Psoriatic Arthritis treatments

Upadacitinib is a Janus kinase (JAK) inhibitor and belongs to a group of medicines known as disease-modifying antirheumatic drugs (DMARDs). It is used to treat adults with active psoriatic arthritis when previous treatment with one or more DMARDs has not worked well enough or has not been tolerated.

Upadacitinib can be used on its own or together with methotrexate.

Upadacitinib works by blocking the activity of enzymes called Janus kinases (JAKs). These enzymes help carry signals involved in inflammation. By reducing these signals, upadacitinib can reduce inflammation associated with psoriatic arthritis.

Treatment can help reduce joint pain, stiffness and swelling and may improve physical function and quality of life. It can also improve some of the skin symptoms associated with psoriatic arthritis and can help slow the progression of joint damage.

Who can get it?

Upadacitinib is available on prescription and treatment should be started and supervised by a specialist experienced in treating psoriatic arthritis.

For psoriatic arthritis, it is prescribed for adults whose disease has not responded adequately to, or who cannot tolerate, one or more DMARDs. It can be used alone or in combination with methotrexate.

Because JAK inhibitors are associated with an increased risk of some serious side effects, particular caution is needed in people aged 65 years or over, people who currently smoke or have smoked for a long time, and people with cardiovascular or other risk factors. In these groups, upadacitinib should only be used when there are no suitable alternative treatments.

You will need blood tests before and during treatment. These may be used to check your blood cell counts, cholesterol and other blood fats, and liver function.

You should avoid food and drink containing grapefruit while taking upadacitinib because grapefruit can increase the amount of medicine in your blood and may increase the risk of side effects.

Do not take upadacitinib if you:

• are allergic to upadacitinib or any of the other ingredients
• have active tuberculosis (TB)
• have an active serious infection
• have severe liver problems
• are pregnant.

Your doctor will also check for infections such as TB before treatment is started.

How is it used?

For psoriatic arthritis, the recommended dose is:

15 mg once a day.

• Take the tablet once a day, preferably at the same time each day.
• It can be taken with or without food.
• Swallow the tablet whole with water.
• Do not split, crush or chew the tablet, as this can affect how the medicine is released into your body.

Your doctor may advise you to interrupt treatment if you develop a serious infection. The dose may also need to be adjusted in some people with severe kidney problems.

What are the side effects?

Like all medicines that affect the immune system, upadacitinib can increase the risk of infections. Common infections include infections of the nose and throat, urinary tract infections, herpes simplex and shingles.

Common side effects can include:

• sore throat and other upper respiratory tract infections
• acne
• cough
• fever
• nausea
• headache
• tiredness
• abdominal pain
• urinary tract infection
• influenza
• cold sores
• rash
• increased cholesterol
• increased liver enzymes shown by blood tests
• increased creatine kinase shown by blood tests
• anaemia or changes in white blood cell counts
• weight gain
• inflammation of the hair follicles (folliculitis)
• hives (urticaria).

Other side effects can include increased triglycerides, oral thrush and diverticulitis.

Upadacitinib can rarely cause serious infections. It is also associated with an increased risk of blood clots, major cardiovascular events and some cancers. These risks are particularly important in certain higher-risk patients, including some older people and people with cardiovascular or smoking risk factors.

Seek urgent medical advice if you develop symptoms that could indicate a serious infection, blood clot or cardiovascular problem, such as persistent fever, severe breathlessness, chest pain, or painful swelling of a leg.

Your doctor will monitor you during treatment and may stop or interrupt treatment if serious side effects occur.

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Upadacitinib is known commercially as Rinvoq® and is marketed in the UK by AbbVie Ltd.

Reviewed: August 2026
Version ID: 2/UPA/PAT/08/26

Risankizumab is a biological medicine used to treat adults with active psoriatic arthritis. It may be used when previous treatment with one or more disease-modifying antirheumatic drugs (DMARDs) has not worked well enough or has not been tolerated.

Risankizumab can be used on its own or in combination with other medicines used to treat psoriatic arthritis.

How does it work?

