This sheet gives you a basic idea about each of the medicines below. Only the most common side effects are listed. Ask your doctor if you need to take any special steps. Use each of these medicines the way your doctor tells you to. Follow the advice you are given. If you have questions, call your doctor.

There are many medicines to treat the pain and inflammation of osteoarthritis (OA). OA is not the same from one person to the next. It may take some time to find the right medicines that give you the least number of problems.

Prescription Medications

Nonsteroidal Anti-inflammatory drugs (NSAIDs)

  • Naproxen
  • Ketoprofen
  • Ibuprofen
  • Indomethacin
  • Sulindac
  • Meclofenamate
  • Ketorolac
  • Piroxicam
  • Diclofenac

Cyclooxgenase-2 or COX-2 Inhibitors

  • Celecoxib
  • Meloxicam

Opioids

  • Hydrocodone
  • Oxycodone
  • Morphine
  • Hydromorphone
  • Fentanyl
  • Methadone

Antidepressants

  • Duloxetine

Over-the-Counter Medications

Acetaminophen

Capsaicin cream

Prescription Medications

 

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

  • Naproxen
  • Ketoprofen
  • Ibuprofen
  • Indomethacin
  • Sulindac
  • Meclofenamate
  • Ketorolac
  • Piroxicam
  • Diclofenac

NSAIDs help to decrease inflammation, swelling, and joint pain. Many are available without a prescription. You may be given a prescription for a higher dose. Some may also be available as creams or patches. They can be placed on skin over the area.

Here are some side effects:

  • Stomach upset
  • Stomach ulcers and bleeding
  • Worsening of some health problems, such as high blood pressure, heart failure, or kidney disease
  • Kidney damage
  • Liver inflammation
  • Lightheadedness
  • Severe allergic reaction, such as hives, problems breathing, or swelling around the eyes
  • Risk of bleeding

Always take NSAIDs with food. This will decrease the risk of stomach upset. Do not drink alcohol while taking NSAIDs, it causes extra stress on the liver. If you are taking NSAIDs beware of any other medicine you are taking. Avoid taking other medicine that also has NSAIDs.

NSAIDs may cause an increased risk of serious problems. This includes a higher risk of a heart attack and stroke. This risk is important for those who already have heart disease or risk factors like high blood pressure.

 

Cyclooxygenase-2 or COX-2 Inhibitors

  • Celecoxib
  • Meloxicam

COX-2 inhibitors work like NSAIDs. They help with inflammation, swelling, and joint pain. They cause less stomach irritation than NSAIDs.

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

Here are some side effects:

  • Stomach problems, such as stomach upset and ulcers
  • Kidney damage
  • Liver inflammation
  • Severe allergic reaction, such as hives, problems 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 a higher risk of heart problems. This can include a higher risk of heart attack or stroke. Talk to your doctor about medicine options if you already have heart disease or risk factors.

 

Opioids

  • Hydrocodone
  • Oxycodone
  • Morphine
  • Hydromorphone
  • Fentanyl
  • Methadone

If you have severe pain from OA, your doctor may prescribe opioids to relieve pain. They work well, but may cause dependence. Your doctor will check in with you often while you are using them.

Some opioids may have acetaminophen. Acetaminophen is also a common ingredient in many over the counter medicines. You may be at risk for taking high doses of acetaminophen. High doses of it can harm your liver. Read the ingredient list on labels. Make sure you are not taking too much acetaminophen.

Here are some side effects:

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

Antidepressants

Antidepressants may help decrease chronic pain. It may be prescribed for chronic pain caused by OA.

Common name: Duloxetine

Here are some side effects:

  • Lightheadedness
  • Sleepiness
  • Problems thinking clearly
  • Feeling nervous or excited
  • Blurred vision
  • Dry mouth
  • Headache
  • Nausea and vomiting
  • Diarrhea
  • Insomnia
  • Change in sexual ability or desire

This type of medicine can cause severe symptoms if it is stopped too fast. Do not stop taking this medicine without talking to your doctor first.

Over-the-Counter Medications

 

Acetaminophen

Acetaminophen can help relieve pain from OA. Do not take a larger dose than your doctor tells you to. Do not drink alcohol if you take it every day. If you take it in high doses or with alcohol, it can harm your liver.

Side effects are rare. A few people may have an allergic reaction. If you get a rash, swelling, or have problems breathing, then stop taking it and get help.

Acetaminophen should be the first option in most people with OA.

 

Capsaicin Cream

Common brand names include:

  • Zostrix

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

It is made from the active part of hot chile peppers. Some people wear rubber gloves when they put it on. If you don’t, be sure to wash your hands with soap and water after you use it. Do not get the cream near your eyes. It will burn and sting. If you do get some in your eyes, flush them well with cool water.

You may have burning, stinging, or a warm feeling when you first put it on

Special Considerations

If you are taking medications, follow these steps:

  • Take your medicine as directed. Do not change the amount or schedule.
  • Ask what side effects could occur. Report them to your doctor.
  • Talk to your doctor before you stop taking any prescription medicine.
  • Do not share your prescription medicine.
  • Medicine can be dangerous when mixed. Talk to your doctor or pharmacist if you are taking more than one medicine, including over-the-counter products and supplements.
  • Plan ahead for refills as needed.
REFERENCES:

ACR issues recommendations on therapies for osteoarthritis of the hand, hip, and knee. Am Fam Physician. 2013;87(7):515-516.

Massey T, Derry S, et al. Topical NSAIDs for acute pain in adults. Cochrane Database Syst Rev. 2010;(6):CD007402.

Osteoarthritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health_Info/Osteoarthritis/default.asp. Updated May 30, 2016. Accessed May 30, 2018.

Osteoarthritis (OA) of the knee. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T116897/Osteoarthritis-OA-of-the-knee. Updated March 15, 2018. Accessed May 30, 2018.

Osteoarthritis (OA) of the hip. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T114846/Osteoarthritis-OA-of-the-hip. Updated March 15, 2018. Accessed May 30, 2018.

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.

Last reviewed May 2018 by EBSCO Medical Review Board Warren A. Bodine, DO, CAQSM  Last Updated: 7/12/2018