects or toxicity: moclobemide, oxpentifylline, probenecid, ritonavir and steroids.

The effect of water tablets (diuretics) and blood pressure lowering agents may be reduced by fenoprofen, resulting in their being less effective.

Use of fenoprofen with diuretics or ACE inhibitors may increase the risk of kidney problems and/or an altered potassium balance.

NSAIDs should not be used within 8-12 days of taking mifepristone.

Fenoprofen should not be taken with another NSAID.

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Fenoprofen is marketed in the UK by Typharm Ltd and is known commercially as Fenopron

Flurbiprofen belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs) and is used to treat pain caused by rheumatoid disease, osteoarthritis, ankylosing spondylitis, acute musculoskeletal disorders.

How does it work?

It works by blocking the production of a chemical (prostaglandin) which the body produces in response to injury or certain diseases. This prostaglandin would otherwise go on to cause swelling, pain and inflammation pain.

Who can get it?

Available on prescription for those over the age of 18.

How is it used?

1 slow release tablet to be taken daily preferably in the evening after food

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the common side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

• GI upset,
• rash,
• rarely jaundice,
• thrombocytopenia

Flurbiprofen may enhance the effect of the following medicines, resulting in an increased risk of side-effects or toxicity: baclofen, ciclosporin, lithium, methotrexate, phenytoin, quinolone antibiotics, zidovudine and blood-thinning or anti-clotting medicines.

Flurbiprofen may also enhance the effect of antidiabetic tablets (belonging to the sulphonylurea group), which could lead to low blood sugar levels.

The effect of flurbiprofen may be enhanced by the following medicines, resulting in an increased risk of side-effects or toxicity: moclobemide, oxpentifylline, probenecid, ritonavir and steroids.

The effect of water tablets (diuretics) and blood pressure lowering agents may be reduced by flurbiprofen, resulting in their being less effective.

Use of flurbiprofen with diuretics or ACE inhibitors may increase the risk of kidney problems and/or an altered potassium balance.

NSAIDs should not be used within 8-12 days of taking mifepristone.

Flurbiprofen should not be taken with another NSAID.

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Flurbiprofen is marketed in the UK by Abbott Laboratories Ltd and is known commercially as Froben SR

Ibugel contains the active ingredient ibuprofen which belongs to the group of medicines known as non-steroidal anti-inflammatory drug (NSAID). It is used to treat pain caused by backache, rheumatic and muscular pain, sprains, strains, and neuralgia.

How does it work?

Ibuprofen works by blocking the action of a substance in the body called cyclo-oxygenase (COX). Cyclo-oxygenase is involved in the production of various chemicals in the body, some of which are known as prostaglandins. Prostaglandins are produced in response to injury and certain diseases and conditions, and cause pain, swelling and inflammation. NSAIDs block the production of these prostaglandins and are therefore effective at reducing inflammation and pain.

When ibuprofen is applied to the skin (topical application) it is absorbed through the skin into the underlying tissues, where it reduces pain and inflammation in the local area. Ibugel and Ibugel forte are aqueous/alcoholic gels, which also has an immediate cooling and soothing effect when applied to the affected area.

Ibugel can be used to relieve the pain of muscular and joint conditions such as sprains, strains, backache, rheumatism and minor arthritic conditions. It should be massaged gently into the affected area.

Ibuprofen is absorbed less into the bloodstream from preparations that are applied to the skin than from preparations that are taken by mouth however absorption can still occur, particularly if large amounts are used on large areas

Who can get it?

Ibugel is available in two strengths. 5% and 10%. The 5% strength can be bought over the counter or prescribed on NHS prescription whereas the stronger preparation can only be supplied on prescription.

How is it used?

For topical application over the affected joints.
Massage in three times each day.

What are the side effects?

None, However it should not be used in the following circumstances

• Broken, damaged, infected or diseased skin
• People in whom aspirin or other medicines in this class (NSAIDs), cause attacks of asthma, itchy rash (urticaria) or nasal inflammation (rhinitis)

Ibugel and Ibugel forte are not recommended for children under 12 years of age unless instructed by a doctor.
This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.

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Ibugel is marketed in the UK by Dermal Laboratories Ltd.

Ibumousse contains the active ingredient ibuprofen which belongs to the group of medicines known as non-steroidal anti-inflammatory drug NSAID). It is used to treat pain caused by backache, rheumatic and muscular pain, sprains, strains, and neuralgia.

How does it work?

Ibuprofen works by blocking the action of a substance in the body called cyclo-oxygenase (COX). Cyclo-oxygenase is involved in the production of various chemicals in the body, some of which are known as prostaglandins. Prostaglandins are produced in response to injury and certain diseases and conditions, and cause pain, swelling and inflammation. Ibuprofen blocks the production of these prostaglandins and is therefore effective at reducing inflammation and pain.

When ibuprofen is applied to the skin (topical application) it is absorbed through the skin into the underlying tissues, where it reduces pain and inflammation in the local area.

Ibumousse can be used to relieve the pain of muscular and joint conditions such as sprains, strains, backache, rheumatism and minor arthritic conditions. It should be massaged gently into the affected area.

Ibuprofen is absorbed less into the bloodstream from preparations that are applied to the skin than from preparations that are taken by mouth however absorption can still occur, particularly if large amounts are used on large areas.

Who can get it?

Ibumousse is available on NHS prescription and can be bought over the counter from most good chemists for adults.
Not suitable for children

How is it used?

For topical application over the affected area.
Massage in three to four times each day.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

•  Skin rashes
•  Abdominal pain
•  Indigestion (dyspepsia)
•  Allergic reactions such as asthma, narrowing of the airways (bronchospasm), swelling of the lips, throat and tongue (angioedema), itchy blistering rash or anaphylactic shock

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Ibumousse is marketed in the UK by Dermal Laboratories Ltd.

Ibuspray contains the active ingredient ibuprofen which belongs to the group of medicines known as non-steroidal anti-inflammatory drug (NSAID). It is used to treat pain caused by backache, rheumatic and muscular pain, sprains, strains, and neuralgia.

How does it work?

