Medications for Osteoarthritis

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The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medications as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.

There are a variety of medications available to treat the pain and inflammation of osteoarthritis. You may have to try different medications before you find the one that works best for you, with the least number of side effects.

Prescription Medications

Nonsteroidal Anti-inflammatory drugs (NSAIDs)

  • Naproxen (Naprosyn, Anaprox, Aleve)
  • Ketoprofen (Nexcede)
  • Ibuprofen (Motrin, Advil, Nuprin)
  • Indomethacin (Indocin)
  • Sulindac (Clinoril)
  • Meclofenamate (Meclomen)
  • Ketorolac (Toradol)
  • Piroxicam (Feldene)
  • Diclofenac (Voltaren, Solaraze )

Cyclooxgenase-2 or COX-2 Inhibitors

  • Celecoxib (Celebrex)
  • Meloxicam (Mobic)

Opioids

  • Hydrocodone (Vicodin, Norco)
  • Oxycodone (Percocet, OxyContin)
  • Morphine (MS-Contin)
  • Hydromorphone (Dilaudid)
  • Fentanyl (Duragesic)
  • Methadone

Antidepressants

  • Duloxetine (Cymbalta)

Over-the-Counter Medications

Acetaminophen (Tylenol)

Capsaicin cream (Zostrix)

Prescription Medications

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
  • Naproxen (Naprosyn, Anaprox, Aleve)
  • Ketoprofen (Nexcede)
  • Ibuprofen (Motrin, Advil, Nuprin)
  • Indomethacin (Indocin)
  • Sulindac (Clinoril)
  • Meclofenamate (Meclomen)
  • Ketorolac (Toradol)
  • Piroxicam (Feldene)
  • Diclofenac (Voltaren, Solaraze )

Nonsteroidal anti-inflammatory drugs (NSAIDs) help decrease inflammation, swelling, and joint pain. Many NSAIDs are available over-the-counter. You may be given a prescription for a higher dose. Topical pain medications, such as creams or patches, are another option. Diclofenac is one example.

Drinking alcoholic beverages or taking other NSAIDs while you are already using an NSAID can increase your risk of side effects. Always take NSAIDs with food to decrease the chance of stomach upset.

Possible side effects include:

  • Stomach problems, including:
  • Worsening of chronic conditions, such as high blood pressure, heart failure, or kidney disease
  • Kidney damage
  • Liver inflammation
  • Lightheadedness
  • Severe allergic reaction, such as hives, difficulty breathing, or swelling around the eyes
  • Increased risk of bleeding—always inform your healthcare providers that you are taking an NSAID before having any medical or dental procedures or surgeries

NSAIDs may cause an increased risk of serious cardiovascular problems, like myocardial infarction and stroke. This risk is especially important for patients with cardiovascular disease or who are have risk factors for cardiovascular disease.

Cyclooxygenase-2 or COX-2 Inhibitors
  • Celecoxib (Celebrex)
  • Meloxicam (Mobic)

COX-2 inhibitors work in a way similar to NSAIDs, helping to decrease inflammation, swelling, and joint pain. In addition, they have the benefit of causing less stomach irritation. In particular, COX-2 inhibitors cause far fewer stomach ulcers than do NSAIDs.

Drinking alcoholic beverages or taking NSAIDs while you are using a COX-2 inhibitor can increase your risk of side effects.

Possible side effects include:

  • Stomach problems, including stomach upset and ulcers
  • Kidney damage
  • Liver inflammation
  • Severe allergic reaction, such as (hives, difficulty breathing, or swelling around the eyes
  • Worsening of chronic conditions, such as high blood pressure, heart failure, or kidney disease

COX-2 inhibitors may cause an increased risk of serious cardiovascular problems, like myocardial infarction and stroke. This risk is especially important for patients with cardiovascular disease or who are have risk factors for cardiovascular disease.

Opioids
  • Hydrocodone (Vicodin, Norco)
  • Oxycodone (Percocet, OxyContin)
  • Morphine (MS-Contin)
  • Hydromorphone (Dilaudid)
  • Fentanyl (Duragesic)
  • Methadone

If you have severe pain from osteoarthritis, your doctor may prescribe opioids. This type of drug works by acting on the central nervous system to relieve pain. Opioids can be very effective. They may cause dependence, so your doctor will closely monitor your while you use them.

Some opioids may contain acetaminophen. Read the ingredient list on medication labels. High doses of acetaminophen can increase the risk of liver damage. Check the ingredient list of all your medications to make sure you are not taking too much acetaminophen.

