Treatment     Taking the drugs      Possible side effects     Downloads     Links & ideas Sitemap
    Sulphasalazine     Methotrexate     Prednisolone  

Possible side effects

Although COBRA therapy is generally well tolerated, all drugs can cause  side effects. These form a big list, but fortunately most side effects are rare.

In the package inserts you can find all possible side effects of the drugs. You should not be alarmed by this list. For sulphasalazine and methotrexate, the most common side effects are nausea and bloating. Abnormalities in blood, liver and lungs are rare. Hypersensitivity reactions are also rare with simultaneous use of prednisolone.  For prednisolone, the most common side effects are (mostly temporary) weight gain caused by fluid retention and increase of appetite; agitation; increases in blood pressure, eye pressure and blood sugar; and with longer use osteoporosis, an increased likelihood of infections and cataract.
To rapidly detect side effects, your rheumatologist will regularly check your blood pressure, blood and urine. If your eyes are causing complaints you should report this to your rheumatologist. Most side effects can be rapidly reversed on adaptation of your treatment.


To further decrease the chance of developing side effects of methotrexate and prednisolone, a combination of vitamins is prescribed. This comprises folic acid, calcium and vitamin D. Folic acid helps to control the side effects of methotrexate. Calcium and vitamin D are for strong bones. Calcium tablets should be taken in the evening.
This vitamin package is the complete nutritional supplement you need as a consequence of your disease and COBRA treatment. We advise against the use of other additional vitamin packages.

Bone measurements

Because you use prednisolone for more than three months in a dosage of more than 7.5mg it is advised to measure bone mass (DEXA-scan). If your bone mass is too low, your rheumatologist will prescribe extra medication (usually a bisphosphonate) to limit further bone loss.

Healthy lifestyle

The rheumatic inflammation costs the body a lot of energy and a lot of people have lost weight since the disease has started. A powerful treatment like COBRA therapy can lead to an increase in weight of some kilo’s. You can anticipate to this by exercising enough and paying attention to your diet.
It is important to inform your rheumatologist when you are considering a pregnancy or if you are pregnant. The drugs can have an effect on your fertility or on the unborn child.

The following links provide a detailed overview of the most frequently seen side effects of the three drugs that have been prescribed to you: sulphasalazine, methotrexate and prednisolone.


Design by: