COX-2 inhibitors

These drugs have been derived from NSAIDs. The cyclooxygenase enzyme inhibited by NSAIDs was discovered to have at least 2 different versions: COX1 and COX2. Research suggested that most of the adverse effects of NSAIDs were mediated by blocking the COX1 (constitutive) enzyme, with the analgesic effects being mediated by the COX2 (inducible) enzyme. The COX2 inhibitors were thus developed to inhibit only the COX2 enzyme (traditional NSAIDs block both versions in general). These drugs (such as rofecoxib and celecoxib) are equally effective analgesics when compared with NSAIDs, but cause less gastrointestinal hemorrhage in particular. However, post-launch data indicated increased risk of cardiac and cerebrovascular events with these drugs; this is probably due to an imbalance in blood coagulation. Rofecoxib (marketed as Vioxx) was subsequently withdrawn from the market. The role for the remaining members of this class of drug is debated.

Opiates and morphinomimetics

Morphine, the archetypal opioid, and various other substances (e.g. codeine, oxycodone, hydrocodone, dihydromorphine, pethidine) all exert a similar influence on the cerebral opioid receptor system. Buprenorphine is thought to be a partial agonist of the opioid receptor, and tramadol is an opiate agonist with SNRI properties.^{[citation needed]} Tramadol is structurally closer to venlafaxine than to codeine and delivers analgesia by not only delivering "opiate-like" effects (through mild agonism of the mu receptor) but also by acting as a weak but fast-acting serotonin releasing agent and norepinephrine reuptake inhibitor.^[3][4][5][6] Dosing of all opioids may be limited by opioid toxicity (confusion, respiratory depression, myoclonic jerks and pinpoint pupils), seizures (tramadol), but there is no dose ceiling in patients who accumulate tolerance.^{[citation needed]}
Opioids, while very effective analgesics, may have some unpleasant side-effects. Patients starting morphine may experience nausea and vomiting (generally relieved by a short course of antiemetics such as phenergan). Pruritus (itching) may require switching to a different opioid. Constipation occurs in almost all patients on opioids, and laxatives (lactulose, macrogol-containing or co-danthramer) are typically co-prescribed.^[7]
When used appropriately, opioids and similar narcotic analgesics are otherwise safe and effective, however risks such as addiction and the body becoming used to the drug (tolerance) can occur. The effect of tolerance means that frequent use of the drug may result in its diminished effect so, when safe to do so, the dosage may need to be increased to maintain effectiveness. This may be of particular concern regarding patients suffering with chronic pain.[cita

Legal status

Tramadol (as the racemic, cis-hydrochloride salt), is available as a generic in the U.S. from any number of different manufacturers, including Amneal, Caraco, Mylan, Cor Pharma, Mallinckrodt, Pur-Pak, APO, Teva, and many more. Typically, the generic tablets are sold in 50 mg tablets. Brand name formulations include Ultram ER, and the original Ultram from Ortho-McNeil (cross-licensed from Grünenthal GmbH). The extended-release formulation of tramadol—which, amongst other factors—was intended to be more abuse-deterrent than the instant release) allegedly possesses more abuse liability than the instant release formulation.^{[citation needed]} The U.S. Food and Drug Administration (FDA) approved tramadol in March 1995 and an extended-release (ER) formulation in September 2005.^[66] It is covered by U.S. patents nos. 6,254,887^[67] and 7,074,430.^[68][69] The FDA lists the patents as scheduled for expiration on May 10, 2014.^[68] However, in August 2009, U.S. District Court for the District of Delaware ruled the patents invalid, which, if it survives appeal, would permit manufacture and distribution of generic equivalents of Ultram ER in the United States.^[70]
Sweden, as of May 2008, has chosen to classify tramadol as a controlled substance in the same way as codeine and dextropropoxyphene. This means that the substance is a scheduled drug. But unlike codeine and dextropropoxyphene, a normal prescription can be used at this time.^[71] In Mexico, combined with paracetamol and sold under the brand name Tramacet, it is widely available without a prescription. In most Asian countries such as the Philippines, it is sold as a capsule under the brand name Tramal, where it is mostly used to treat labor pains.

Careful

Most people who take anti-inflammatories have no side-effects, or only minor ones. When taken appropriately, the benefit usually far outweighs the potential harms. In particular, many people take a short course of an anti-inflammatory for all sorts of painful conditions. However, side-effects, and sometimes very serious possible adverse effects, can occur. Therefore ...

Do read the leaflet that comes with the tablets for a full list of cautions and possible side-effects. In particular, check if you have any of the conditions or take other medicines where the risk of side-effects is increased.

For example, one important caution is that, ideally, you should not take anti-inflammatories if you are pregnant. Also, if you have any cardiovascular (heart, stroke or blood vessel condition) or certain gut conditions, or are elderly, then these medicines are prescribed with caution and only where there are no alternatives and at the lowest doses and durations necessary.

precautions and side-effects

Is It Safe or Advisable to Take Expired Arthritis Medication?

An expiration date is put on a product to make us aware that the quality of the product is diminishing. When it comes to arthritis medication, does the expiration date just warn us about quality or is it unsafe to take expired medication? There are two schools of thought on expired medication.

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Arthritis Drugs: What Are My Options?

Medications have long been considered "traditional" treatment. Since individual response to a specific medication can vary and because possible side effects are also a factor, finding the most effective medication or combination of medications can be a more difficult process than one would expect.

Arthritis Medications - Test Your Knowledge

There are several different classes of arthritis medications, and often many drugs within each class. In recent years, new arthritis drugs have become available. More are in the product pipeline. How much do you know about arthritis medications?

A Decade of Drugs for Arthritis-Related Conditions

Arthritis drugs are a significant part of most arthritis treatment regimens. Arthritis patients are often eager to learn about newer arthritis drugs. The past decade has brought us 10 new drugs for arthritis-related conditions.

What Are Drug Side Effects?

Drug side effects are unintended, adverse effects that can develop with medication use. It's important for you to recognize whether the drug side effects are mild or serious and require medical attention.

Self-Injection of Arthritis Drugs

Since 1998, when Enbrel became the first biologic drug approved for arthritis, self-injection has become more common. Self-injection had been an option for methotrexate for a number of years, but now several arthritis drugs require self-injection.

Arthritis Medication Side Effects - What You Should Know

Arthritis medication side effects are a possibility. Be aware of arthritis medication side effects and call your doctor if a persistent or potentially serious problem develops.

Don't Stop Medication Without Doctor's Input

For various reasons, arthritis patients sometimes become frustrated and want to stop medication. They may want to stop -- either one pill or many pills -- but they should not stop medication without doctor's advice.

Swallowing Pills: A Major Problem for Some Arthritis Patients

Swallowing pills is difficult for more people than you might think. I saw a survey that suggested 40% of people have trouble swallowing pills. Some become pill-chewers -- and for more than one reason, that's not the way to go.

Rheumatoid Arthritis Treatments - 2008 ACR Recommendations

Rheumatoid arthritis treatments include medication options that have expanded over the last decade. The American College of Rheumatology (ACR) has released its 2008 guidelines for rheumatoid arthritis treatments -- an update of the 2002 guidelines.

10 Most Popular Arthritis Drugs Prescribed by Rheumatologists

Arthritis drugs are used by most arthritis patients as part of their treatment plan. Patient response to arthritis drugs can vary so it's impossible to say ahead of time which drug will be most effective. Learn more about the 10 arthritis drugs most commonly prescribed by rheumatologists.

10 Ways to Ensure Drug Safety

Drug safety requires patient involvement. A patient should and should not do certain things to ensure drug safety. Patients should fully understand their prescription after discussing it with the doctor and pharmacist. Patients should never take drugs if they are unsure about the directions. Follow these tips for drug safety.

Do Antidepressants Help Chronic Pain Patients?

Antidepressants are sometimes prescribed for patients with chronic pain, such as arthritis and fibromyalgia. When is it appropriate to prescribe one of the antidepressants for an arthritis or fibromyalgia patient?

10 Things You Should Do When Given a New Prescription

When your doctor hands you a new prescription, it becomes your responsibility to know what the drug is for, how to take it, what side effects may occur and more. Here are 10 tips for what you should do when given a new prescription.