Ibuprofen works by blocking the action of a substance in the body called cyclo-oxygenase (COX). Cyclo-oxygenase is involved in the production of various chemicals in the body, some of which are known as prostaglandins. Prostaglandins are produced in response to injury and certain diseases and conditions, and cause pain, swelling and inflammation. Ibuprofen blocks the production of these prostaglandins and is therefore effective at reducing inflammation and pain.

When ibuprofen is applied to the skin (topical application) it is absorbed through the skin into the underlying tissues, where it reduces pain and inflammation in the local area.

Ibuspray can be used to relieve the pain of muscular and joint conditions such as sprains, strains, backache, rheumatism and minor arthritic conditions. It should be massaged gently into the affected area.

Ibuprofen is absorbed less into the bloodstream from preparations that are applied to the skin than from preparations that are taken by mouth, however absorption can still occur, particularly if large amounts are used on large areas.

Who can get it?

Ibuspray is available on NHS prescription and can be bought over the counter from most good chemists for adults.
Not suitable for children

How is it used?

For topical application over the affected joint.
5—10 sprays to affected area 3 to 4 times daily.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

• Skin rashes
• Abdominal pain
• Indigestion (dyspepsia)
• Allergic reactions such as asthma, narrowing of the airways (bronchospasm), swelling of the lips, throat and tongue (angioedema), itchy blistering rash or anaphylactic shock

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Ibuspray is marketed in the UK by Dermal Laboratories Ltd.

Lodine SR contains the active ingredient etodolac which is a type of medicine known as a non-steroidal anti-inflammatory drug (NSAID) used to relieve pain and inflammation as seen in rheumatoid arthritis and osteoarthritis.

How does it work?

NSAIDs work by blocking the action of a substance in the body called cyclo-oxygenase. Cyclo-oxygenase is involved in producing prostaglandins, in response to injury or certain diseases. These prostaglandins cause pain, swelling and inflammation. Because NSAIDs block the production of these prostaglandins, they are effective at relieving pain and inflammation.

Cyclo-oxygenase does not only produce prostaglandins that cause inflammation. It also produces prostaglandins that have useful roles in the body. There are two different forms of cyclo-oxygenase, COX-1 and COX-2. COX-2 is the form that (among other things) produces prostaglandins that cause inflammation. COX-1 does not produce inflammatory prostaglandins, but does produce others that have useful effects, including some that are involved in maintaining a healthy stomach and intestinal lining.

Traditional NSAIDs, such as ibuprofen or diclofenac, block the action of both COX-1 and COX-2, and this is why they can sometimes cause side effects such as stomach irritation and peptic ulcers. Etodolac belongs to a new generation of NSAIDs that selectively block the action of COX-2. This means that it stops the production of inflammatory prostaglandins, without stopping the production of prostaglandins that protect the stomach and intestines. It therefore reduces pain and inflammation, but is less likely than traditional NSAIDs to cause side effects on the stomach and intestines (although such side effects are still possible).

Etodolac is used to relieve the pain of osteoarthritis and rheumatoid arthritis, which is caused by inflammation of the joints.

Who can get it?

This medicine is available on prescription for adults. Not recommended for children.

How is it used?

400-600 mg daily in two divided doses or as a single daily dose.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

• Epigastric pain,
• GI upset or bleeding,
• headache,
• dizziness,
• tinnitus,
• rash,
• angioedema.

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Lodine SR is marketed in the UK by Almirall Ltd

Mefenamic acid is a type of medicine called a non-steroidal anti-inflammatory drug (NSAID) used to treat mild to moderate pain caused by rheumatoid arthritis and osteoarthritis.

How does it work?

Mefenamic acid works by blocking the action of a substance in the body called cyclo-oxygenase (COX). Cyclo-oxygenase is involved in the production of various chemicals in the body, some of which are known as prostaglandins. Prostaglandins are produced by the body in response to injury and certain diseases and conditions, and cause pain, swelling and inflammation. Mefenamic acid blocks the production of these prostaglandins and is therefore effective at reducing inflammation and pain.

Mefenamic acid may also work by preventing the action of prostaglandins after they have already been formed.

Mefenamic acid is used to relieve pain and inflammation in a wide range of musculoskeletal conditions, including rheumatoid arthritis, muscular pain and traumatic pain such as sprains, fractures and dislocations.

Who can get it?

Available on prescription for adults.

How is it used?

The usual adult dose is 500 mg three times daily

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

• GI intolerance,
• skin rash (discontinue).
• Renal impairment,
• allergic glomerulonephritis.
• Blood dyscrasias (rare).
• Raised liver enzymes.

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Mefenamic acid is known commercially as Ponstan Capsules and Ponstan forte Tablets and is marketed in the UK by Chemidex Pharma Ltd.

Motifene contains the active ingredient diclofenac. Diclofenac is a NSAID/analgesic (painkiller) and can be used for the treatment of pain and inflammation due to:

Acute attacks of gout, acute musculo-skeletal disorders, dental or other minor surgery, joint disorders, traumatic conditions and lower back pain.

How does it work?

Diclofenac works by blocking the action of a substance in the body called cyclo-oxygenase (COX). Cyclo-oxygenase is involved in the production of various chemicals in the body, some of which are known as prostaglandins. Prostaglandins are produced by the body in response to injury and certain diseases and conditions, and cause pain, swelling and inflammation. Diclofenac blocks the production of these prostaglandins and is therefore effective at reducing inflammation and pain.
Motifene capsules contain 25mg of diclofenac as enteric-coated pellets and 50mg of diclofenac as sustained-release pellets. Some of the pellets contained in the capsule release diclofenac quickly to give a rapid effect. The remainder of the pellets dissolve more slowly to produce a longer lasting effect.
The enteric-coated pellets have a special coat that is designed to prevent the absorption of the diclofenac in the stomach, and thus reduce the risk of stomach irritation. When the capsule reaches the intestine, these pellets dissolve and the diclofenac is absorbed into the bloodstream. This provides the initial pain relief.

The sustained-release pellets are designed to release their diclofenac slowly and continuously over a few hours. This provides more prolonged pain relief. The capsules are usually taken once a day. They must be swallowed whole to avoid damaging the pellets.

Who can get it?

Available on prescription for those over the age of 18.

How is it used?

Take 1 capsule daily in the morning before food. Increase if necessary to 1 twice daily taken at 8—12 hourly intervals

What are the side effects?

The most common side effects are related to the gut: stomach ulcer or duodenal ulcer, bleeding from the stomach or intestines (eg passing tarry stools) vomiting blood or dark particles that look like coffee grounds, stomach pa8in, indigestion, heartburn, sickness, feeling sick, flatulence, diarrhoea, constipation, worsening of Crohn’s disease or of ulcerative colitis.

Allergic reactions (such as difficulty breathing, swelling of the face, mouth and/or larynx (voice box), rashes, itching) have been reported.
Swelling of the feet or ankles has also been reported.

Other less common side effects include kidney problems, urinary problems (eg any change in the usual amount or colour of the urine), liver problems, jaundice (yellowing of the skin or whites of the eyes) blurred vision, double vision, headache, pins and needles, stiff neck, depression, confusion, hallucinations, tinnitus (ringing in the ears), dizziness or giddiness, feeling unwell, tiredness, sleepiness, sensitivity to light, rashes and spots, changes in blood test results.

If you experience any of the above tell your doctor.

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Motifene is marketed in the UK by Daiichi Sankyo UK Ltd.

Nabumetone is a non acidic non steroidal anti inflammatory agent which is a relatively weak inhibtor of prostaglandin synthesis which is used in osteoarthritis and rheumatoid arthritis

How does it work?

Nabumetone helps to reduce inflammation and to reduce pain. Nabumetone works by blocking the production of some of the body chemicals that cause inflammation, pain, stiffness, tenderness, swelling and increased temperature.
By reducing inflammation in conditions affecting muscles and joints Nabumetone helps to improve movement.
Nabumetone can take a few weeks to help improve inflammation but can start to relieve pain after the first few doses.

How is it used?

The usual dose of nabumetone is 1 g once a day taken preferably at bedtime with or just after food. The dose may be increased by 500 mg – 1 g a day depending on your symptoms.

What are the side effects?

The most common side effects reported are

• Dry mouth
• Faecal occult blood
• Diarrhoea
• Dyspepsia
• Nausea
• Constipation
• Abdominal pain
• Rash

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Nabumetone is known commercially as Relifex and is marketed in the UK by Meda Pharmaceuticals Ltd

Napratec contains the active ingredients naproxen which belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs) in one tablet plus a Cytotec tablet containing Misoprostol, a synthetic prostaglandin used to prevent gastric effects of the naproxen. Napratec is used for the treatment of acute osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.

How does it work?

It works by blocking the production of a group of chemical (prostaglandins) which the body produces in response to injury or certain diseases. These prostaglandins would otherwise go on to cause swelling, pain and inflammation.

Since prostaglandins also have a role in protecting the stomach lining, a reduction in prostaglandin levels sometimes causes gastric irritation or ulceration.

Misoprostol is a synthetic prostaglandin E1 analogue. It protects the lining of the stomach by mimicking the action of the naturally-occurring prostaglandins. Prostaglandins influence several factors involved in protection of the stomach lining. Misoprostol is used to promote peptic ulcer healing and relief of symptoms.

Misoprostol is added to the naproxen in this medicine to prevent the formation of ulcers caused by the effects of the naproxen.

Who can get it?

Available on prescription for adults.

How is it used?

You should normally take one Cytotec tablet and one naproxen tablet at the same time, twice a day with food.
Each wallet contains one week's supply of tablets. The wallet is divided into morning and evening doses and marked with the days of the week to help you remember how to take them.

What are the side effects?

All medicines can sometimes cause problems. You may get some of the following effects.

• The most common side effects are feeling or being sick, stomach pain, indigestion. Sometimes this can be a sign of an ulcer. This is unlikely to happen with Napratec. Occasionally you can get an inflammation of the bowel (symptoms may include cramp, bloating and possible diarrhoea). See your doctor if you get any of these problems for the first time.
• The Cytotec in Napratec can also cause stomach upsets and wind. Diarrhoea is the most common problem and is usually mild. You have less chance of getting diarrhoea if you take Napratec with food. If you use an antacid (something to reduce acid in the stomach) you should avoid antacids with magnesium in them as these may make diarrhoea worse. Your pharmacist can help you choose a suitable antacid. If this diarrhoea continues and causes you trouble, tell your doctor.
• Some people get skin rashes or other effects on the skin such as an increased sensitivity to sunlight, tingling and prickling feeling or bruising. If you get a rash or other skin reaction contact your doctor. Some people may get respiratory tract reactions such as asthma, bronchospasm or difficulty breathing. There have also been cases of hair loss or thinning in people taking naproxen.
• Some people also occasionally get disorders of the blood. You can become anaemic, or have problems with some types of blood cells called 'platelets' or 'granulocytes'. These problems can be picked up with blood tests.
• The Cytotec tablets occasionally can cause women to have problems with their periods. This can mean they may have heavy bleeding or bleeding between periods. Some women may have vaginal bleeding even though they have gone through the menopause.
• Some people get headaches, fatigue, drowsiness, confusion, depression, hallucinations, have trouble sleeping or concentrating or performing mental tasks.
• Some people get kidney or liver problems (these show up in their blood tests) although these are rarely serious, they can be fatal.
• Some people get dizzy or have balance problems. They may have ringing in the ears or other hearing problems. You may get swelling of the feet, ankles or hands. Very occasionally you may have problems with your sight (for example blurred vision), or with your kidneys, including passing urine with blood in it.
• Some people may develop an allergic reaction in their lungs and develop wheezing or breathlessness.
• You could also get inflammation of your blood vessels resulting in swelling of the face and/or throat, a sore mouth, mouth ulcers or meningitis (symptoms which may include neck stiffness, dislike of bright lights and a rash). These problems are rare.

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Napratec is marketed in the UK by Pfizer Ltd.

Naprosyn contains the active ingredient naproxen, which belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs) used for the treatment of acute osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.

How does it work?

Naproxen works by blocking the action of a substance in the body called cyclo-oxygenase (COX). Cyclo-oxygenase is involved in the production of various chemicals in the body, some of which are known as prostaglandins. Prostaglandins are produced by the body in response to injury and certain diseases and conditions, and cause pain, swelling and inflammation. Naproxen blocks the production of these prostaglandins and is therefore effective at reducing inflammation and pain.

