Health Information

Medications for Osteoarthritis

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 (OA). Since OA is different in everyone, it may take some time to find the right combination of medications that give you the least number of side effects.

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

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, may also be an option.

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 upset
  • Stomach ulcers and bleeding
  • 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

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

Cyclooxygenase-2 or COX-2 Inhibitors
  • Celecoxib
  • Meloxicam

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 those currently with cardiovascular disease, or those with risk factors.

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

If you have severe pain from OA, 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 regular monitoring is likely during the times they are used.

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

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

Common name: Duloxetine

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. They may cause severe withdrawal symptoms.

Over-the-Counter Medications

Acetaminophen

Common brand names include:

  • Tylenol

Acetaminophen can be helpful in relieving some of the pain associated with OA. 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. 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 people with RA.

Capsaicin Cream

Common brand names include:

  • Zostrix

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

Capsaicin cream is made from the active ingredient in 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

If you are taking medications, follow these general guidelines:

  • Take your medications as directed. Do not change the amount or the schedule.
  • Ask what side effects could occur. Discuss them with your doctor.
  • Talk to your doctor before you stop taking any prescription medication.
  • Plan ahead for refills if you need them.
  • Do not share your prescription medication with anyone.
  • Drugs can be dangerous when mixed. Talk to your doctor if you are taking more than one drug, including over-the-counter products and supplements.

Revision Information

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

  • Degenerative joint disease of the hip. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated November 17, 2014. Accessed December 1, 2014.

  • Degenerative joint disease of the knee. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated November 25, 2014. Accessed December 1, 2014.

  • 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 December 1, 2014.

  • Osteoarthritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health%5FInfo/Osteoarthritis/default.asp. Updated August 2013. Accessed December 1, 2014.

  • 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.

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

  • 2/17/2012 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: 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 December 1, 2014.