10 Things You Should Know About Tylenol / Acetaminophen

Tylenol safety decreases the chance for undesirable side effects. Safety warnings about Tylenol should be respected. To enhance patient safety, Tylenol / acetaminophen must be taken according to directions.

10 Things You Should Know About Prednisone

Prednisone safety decreases the chance for undesirable side effects. Prednisone is a powerful anti-inflammatory medication which must be taken according to directions. Prednisone is used to treat inflammatory forms of arthritis and other conditions.

10 Things You Should Know About Lyrica

Lyrica (pregabalin) has been approved for the treatment of fibromyalgia. Several million patients have taken Lyrica worldwide, including those who were prescribed the drug for other indications. Here are 10 things you should know about Lyrica, including safety warnings.

10 Things You Should Know About Methotrexate

Methotrexate is a DMARD (disease-modifying anti-rheumatic drug) used to treat certain types of arthritis and rheumatic conditions. There are important safety facts and warnings you should know about methotrexate.

10 Things You Should Know About Colchicine

Colchicine is used for the treatment of gout. For safe use of the drug, here are 10 things you should know about colchicine including how it works, potential side effects, and warnings.

Review Prescription Medications With Your Doctor

Prescription medications are commonly ordered by a doctor to treat arthritis and other chronic conditions. Patients should review their regimen of prescription medications with their doctor on a regular basis.

When Are Arthritis Medications Contraindicated?

Sometimes arthritis medications are contraindicated, meaning they shouldn't be given to specific patients. Are there contraindications which may eliminate a patient from taking a specific drug? What are "absolute" contraindications?

Review Prescription Label Directions

Prescription labels are confusing for many patients. Here are some tips to help you make sure you're using medications correctly.

How to Spot Pharmacy Errors

Pharmacy errors can have serious consequences.

Proton Pump Inhibitors Increase Risk of Hip Fracture

Proton pump inhibitors which are taken for acid-related diseases and also by many arthritis patients trying to reduce gastrointestinal side effects caused by NSAIDs have been linked to an increased risk of hip fracture. Proton pump inhibitors include Nexium, Protonix, Prevacid, Aciphex and Prilosec.

What Are Salicylates? When Are Salicylates Prescribed To Treat Arthritis?

What are salicylates? When are salicylates prescribed to treat arthritis? Do salicylates carry the same cardiovascular risk as nonselective NSAIDs and COX-2 selective inhibitors?

Sun Sensitivity Can Be Side Effect of Some Medications

Some medications cause sun sensitivity.

Traveling With Medications - What You Need to Know

Medications are part of a daily routine for people living with arthritis. When away from home for a period of time or traveling, it's important to manage medications appropriately. These tips will help you avoid problems with medication when traveling.

Can Low or High Potassium Levels Be Caused by Medications?

Potassium levels in the blood can be abnormally high or low due to medication side effects.

Hair Loss Caused By Medications - Can It Be Prevented Or Treated?

Hair loss is an unwanted side effect of some arthritis medications. Can hair loss be stopped or prevented with treatment?

Rheumatoid Arthritis Drugs Linked To Increased Risk of Infections And Cancer

TNF Blockers, specifically Humira and Remicade reportedly increase the risk of cancer and serious infection.

TNF Blockers (Enbrel, Remicade, Humira) - Test Your Knowledge

New arthritis drug classes have been developed and approved for marketing since 1998. How much do you know about rheumatoid arthritis drugs Enbrel, Remicade, and Humira? Take the quiz and test your knowledge.

Biologic Drugs - Are Some Arthritis Patients Unsuitable Candidates For Biologic Drugs?

The medical history of some arthritis patients make them unsuitable candidates for biologic drugs such as Enbrel, Remicade, Humira, Orencia, and Rituxan.

Is It Possible To Decrease The Risk Of An Allergic Reaction To Remicade?

Dr. Zashin explains what can be done to decrease the chance of having an allergic reaction to Remicade.

Prescription Drug Information Package Inserts Get New Design

Package inserts containing prescription drug information are being redesigned in an effort to manage the risks of medication use.

Driving Safely When You Take Medications

How can medications affect my ability to drive safely? Can I still drive safely if I am taking medications?

The Prednisone Quiz - True or False?

Prednisone is a potent medication which is used to treat many inflammatory conditions including rheumatoid arthritis. It is important to know the proper use of the drug and be aware of the potential serious side effects. Consult your doctor if you have questions. How much do you know about prednisone? Take the quiz.

Steroid Withdrawal - Corticosteroid Withdrawal Symptoms

Steroid withdrawal symptoms can occur if corticosteroid drugs are not discontinued gradually. Tapering the dose of steroids minimizes corticosteroid withdrawal symptoms.

What Are Cytotoxic Drugs?

Cytotoxic drugs, such as methotrexate, Cytoxan, and Imuran are used to treat rheumatoid arthritis and some other rheumatic diseases. There are potentially serious side effects associated with these drugs, but methotrexate appears to have the best safety profile. Learn more about cytotoxic drugs.

Biologic Response Modifier: What is it?

Biological therapy, also referred to as immunotherapy or biotherapy, employ biologic response modifiers (BRMs) to stimulate or restore the ability of the immune system to fight disease and/or infection. BRMs can include monoclonal antibodies, interferon, interleukin-2, and various types of colony-stimulating factors (CSF, GM-CSF, G-CSF).

Orencia (Abatacept) Approved For Rheumatoid Arthritis

Orencia (abatacept) is the first T-cell co-stimulation modulator approved for the treatment of rheumatoid arthritis.

Rituxan Approved For Rheumatoid Arthritis - The Facts Of Rituxan

03/01/2006, Rituxan, the world's best-selling cancer drug, has been FDA approved to be used in combination with methotrexate to treat rheumatoid arthritis by reducing the signs and symptoms in adult patients who have moderately-to-severely active rheumatoid arthritis and have failed one or more anti-TNF drugs e.g. Enbrel (etanercept), Remicade (infliximab), or Humira (adalimumab).

Enbrel, Remicade, and Humira - How are the drugs similar and different?

Patients are often advised to weigh the benefit and risk of any medication, including TNF blockers Enbrel, Remicade, and Humira. What similarities and differences are there between the three drugs?

FDA Announces Changes For All NSAIDS; Bextra Withdrawn From Market

Following scrutiny of the class of arthritis drugs known as NSAIDS and COX-2 inhibitors, the FDA has taken action.

Help Your Arthritis Treatment Work

You can help your treatment work. Arthritis can strike at any age. It hurts the joints, where two bones meet. It damages the joints and makes them stiff and painful. Correct treatment can ease the pain and help prevent more damage.

Combination Treatment for Rheumatoid Arthritis

Dr. Isadore Rosenfeld offers information about what's the latest arthritis treatment, including the benefit of combination therapy.

When Are Pain Medications Appropriate For Arthritis Patients?

When is it appropriate for pain medications (analgesics) to be prescribed as part of the treatment plan for arthritis patients? Are analgesic pain medications appropriate as a long-term treatment or maintenance treatment, or should they only be used short-term?

Does It Matter If Take Arthritis Drugs With Or Without Food?

Follow instructions from your pharmacist when taking arthritis medications.

How Long Should You Give A New Drug A Chance To Work?

How long should a patient stick with a new medication before considering it ineffective? New medications can take time to become fully effective. It's hard to tell sometimes if you have given it a fair chance or if you should give up on a particular drug.

How To Avoid Medication Errors

A few simple, common sense tasks can help you avoid medication errors and ensure your safety.

How To Reduce The Risks Of Using Arthritis Medicines

All medicines have risks. To reduce the risks related to using arthritis medicines and to get the maximum benefit, you need to play an active role on your health care team.

How to Safely Dispose of Unused Medications

It happens to everyone for a variety of reasons. You end up with a medicine cabinet full of expired or unused medications, now considered a toxic form of household hazardous waste. Proper drug disposal is an emerging environmental issue. As with any household waste, the disposal method chosen can have a direct effect on safety and the health of...

How to Store Medicine Safely

Many people store their medications in the bathroom. But this popular spot is actually one of the worst places to keep medicine. Unnecessary exposure to heat and moisture can cause medicines to lose their potency. Travelers need to follow additional tips for safe storage of their medications.

Inflammation: The Battle Within

Inflammation is a natural defense of the body to protect against foreign substances or injury, but it can cause problems in certain diseases.

How To Treat Gout With Diet And Medication

Gout is one of the most painful types of arthritis. Gout attacks can be controlled or prevented by lifestyle changes and the use of certain medications.

Is Early, Aggressive Treatment Needed For New Diagnosed Patients?

Early, aggressive treatment for arthritis can prevent joint damage and deformity.

Is There Such A Thing As A "Plateau Effect" For Arthritis Medications?

It has been the experience of many arthritis patients that after taking a particular NSAID for awhile it seems to stop working or lose effectiveness.

Minocycline - Is minocycline functioning as an antibiotic when used to treat arthritis?

Some people have had good results while taking minocycline for the treatment of rheumatoid arthritis.

Nexium Reduces Risk Of Ulcers For Long-term NSAID Users

The potential development of ulcers in regular users of NSAIDS (nonsteroidal anti-inflammatory drugs) is well known. A new study suggests the infamous "Purple Pill", otherwise known as Nexium, might make a difference.

Pain Relievers - Use Caution With Over-the-Counter Pain Relievers

All over-the-counter pain relievers should be taken with care to avoid serious problems that can occur with misuse. Certain factors can increase the risk of liver toxicity from products containing acetaminophen and the risk of GI bleeding from the use of products containing NSAIDs.

Prednisone - Benefits vs. Risks Of Longterm Prednisone Use

Prednisone is a potent medications used to control symptoms of arthritis but there are potential side effects with longterm use.

Q & A: FDA Actions On COX-2 Inhibitors & NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)

On April 7, 2005, FDA announces planned regulatory actions for Bextra, Celebrex, and the non-selective prescription and over-the-counter (OTC) non-steroidal anti-inflammatory drugs (NSAIDs).

Book Review: Overdosed America

Book review of Overdosed America by John Abramson, M.D., a book which exposes what's wrong with the pharmaceutical and health care industry.

Rheumatoid Arthritis Treatments Do Not Increase Breast Cancer Risk

Research shows no evidence to date that rheumatoid arthritis treatments, particularly the newest medications, increases the risk of breast cancer.

Safety Of Arthritis Drugs: Weighing The Risks And Rewards

It's unsettling, the long-term safety of many arthritis drugs has been called into question. However, as the facts emerge, only you and your doctor can determine the level of risk that is acceptable with drugs currently available to treat arthritis.

Side Effects Of Enbrel, Remicade, and Humira - Weighing The Risk vs. Benefits

Arthritis patients sometimes fear the side effects of the TNF blockers Enbrel, Remicade, and Humira. Should they be afraid and avoid these drugs?

Steroid Injections - When are steroid injections indicated as a treatment for arthritis?

Corticosteroids are used to treat inflammation and arthritis. When are local steroid injections indicated?

The Facts Of Analgesics (Painkillers)

Analgesic medication are commonly referred to as painkillers. There are basically two kinds of analgesics: non-narcotics and narcotics.

The Facts Of Corticosteroids

Corticosteroids are powerful drugs which can improve arthritis dramatically if administered within proper guidelines.

The Facts of NSAIDS

NSAIDS work to combat arthritis by interfering with the inflammatory process.

Top Arthritis Cream Products

Arthritis creams can be effective for soothing minor arthritis and muscle pain. Some contain the active ingredient salicylate while others are based on the pain-relieving effect of capsaicin or menthol.

Top Pill Boxes - Pill Box Reminders

For people who take medications on a regular basis, a pill box or pill reminder is a useful item. Pill boxes are easy to take along, no matter where you go, and keep you on your medication schedule. Pill boxes are organized daily, weekly, or monthly. Some pill boxes lock or have timers. Some are even made to look like jewelry.

Understanding The Prescription Abbreviations

Use of Latin prescription abbreviations has become a kind of medical shorthand. However, unless you have a medical background, prescription abbreviations can be hard to follow. What do the prescription abbreviations mean?

When Is It Appropriate To Switch Your TNF Blocker Drug?

If an arthritis patient is on one of the TNF blocker drugs, when is it appropriate to switch to another? Is it possible for a patient to respond differently to another TNF blocker drug? Can a patient go back on one of the TNF blocker drugs after having stopped treatment?