Naproxen is used to relieve pain and inflammation in a wide range of musculoskeletal conditions, including various forms of arthritis, gout, muscle sprains and strains, back pain, neck pain and tendinitis. It can also be used to relieve period pain.

Naprosyn EC tablets have a special 'enteric coat' that is designed to prevent the tablet breaking down and releasing the naproxen in the stomach, and thus reduce the risk of it irritating the stomach. When the tablet reaches the intestine, the coating dissolves and the naproxen is absorbed into the bloodstream. The tablets should be swallowed whole and not broken or chewed to avoid damaging this coating.

Who can get it?

Available on prescription for adults and children over the age of 16 years.

How is it used?

For rheumatoid arthritis, osteoarthritis or ankylosing spondylitis

Take between 500mg and 1g each day in two separate doses, 12 hours apart. Where 1g per day is needed, you can take 500mg twice each day, or 1g in one single dose (morning or evening).

In some people, a larger dose of between 750mg and 1g per day may be taken to start with to control the pain. This is in patients with:

- severe night-time pain and/or morning stiffness.
- if your tablets have recently been changed from a high dose of another treatment for pain.
- osteoarthritis where pain is your main problem.

What are the side effects?

All medicines can sometimes cause problems. You may get some of the following effects.

• Rash,
• GI intolerance,
• headache,
• tinnitus,
• vertigo,
• blood dyscrasias,
• renal impairment,
• cardiovascular disorders

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Naproxen is known commercially as Naprosyn is marketed in the UK by Roche Products Ltd

Orudis capsules and suppositories contain the active ingredient ketoprofen, which is a type of medicine called a non-steroidal anti-inflammatory drug (NSAID) and is used to treat pain caused by rheumatoid arthritis, osteoarthrosis, and ankylosing spondylitis.

How does it work?

Ketoprofen works by blocking the action of a substance in the body called cyclo-oxygenase (COX). Cyclo-oxygenase is involved in the production of various chemicals in the body, some of which are known as prostaglandins. Prostaglandins are produced by the body in response to injury and certain diseases and conditions, and cause pain, swelling and inflammation. Ketoprofen blocks the production of these prostaglandins and is therefore effective at reducing inflammation and pain.

Ketoprofen is used to relieve pain and inflammation in a wide range of musculoskeletal conditions, including various forms of arthritis, gout, muscle sprains and strains, back pain, neck pain and tendinitis. It can also be used to relieve period pain.

Who can get it?

Available on prescription for adults.

How is it used?

The recommended dose in adults is 50—100 mg twice daily.
Orudis capsules should be taken with or after food to help avoid irritating the stomach.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

• GI intolerance,
• ulcerative stomatitis,
• CNS effects,
• malaise,
• fatigue,
• paraesthesia,
• hypersensitivity reactions,
• nephrotoxicity,
• abnormal liver function,
• neurological and haematological reactions.

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Ketoprofen is known commercially as Orudis and is marketed in the UK by Sanofi Aventis

Oruvail controlled release capsules and Oruvail injection contain the active ingredient ketoprofen, which is a type of medicine called a non-steroidal anti-inflammatory drug (NSAID) and is used to treat pain caused by rheumatoid arthritis, osteoarthrosis, and ankylosing spondylitis.

How does it work?

Ketoprofen works by blocking the action of a substance in the body called cyclo-oxygenase (COX). Cyclo-oxygenase is involved in the production of various chemicals in the body, some of which are known as prostaglandins. Prostaglandins are produced by the body in response to injury and certain diseases and conditions, and cause pain, swelling and inflammation. Ketoprofen blocks the production of these prostaglandins and is therefore effective at reducing inflammation and pain.
Ketoprofen is used to relieve pain and inflammation in a wide range of musculoskeletal conditions, including various forms of arthritis, gout, muscle sprains and strains, back pain, neck pain and tendinitis. It can also be used to relieve period pain.
Oruvail injection may be given for the initial relief of acute musculoskeletal pain, but you will be switched onto oral treatment as soon as possible, preferably within three days. The injection is given into the muscle of the buttock.

Oruvail capsules are controlled release capsules. They are designed to release the ketoprofen slowly and continuously over several hours. This provides prolonged pain relief, so these capsules are taken once a day. The capsules must be swallowed whole to avoid damaging the controlled release action. Oruvail capsules should preferably be taken with food to help avoid irritating the stomach.

Who can get it?

Available on prescription for adults.

How is it used?

The usual adult dose is 1 to 2ml by injection into the muscle. This maybe repeated every 4 hours up to a maximum of 4ml in 24 hours. Treatment by injection is not normally continued for longer than 3 days. Elderly patients will normally be given the lowest effective dose.

Treatment by injection will usually be followed by a course of Oruvail capsules taken by mouth

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

•Wheezing or tightness of the chest
•Faintness

• Skin rash
• Sensitivity to sunlight
• Swollen ankles
• Bad stomach pains
• Vomiting blood or dark coffee coloured granules
• Passing dark tarry bowel motions
• Bruising on your body
• Yellowing of the skin, aching limbs
• Reduced urine levels, low pack pain

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Ketoprofen is known commercially as Oruvail and is marketed in the UK by Sanofi Aventis

Pennsaid belongs to the group of medicines known as non-steroidal anti-inflammatory drugs (NSAIDs) and is made up from the active ingredient of Diclofenac. It is used for the relief of pain associated with osteoarthritis of superficial joints.

How does it work?

Diclofenac works by blocking the action of a substance in the body called cyclo-oxygenase (COX). Cyclo-oxygenase is involved in the production of various chemicals in the body, some of which are known as prostaglandins. Prostaglandins are produced by the body in response to injury and certain diseases and conditions, and cause pain, swelling and inflammation. Diclofenac blocks the production of these prostaglandins and is therefore effective at reducing inflammation and pain.

When diclofenac is applied to the skin (topical application) it is absorbed through the skin into the underlying tissues, where it reduces pain and inflammation in the local area.

Pennsaid solution is used to relieve pain associated with osteoarthritis in superficial joints, such as the wrist or knee. There is no data on the use of Pennsaid for large, deep joints covered by layers of muscle or other soft tissues, such as the hip or spine.

Who can get it?

Available on prescription for those over the age of 18.