Possible side effects include:

  • Feeling lightheaded, sleepy, having blurred vision, or a change in thinking clearly
  • Nausea or vomiting
  • Constipation
  • Itching
  • Dry mouth
Antidepressants

Common name: Duloxetine (Cymbalta)

Antidepressants may also be prescribed for chronic pain caused by osteoarthritis.

Possible side effects include:

  • Lightheadedness
  • Sleepiness
  • Change in ability to think clearly
  • Feeling nervous or excited
  • Blurred vision
  • Dry mouth
  • Headache
  • Nausea, vomiting
  • Diarrhea
  • Insomnia
  • Change in sexual ability or desire

Do not stop taking antidepressants without first checking with your doctor.

Over-the-Counter Medications

Acetaminophen

Common brand names include:

  • Tylenol

Acetaminophen can be helpful in relieving some of the pain associated with osteoarthritis. Do not take a larger dose than is recommended by your healthcare provider. Do not drink alcoholic beverages if you are taking acetaminophen on a daily basis. This is because acetaminophen in high doses or with alcohol can increase the risk of liver damage.

Side effects are rare. A few people may experience an allergic reaction after taking the drug. If you develop a rash, swelling, or difficulty breathing, stop taking the acetaminophen and get medical attention.

Acetaminophen should be considered the first-line drug treatment in most osteoarthritis patients.

Capsaicin Cream

Common brand names include:

  • Zostrix

Capsaicin cream is a rubbed on the skin of an affected joint to relieve the pain and inflammation of osteoarthritis.

Capsaicin cream is made from the active ingredient of hot chile peppers. Some people prefer to wear rubber gloves while applying the cream. If you don’t, be sure to wash your hands thoroughly with soap and water after using the cream. Be very careful not to get the cream near your eyes, as it will burn and sting. If you do get some in your eyes, flush them thoroughly with cool water.

Possible side effects include:

  • Burning, stinging, or warm sensation when first applied to the skin.

Special Considerations

Whenever you are taking a prescription medication, take the following precautions:

  • Take your medication as directed. Do not change the amount or the schedule.
  • Do not stop taking them without talking to your doctor.
  • Do not share them.
  • Know what the results and side effects may be. Report them to your doctor.
  • Some drugs can be dangerous when mixed. Talk to a doctor or pharmacist if you are taking more than one drug. This includes over-the-counter medication and herb or dietary supplements.
  • Plan ahead for refills so you do not run out.

Revision Information

  • John M Eisenberg Center for Clinical Decisions and Communications Science. Managing osteoarthritis pain with medicines: a review of the research for adults. Agency for Healthcare Research and Quality website. Available at: http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=950&ECem=120215. Published February 15, 2012. Accessed July 23, 2013.

  • Osteoarthritis. Arthritis Foundation website. Available at: http://www.arthritis.org/conditions-treatments/disease-center/osteoarthritis. Accessed July 23, 2013.

  • Osteoarthritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health%5FInfo/Osteoarthritis/default.asp. Updated July 2010. Accessed July 23, 2013.

  • Sinusas, K. Osteoarthritis: Diagnosis and treatment. Am Fam Physician. 2012;85(1):49-56.

  • White WB. Cardiovascular risk, hypertension, and NSAIDs. Curr Rheumatol Rep. 2007;9(1):36-43.

  • Wong M, Chowienczyk P, et al.Cardiovascular issues of COX-2 inhibitors and NSAIDs. Aust Fam Physician. 2005;34(11):945-948

  • 3/17/2007 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Yelland MJ, Nickles CJ, et al. Celecoxib compared with sustained-release paracetamol for osteoarthritis: a series of n-of-1 trials. Rheumatology (Oxford). 2007;46:135-140. Epub 2006 Jun.

  • 2/7/2008 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Underwood M, Ashby D, et al. Advice to use topical or oral ibuprofen for chronic knee pain in older people: randomised controlled trial and patient preference study. BMJ. 2008;336:138-142. Epub 2007 Dec 4.

  • 10/26/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Massey T, Derry S, et al. Topical NSAIDs for acute pain in adults. Cochrane Database Syst Rev. 2010;(6):CD007402.

  • 11/15/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: US Food and Drug Administration. FDA clears Cymbalta to treat chronic musculoskeletal pain. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm232708.htm. Published November 4, 2010. Accessed November 12, 2010.

  • 2/17/2012 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Agency for Healthcare Research and Quality. Analgesics for osteoarthritis: an update of the 2006 comparative effectiveness review. Agency for Healthcare Research and Quality website. Available at: http://effectivehealthcare.ahrq.gov/ehc/products/180/795/Analgesics-Update%5FCER-38%5F20111007.pdf. Published October 2011. Accessed July 23, 2013.