What Causes And Heals Mouth Sores?

Mouth sores are not uncommon in arthritis patients. We examine the reasons for mouth sores and treatments for mouth sores.

Pill Reminder - Pill Reminder for Arthritis Medications

It's important to take pills on time and according to directions. Do you need a pill reminder to help you remember? What type of pill reminder works for you?

What Is DAS28?

DAS-28 is an assessment of disease activity in rheumatoid arthritis patients. It is used in clinical trials and in practice.

Emergency Preparedness - Stay Ahead on Medications

Earthquakes, hurricanes, wildfires, and terrorism have taught us the importance of emergency preparedness. People who take medications should always have enough on hand to be able to withstand an emergency situation.

Tramadol - 10 Things You Should Know Painkiller Associated With Decreased Side Effects

Tramadol, the generic version of Ultram, is a synthetic analgesic medication. The exact mode of action of tramadol is unknown but it is said to work like morphine. Tramadol binds to opioid receptors in the brain -- receptors that transmit the sensation of pain throughout the body. Here are 10 things you should know about tramadol to ensure its safe use.

1 - Tramadol is prescribed to treat moderate to moderately severe pain.

Tramadol belongs to the class of drugs known as opiate agonists. Primarily, tramadol works by changing the way the body senses pain. Some people mistakenly believe that tramadol is an NSAID (nonsteroidal anti-inflammatory drug), but it is not.

2 - Tramadol is available in immediate release and extended release formulations.

Tramadol may be prescribed as an immediate release tablet (50 mg.) or as an extended release tablet (100, 200, or 300 mg.). The extended release tablets are usually reserved for patients with chronic pain who require continuous, long-term treatment. Your doctor will determine the appropriate dosage schedule for you.

3 - Tramadol extended release tablets must be taken whole, not split, chewed or crushed.

It is important to take tramadol properly and to follow prescribing instructions. If taken improperly or in a way that is not recommended, serious side effects and even death can result.

4 - Tramadol can be habit-forming for some people.

Do not take more tramadol than has been prescribed for you. Taking more tramadol or taking it more often can cause dependency on it. You should also not stop taking tramadol without first consulting your doctor. You may experience withdrawal symptoms if you stopped it suddenly. You doctor will likely decrease your dose of tramadol gradually.

5 - Drug interactions are possible with tramadol.

Be aware of the following possible drug interactions:

• Carbamazepine reduces the effect of tramadol
• Quinidine increases the concentration of tramadol by 50% to 60%
• Combining tramadol with an MAO (monoamine oxidase inhibitor) inhibitor or SSRI (selective serotonin reuptake inhibitors) can lead to seizures or other serious side effects.

Be sure to tell your doctor about all medications you are taking.

6 - Tramadol, when combined with certain other substances, can increase central nervous system and respiratory depression.

In other words, breathing may be affected or even stop if tramadol is combined with alcohol, narcotic drugs, anesthetics, tranquilizers, or sedatives.

7 - The use of tramadol during pregnancy should be avoided.

Because the safety of tramadol use during pregnancy has not been established, the medication should not be used during pregnancy. The safe use of tramadol in nursing mothers has also not been established.

8 - Tramadol is usually well-tolerated. Any side effects are usually temporary.

Some of the common side effects associated with tramadol include:

• nausea
• constipation
• dizziness
• headache
• drowsiness
• vomiting

Less common side effects include: itching, sweating, diarrhea, rash, dry mouth, and vertigo. There have been patients who developed seizures after taking tramadol.

9 - A Cochrane Review of tramadol to treat osteoarthritis revealed some small benefit.

The Cochrane Review stated that when tramadol is taken for up to 3 months, there may be decreased pain, improvements in function and stiffness and overall well-being. However, tramadol can cause side effects that are significant enough to require that the patient must stop taking the medication. Risks outweigh benefits for many people who have tried tramadol.

10 - If an overdose of tramadol has occurred, call your local poison control center, or call 911 if it appears to be an emergency situation.

Symptoms of an overdose include decreased pupil size, difficulty breathing or staying awake, unconscious, coma, heart attack, or seizure. Call for help, even if you are unsure about what to do.