How is it used?

Apply 20—40 drops, depending on size of joint, in stages without rubbing in, repeat four times daily. The skin over the painful joint should be washed and dried before applying 20 – 40 drops of the solution. It should then be applied to the skin and spread evenly over the joint. The diclofenac will be absorbed into the underlying tissues of the joint where it will relieve pain.

What are the side effects?

Dry skin at application site, rash, possible systemic side effects if applied to large areas for prolonged periods. This medicine may cause dizziness and so may affect your ability to drive or operate machinery safely.
Pennsaid solution should not be taken by mouth. It is for application to the skin only.
Do not apply the solution to broken, damaged or infected skin. Do not apply to areas of skin that have been affected by skin diseases such as psoriasis, unless advised by your doctor. You should not cover the treated area with dressings.
Wash your hands after applying the solution, unless the hands are the area being treated.
Avoid contact of this medicine with the eyes and mucous membranes, such as the inside of the nose or mouth.
When diclofenac is applied to the skin it is absorbed into the bloodstream to a far lesser degree than diclofenac taken by mouth. This means it is much less likely to cause side effects on the gut than oral diclofenac. However, it is important that people with a history of disorders affecting the stomach or intestines are closely monitored by a doctor while using this medicine, particularly if elderly. Consult your doctor immediately if you experience side effects such as stomach pain, indigestion, heartburn or signs of bleeding in the stomach or intestines, e.g. blood in the stools, while using this medicine.
As it decreases pain and inflammation this medicine may mask the signs and symptoms of skin infections in the area that you apply it to. This may make you think mistakenly that an infection is getting better when it isn't, or that an infection is less serious than it is. For this reason you should tell your doctor if you get a skin infection in the area that you are using this medicine.
This medicine is not recommended for use in children

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Pennsaid is marketed in the UK by Dimethaid International.

Tenoxicam is a non-steroidal anti-inflammatory drug which helps to reduce inflammation and to reduce the pain caused by arthritis

How does it work?

Tenoxicam works by blocking the production of some of the body chemicals that cause inflammation, pain, stiffness, tenderness, swelling and increased temperature.
By reducing inflammation in conditions affecting muscles and joints Tenoxicam helps to improve movement.
Tenoxicam can take a few weeks to help improve inflammation but can start to relieve pain after the first few doses.

Who can get it?

Not recommended for children

How is it used?

The usual daily dose for adults is 20mg, taken as a single tablet at the same time each day.
Tablets should be taken with water or other fluid.

What are the side effects?

Clinical studies have shown the following side effects can occur:

• Stomach upset
• Oedema, swelling of tissues
• Headache
• Rashes
• blood dyscrasias
• Raised liver enzymes
• visual disturbances
• hypersensitivity reactions
• plastic anaemia
• haemolytic anaemia
• hepatitis
• jaundice
• nephrotoxicity

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Tenoxicam is available on prescription. It is known commercially as Mobiflex and is marketed in the UK by Meda Pharmaceuticals Ltd.

Tiaprofenic acid is a non steroidal anti-inflammatory drug used for the treatment of rheumatoid arthritis, ankylosing spondylitis, osteoarthrosis, lumbago, acute musculo-skeletal disorders, soft tissue injuries.

How does it work?

Tiaprofenic acid helps to reduce inflammation and to reduce pain. Tiaprofenic acid works by blocking the production of some of the body chemicals that cause inflammation, pain, stiffness, tenderness, swelling and increased temperature.
By reducing inflammation in conditions affecting muscles and joints Tiaprofenic acid helps to improve movement.
Tiaprofenic acid can take a few weeks to help improve inflammation but can start to relieve pain after the first few doses.

Who can get it?

Tiaprofenic acid is available on prescription for adults. It is not suitable for children

How is it used?

• swallow the medicine whole with a glass of water
• take your medicine in its original form. You must not break, chew or crush it

What are the side effects?

Clinical studies have shown the following side effects can occur.

• GI upset
• Headache
• Drowsiness
• Rash
• Urinary frequency

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Tiaprofenic acid is available on prescription and is commercial known as Surgam. It is marketed in the UK by Sanofi Aventis

Vimovo contains the active ingredients naproxen and esomeprazole and belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs). Vimovo is used for the treatment of acute osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.

How does it work?

Naproxen belongs to a group of medicines called "Non-Steroidal Anti-Inflammatory Drugs" (NSAIDs). It reduces pain and inflammation. Esomeprazole belongs to a group of medicines called "proton pump inhibitors". It reduces the amount of acid in your stomach. Esomeprazole helps to reduce the risk of ulcers and stomach problems developing in patients who need to take NSAIDs.

Who can get it?

Available on prescription for adults.

How is it used?

Taking this medicineSwallow your tablets whole with a drink of water. Do not chew, split or crush the tablets. It is important that you take your tablets whole for your medicine to work properly.
Take your tablets at least 30 minutes before you have a meal.
If you are taking this medicine for a long time, your doctor will want to monitor you (particularly if you are taking it for more than a year).
How much to takeTake one tablet twice a day for as long as your doctor has told you.
Vimovo is only available in 500 mg/20 mg. If your doctor thinks this dose is not suitable for you they may prescribe another treatment.
If you take more Vimovo than you shouldIf you take more Vimovo than you should, talk to your doctor or pharmacist straight away.
Symptoms of an overdose may include dizziness, drowsiness, upper abdominal pain and or discomfort, heartburn, nausea, confusion, vomiting, bleeding of the stomach or intestines, loss of consciousness, severe swelling of the face, allergic reactions and uncontrolled movements of the body.
If you forget to take VimovoIf you forget to take a dose, take it as soon as you remember it. However, if it is almost time for your next dose, skip the missed dose.
Do not take a double dose (two doses at the same time) to make up for a forgotten dose.

What are the side effects?

Like all medicines, Vimovo can cause side effects, although not everybody gets them.
The following side effects may happen with this medicine.

• Headache.
• Feeling tired.
• Feeling thirsty.
• Feeling depressed.
• Feeling breathless.
• Increased sweating.
• Itchy skin and skin rashes.
• Spinning feeling (vertigo).
• Red or purple marks, bruising or spots on your skin.
• Feeling sick (nausea) or being sick (vomiting).
• A fluttering feeling in your heart (palpitations).
• Disturbed sleep or trouble sleeping (insomnia).
• Hearing problems such as ringing in your ears.
• Dizziness, feeling drowsy or feeling light-headed.
• Swelling of your hands, feet and ankles (oedema).
• An inflammation inside the mouth, a sore mouth or mouth ulcers.
• Eyesight problems such as blurred vision, conjunctivitis or eye pain.
• Diarrhoea, stomach pain, heartburn, indigestion, constipation, burping or wind (flatulence).

Stop taking Vimovo and see a doctor immediately if you notice any of the following serious side effects - you may need urgent medical treatment:

• Sudden wheezing, swelling of your lips, tongue and throat or body, rash, fainting or difficulties in swallowing (severe allergic reaction).
• Reddening of your skin with blisters or peeling. There may also be severe blisters and bleeding in the lips, eyes, mouth, nose and genitals.
• Yellowing of the skin or the whites of your eyes, having dark urine and tiredness which can be symptoms of liver problems.
• Medicines such as Vimovo may be associated with a small increased risk of heart attack (myocardial infarction) or stroke. Signs include chest pain spreading to your neck and shoulders and down your left arm, confusion or muscle weakness or numbness which may only be on one side of your body.
• You pass black sticky bowel motions (stools) or have bloody diarrhoea.
• You vomit any blood or dark particles that look like coffee grounds.

Vimovo may in rare cases affect the white blood cells leading to immune deficiency.

If you have an infection with symptoms such as fever with a severely reduced general condition or fever with symptoms of a local infection such as pain in the neck, throat or mouth or difficulties in urinating, you must consult your doctor as soon as possible so that a lack of white blood cells (agranulocytosis) can be ruled out by a blood test. It is important for you to give information about your medication at this time.

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Vimovo is marketed in the UK by Astra Zeneca

Volsaid retard tablets contain the active ingredient diclofenac sodium, which is a type of medicine called a non-steroidal anti-inflammatory drug (NSAID). NSAIDs are used to relieve pain and inflammation caused by Musculo-skeletal disorders, sprains, strains, back pain, rheumatoid arthritis, osteoarthritis and ankylosing spondylitis.

How does it work?

Diclofenac works by blocking the action of a substance in the body called cyclo-oxygenase (COX). Cyclo-oxygenase is involved in the production of various chemicals in the body, some of which are known as prostaglandins. Prostaglandins are produced by the body in response to injury and certain diseases and conditions, and cause pain, swelling and inflammation. Diclofenac blocks the production of these prostaglandins and is therefore effective at reducing inflammation and pain.

Diclofenac is used to relieve pain and inflammation in a wide range of musculoskeletal conditions, including various forms of arthritis, gout, sprains, fractures, dislocations, back pain, tendinitis and frozen shoulder. It is also used to relieve pain and inflammation following dental, orthopaedic (bone) and other minor surgery.

Volsaid retard tablets are sustained-release tablets. They are designed to release the diclofenac slowly and continuously over a few hours. This provides prolonged pain relief, so these tablets are usually taken once or twice a day. The tablets must be swallowed whole to avoid damaging the sustained-release action.

Volsaid retard tablets should preferably be taken with food to help avoid irritating the stomach.

Who can get it?

Available on prescription for those over the age of 18.

How is it used?

75mg tablet; once or twice daily with or after food.
100mg tablet; once daily with or after food.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

• Disturbances of the gut such as diarrhoea, constipation, nausea, vomiting or abdominal pain
• Indigestion (dyspepsia)
• Excess gas in the stomach and intestines (flatulence)
• Loss of appetite
• Headache
• Dizziness
• Balance disorders involving the inner ear (vertigo)
• Skin rashes
• Ulceration of the stomach or intestine
• Bleeding from the stomach or intestine
• Allergic reactions such as skin rashes, swelling of the lips, tongue and throat (angioedema) or narrowing of the airways (bronchospasm)
• Drowsiness
• Fluid retention (oedema)
• Kidney, liver or blood disorders

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Volsaid Retard is marketed in the UK by Chiesi Ltd

Voltarol contains the active ingredient diclofenac sodium, which is a type of medicine called a non-steroidal anti-inflammatory drug (NSAID). NSAIDs are used to relieve pain and inflammation.

How does it work?

Diclofenac works by blocking the action of a substance in the body called cyclo-oxygenase (COX). Cyclo-oxygenase is involved in the production of various chemicals in the body, some of which are known as prostaglandins. Prostaglandins are produced by the body in response to injury and certain diseases and conditions, and cause pain, swelling and inflammation. Diclofenac blocks the production of these prostaglandins and is therefore effective at reducing inflammation and pain.
Diclofenac is used to relieve pain and inflammation in a wide range of musculoskeletal conditions, including various forms of arthritis, gout, sprains, fractures, dislocations, back pain, tendonitis and frozen shoulder. It is also used to relieve pain and inflammation following dental, orthopaedic (bone) and other minor surgery.
Voltarol e/c tablets have a special 'enteric coating' that is designed to prevent the absorption of the diclofenac in the stomach, and thus reduce the risk of stomach irritation. The diclofenac is absorbed when the tablet reaches the intestine. The tablets should be swallowed whole to avoid damaging this coating.
Voltarol dispersible tablets are dissolved in water before taking. The diclofenac solution is rapidly absorbed from the gut, so this type of Voltarol tablet provides pain relief more quickly than the other types of tablet. However, the solution is more likely to irritate the stomach lining, because it doesn't have the advantage of the protective enteric-coat. The dispersible tablets are therefore most suitable for short-term use. They shouldn't be used for longer than three months.
Voltarol SR tablets and Voltarol Retard tablets are sustained-release tablets. They contain higher doses of diclofenac and are designed to release this slowly and continuously over a few hours. This provides more prolonged pain relief, so these tablets are usually taken once a day. These tablets must also be swallowed whole to avoid damaging the sustained-release action.

Who can get it?

This medicine is available on prescription.

How is it used?

