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Taking the drugs/Administration

The best way to take your tablets is during a meal with food and water. It is important that you do not break or chew the tablets, but swallow them whole (exception: you can break the 5 mg prednisolone tablets).
After the first three months, your rheumatologist will check whether the disease has been suppressed sufficiently or that the dosage of your medication has to be adjusted. When the disease has been sufficiently suppressed, the tapering of prednisolone can start after 6 months.  In this way, you and your rheumatologist evaluate every three months what treatment has the best effect on you. The tables in the download-menu provide a tool for you to remember the correct way of intake of all drugs.

I forgot to take my drugs

If you have forgotten to take your drugs at the correct time, try to take them on a later time, during the same day. If you forgot to take methotrexate, try to take it the same day, or at most one day later. If this is not possible skip your methotrexate tablets for that week and continue taking the regular amount of tablets on your usual methotrexate-day the next week.
Only for prednisolone it is important that: if you are ill and have to vomit within two hours of taking the tablets, please take the same amount of tablets again.

Non-steroidal anti inflammatory drugs (NSAID’s) and stomach-protectors

Most patients with active arthritis use specific painkillers  and stomach protectors. These specific painkillers are also called NSAID’s which means: Non-Steroidal-Anti-Inflammatory-Drugs. Examples of NSAIDs are: naproxen, diclofenac and ibuprofen. Stomach protectors protect your stomach from the NSAIDs.
We advise you to discuss with your rheumatologist whether you can stop the NSAIDs and stomach protectors as soon as COBRA therapy is working for you. This is usually within a few days.

Use in combination with other drugs
In general, methotrexate, sulphasalazine and prednisolone can be used in combination with almost any other drug. Nevertheless, tell you general practitioner and also your dentist, what drugs you use.
Sulfasalazine can influence the action of anticoagulant drugs such as warfarin (and other coumarin derivatives). The same is true for the combination of sulfasalazine and iron supplements, digoxin, and some drugs for diabetes.
In contrast to what is sometimes stated in package inserts methotrexate can be used together with NSAIDs because the dose of methotrexate is low. You should not combine methotrexate with some antibiotics, especially cotrimoxazol and other sulfa-containing drugs. These antibiotics are sometimes used to treat pneumonia and urinary tract infections.


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