All types of Voltarol tablets should preferably be taken with food to help avoid irritating the stomach.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

• Disturbances of the gut such as diarrhoea, constipation, nausea, vomiting or abdominal pain
• Indigestion (dyspepsia)
• Excess gas in the stomach and intestines (flatulence)
• Loss of appetite
• Headache
• Dizziness
• Balance disorders involving the inner ear (vertigo)
• Skin rashes
• Ulceration of the stomach or intestine
• Bleeding from the stomach or intestine
• Allergic reactions such as skin rashes, swelling of the lips, tongue and throat (angioedema) or narrowing of the airways (bronchospasm)
• Drowsiness
• Fluid retention (oedema)
• Kidney, liver or blood disorders

Diclofenac Cardiac Warning

Recent cardiovascular safety concerns have led the MHRA to issue new prescribing advice for systemic forumlations of diclofenac.

The Agency cited a recently published meta-analysis that provided further evidence of an increased risk of arterial thrombosis with diclofenac, similar to that observed with COX-2 inhibitors.

The use of diclofenac is now contraindicated in patients with ischaemic heart disease, peripheral arterial disease, cerebrovascular disease or  congestive heart failure.

Patients with any of these conditions who are currently receiving diclofenac should be switched to an alternative treatment at their next appointment.

In addition, caution should be used when prescribing diclofenac in patients with significant risk factors for cardiovascular events, such as hypertension, hyperlipidaemia, diabetes mellitus and smoking.

These new contraindications and warnings apply to systemic formulations of diclofenac (tablets, capsules, suppositories and injections) but not topical products (creams and gels).

Reference: Mims August 2013 Product Update

You can report adverse drug reactions to the MHRA via the Yellow Card scheme.

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Voltarol is marketed in the UK by Novartis Pharmaceuticals UK Ltd

Axsain cream is used to relieve the pain arising from nerves near to the surface of the skin. It belongs to a group of drugs known as topical analgesics.

How does it work?

Capsaicin is a compound which is present in the capsicum vegetable. The precise mechanism of action of capsaicin is not fully understood, however it is believed that it relieves pain by reducing and preventing the re-accumulation of a chemical called Substance P which is found in pain receptor nerve cells in the body. This is believed to be the main chemical responsible for sending pain signals from the body to the brain.

Who can get it?

Axsain is not suitable for children

How is it used?

Axsain should be applied sparingly three or four times daily or as prescribed by your doctor.
Avoid contact with eyes, and inflamed or broken skin. Hands should be washed immediately after use. Not for use under tight bandages. Avoid taking a hot shower or bath just before or after applying capsaicin as the burning sensation enhanced

Axsain should not be used in children.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.
Axsain cream can cause a brief burning feeling when applied. This burning is more
common when:

• The cream is used less than 3 or 4 times a day.
• Too much cream is applied.
• The cream is applied just before or after a hot bath or shower.

Rarely when Axsain cream is applied the vapour can cause brief irritation of the eyes, nose, and throat, such as runny nose, cough or sneezing, breathlessness or worsening of asthma.
Axsain may cause local skin reactions (e.g. contact dermatitis) due to the product containing cetyl alcohol.
If any of the side effects become serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.

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Capsaicin is available on prescription and is commercial known as Axsain. It is marketed in the UK by Cephalon Ltd

Balmosa is a warming pain relieving cream that contains a combination of menthol, camphor, methyl salicylate and oleoresin capsicum as active ingredients and is used in the treatment of muscular rheumatism, fibrositis, lumbago, sciatica and unbroken chilblains.

How does it work?

Menthol relieves itching and causes the blood vessels on the surface of the skin to widen. This causes a sensation of coldness followed by a reduction in pain.

Camphor, methyl salicylate and oloeresin capsicum are counter-irritants, which when applied, cause redness and heat to be produced. This distracts the brain from the original pain and therefore reduces the perception of pain.

Who can get it?

Available over the counter for adults.  Not recommended for use in children

How is it used?

Massage in as and when required.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

•  Skin reactions such as rash and itch

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If you would like to read other people’s experience of this treatment, or have any comments to share, good or bad, you might like to go to iWantGreatCare 

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Balmosa  is marketed in the UK by Galen Consumer

Qutenza is a self adhesive pad containing the active ingredient capsaicin and it  belongs to a group of drugs known as topical analgesics.

How does it work?

Capsaicin is a compound which is present in the capsicum vegetable. The precise mechanism of action of capsaicin is not fully understood, however it is believed that it relieves pain by reducing and preventing the re-accumulation of a chemical called Substance P which is found in pain receptor nerve cells in the body. This is believed to be the main chemical responsible for sending pain signals from the body to the brain.

Who can get it?

Qutenza is available on prescription for adults only.  

How is it used?

After pre-treatment of the affected area with topical anaesthetic, up to 4 patches should be applied by a healthcare professional to painful areas for up to 30 minutes (feet) or 60 minutes (other areas).  Repeat after 90 days if necessary

What are the side effects?

LIke all medicines, Qutenza can cause side effects, although not everybody gets them.
The frequency of possible side effects listed below is defined using the following convention:
Very common(affects more than 1 user in 10)
Common (affects 1 to 10 users in 100)
Uncommon (affects 1 to 10 users in 1,000)

Very common side effects:

• redness, pain on the area where the patch is applied

Common side effects:

• itching, bumps, blisters, swelling, dryness on the area where the patch is applied

Uncommon side effects:

•  Wheals, prickling sensation, inflammation of the, skin, increased sensitivity, inflammation, skin reaction, irritation, bruising on the area where the patch is applied.
• high blood pressure, slowing of the electrical signals in the heart, rapid beating of the heart,  abnormal awareness of the beating of the heart, decreased taste, reduced sensations in limbs,  burning sensation, eye irritation, cough, throat irritation, nausea, itching, pain in limbs, muscle spasms, shingles, swelling of limbs.

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If you would like to read other people’s experience of this treatment, or have any comments to share, good or bad, you might like to go to iWantGreatCare 

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Qutenza is marketed in the UK by Astellas

Zacin cream is for the treatment of mild to moderate pain caused by osteoarthritis. It belongs to a group of drugs known as topical analgesics.

How does it work?

Capsaicin is a compound which is present in the capsicum vegetable. The precise mechanism of action of capsaicin is not fully understood, however it is believed that it relieves pain by reducing and preventing the re-accumulation of a chemical called Substance P which is foudn in pain receptor nerve cells in the body. This is believed to be the main chemical responsible for sending pain signals from the body to the brain.

This strength of capsaicin when applied to the skin is used to relieve the pain associated with osteoarthritis.

Who can get it?

Zacin is not suitable for children. It is available on prescription.

How is it used?

Zacin should be applied sparingly four times daily.
Avoid contact with eyes and inflamed or broken skin such as in an open wound. Hands should be washed immediately after use. Not for use under tight bandages. Avoid taking a hot shower or bath just before or after applying capsaicin as the burning sensation may be enhanced.

Zacin should not be used in children.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.
Zacin may cause a transient burning sensation following application. This sensation generally disappears after several days of treatment, but may persist particularly when application schedules of less than 4 times daily are used. The burning can be enhanced if too much cream is used or if it is applied just before or after a bath or shower.

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If you would like to read other people’s experience of this treatment, or have any comments to share, good or bad, you might like to go to iWantGreatCare

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Zacin is available on prescription for adults. It is marketed in the UK by Cephalon Ltd

Apremilast belongs to a group of medicines called phosphodiesterase 4 inhibitors, which help to reduce inflammation and swollen joints.  It is used to treat adults with psoriatic arthritis who have not responded to at least 2 standard DMARDs given either alone or in combination.

How does it work?

Apremilast  works by reducing the activity of an enzyme in the body called ‘phosphodiesterase 4’, which is involved in the process of inflammation. By reducing the activity of this enzyme, it can help to control the inflammation associated with psoriatic arthritis

 Who can get it?

Apremilast is only available to adults on prescription (POM)

How is it used?

Apremilast is administered orally and is started with a low dose and is gradually increased.   Initially 10 mg daily on day 1, then 10 mg twice daily on day 2, then 10 mg in the morning and 20 mg in the evening on day 3, then 20 mg twice daily on day 4, then 20 mg in the morning and 30 mg in the evening on day 5, then maintenance 30 mg twice daily, doses should be taken approximately 12 hours apart; review treatment if no response within 24 weeks of initiation.

What are the side effects?

Very common side effects (may affect more than 1 in 10 people)

• diarrhoea
• nausea
• headaches, migraines or tension headaches
• upper respiratory tract infections such as cold, runny nose, sinus infection

Common side effects (may affect up to 1 in 10 people)

• cough
• back pain
• vomiting
• feeling tired
• stomach pain
• loss of appetite
• frequent bowel movements
• difficulty sleeping (insomnia)
• indigestion or heartburn
• inflammation and swelling of the tubes in your lungs (bronchitis)
• common cold (nasopharyngitis)
• depression

Uncommon side effects (may affect up to 1 in 100 people)

• rash
• hives (urticaria)
• weight loss
• allergic reaction
• bleeding in the bowel or in the stomach
• suicidal ideation or behaviour

Serious side effects – depression and suicidal thoughts

• Tell your doctor straight away about any changes in behaviour or mood, feelings of depression, thoughts of suicide or suicidal behaviour (this is uncommon).

If you would like to read other people’s experience of this treatment, or have any comments to share, good or bad, you might like to go to iWantGreatCare for Apremilast or iWantGreatCare for Otezla.

Apremilast is known commercially as Otezla and is marketed in the UK by Amgen Ltd

Tofacitinib is a medicine known as a Janus kinase (JAK) inhibitor. It belongs to a group of medicines called disease-modifying antirheumatic drugs (DMARDs). It is used to treat active psoriatic arthritis in adults whose disease has not responded adequately to previous DMARD treatment or who cannot tolerate these medicines.

Tofacitinib works by blocking the activity of enzymes called Janus kinases (JAKs). These enzymes are involved in sending signals that promote inflammation. By reducing these signals, tofacitinib can help reduce inflammation, pain and swelling in the joints associated with psoriatic arthritis.

Who can get it?

Tofacitinib is available on prescription and treatment should be started and supervised by a specialist experienced in treating psoriatic arthritis.

For psoriatic arthritis, tofacitinib can be used with methotrexate or on its own if methotrexate is not tolerated or is considered inappropriate.

Because JAK inhibitors are associated with increased risks of serious infections, cardiovascular events, blood clots and some cancers, particular caution is needed in people aged 65 or over, people who currently or previously smoked for a long time, and people with cardiovascular or malignancy risk factors. In these groups, tofacitinib should only be used when there are no suitable alternative treatments.

Tofacitinib should not be used in people with an allergy to the medicine, active tuberculosis, serious infection such as sepsis, opportunistic infection, severe liver impairment, or during pregnancy or breastfeeding.

How is it used?

Tofacitinib is taken by mouth and can be taken with or without food.

For adults with psoriatic arthritis, the usual dose is:

5 mg twice a day.

The dose may need to be reduced in certain circumstances, including some people with severe kidney impairment or moderate liver impairment. Your doctor will decide whether a reduced dose is necessary.

Tofacitinib should not be taken with certain other medicines that can excessively suppress the immune system, including some biological treatments and potent immunosuppressants.

What are the side effects?

Tofacitinib affects the immune system and can increase the risk of infections. Some infections can be serious. Treatment should be interrupted if a serious infection develops until the infection is controlled.

Possible side effects include:

• Upper respiratory tract infections
• Headache
• Diarrhoea
• Nausea
• High blood pressure
• Increased cholesterol and other changes in blood fats
• Changes in blood cell counts, including anaemia or reduced white blood cells
• Increased risk of infections
• Increased risk of shingles
• Liver enzyme abnormalities

Less commonly, more serious problems can occur, including serious infections, blood clots, major cardiovascular events such as heart attack, and certain cancers. The risk of some of these problems is particularly important in older people and those with cardiovascular, smoking or cancer risk factors.

Tell your doctor urgently if you develop symptoms of a serious infection, unexplained chest pain, sudden breathlessness, swelling or pain in a leg, or other symptoms that could indicate a blood clot or cardiovascular problem.

Before and during treatment, your healthcare team will carry out appropriate checks, which may include blood tests and monitoring for infections, liver abnormalities, changes in blood counts and cholesterol.

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Tofacitinib is known commercially as Xeljanz® and is marketed in the UK by Pfizer.

Reviewed: August 2026
Version ID: 2/TOF/PTA/08/26