Risankizumab is a biological medicine that specifically blocks a protein called interleukin-23 (IL-23). IL-23 plays an important role in causing inflammation in psoriasis and psoriatic arthritis.

By blocking IL-23, risankizumab reduces inflammation and can help improve symptoms such as joint pain, stiffness and swelling. It can also improve psoriasis affecting the skin and nails and may help slow the progression of joint damage.

Who can get it?

Risankizumab is available on prescription for adults with active psoriatic arthritis.

Your specialist will decide whether risankizumab is suitable for you, taking into account your previous treatments and how active your condition is.

Before treatment begins, you will usually be checked for infections, including tuberculosis (TB). Risankizumab should not normally be given to people with a clinically important active infection.

How is it used?

Risankizumab is given as an injection under the skin (subcutaneous injection).

For psoriatic arthritis, the usual dose is:

• 150 mg at week 0
• 150 mg at week 4
• followed by 150 mg every 12 weeks.

Each 150 mg dose is given as two 75 mg injections.

Your healthcare professional may teach you how to give the injections yourself, or they may be administered by a healthcare professional.

What are the side effects?

Like all medicines, risankizumab can cause side effects, although not everyone experiences them.

Very common: may affect more than 1 in 10 people

• Upper respiratory tract infections, such as a sore throat or blocked nose.

Common: may affect up to 1 in 10 people

• Tiredness
• Fungal skin infections
• Injection-site reactions, such as redness, swelling or pain
• Itching

• Headache.

Uncommon: may affect up to 1 in 100 people

• Small raised red bumps on the skin.

Because risankizumab affects part of the immune system, it can make some infections more likely. Tell your doctor if you develop signs of an infection, particularly a persistent fever, chills, night sweats, a persistent cough, shortness of breath, or painful, warm or reddened skin.

You should also tell your doctor if you have an infection before having an injection.

How do I get risankizumab?

Risankizumab is available on prescription only and is normally prescribed and monitored by a specialist.

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Risankizumab is known commercially as Skyrizi® and is marketed in the UK by AbbVie Ltd.

Reviewed: August 2026
Version ID: 2/RIS/PAT/08/26

Bimekizumab is a biologic medicine used to treat adults with active psoriatic arthritis when other disease-modifying antirheumatic drugs (DMARDs) have not worked well enough or cannot be tolerated. It can be used on its own or together with methotrexate. NICE recommends bimekizumab for certain adults with active psoriatic arthritis who have not responded adequately to previous DMARD treatment.

Bimekizumab is also used to treat moderate to severe plaque psoriasis and some other inflammatory conditions.

How does it work?

Bimekizumab is a biologic medicine called an interleukin-17 (IL-17) inhibitor. It blocks two inflammatory proteins, IL-17A and IL-17F, which play an important role in the inflammation associated with psoriatic arthritis and psoriasis.

By reducing the activity of these proteins, bimekizumab reduces inflammation. This can help improve joint pain, stiffness and swelling, as well as psoriasis affecting the skin and nails. It can also improve physical functioning and quality of life.

Who can get it?

Bimekizumab is available on prescription for adults with active psoriatic arthritis.

For NHS treatment, NICE recommends it for adults whose psoriatic arthritis has not responded well enough to DMARDs or who cannot tolerate them, and who have had two conventional DMARDs and at least one biological DMARD, or for whom TNF-alpha inhibitors are contraindicated.

It can be used on its own or with methotrexate.

How is it used?

Bimekizumab is given as an injection under the skin (subcutaneous injection).

For psoriatic arthritis, the usual dose is:

• 160 mg once every 4 weeks.

If you have psoriatic arthritis together with moderate to severe plaque psoriasis, the recommended dose is:

• 320 mg at weeks 0, 4, 8, 12 and 16, followed by 320 mg every 8 weeks.
• After week 16, if the joint response is not maintained, your doctor may consider changing the dose to 160 mg every 4 weeks.

Your doctor will assess how well the treatment is working and decide whether you should continue treatment.

What are the side effects?

Like all medicines, bimekizumab can cause side effects, although not everyone gets them.

Very common

• Upper respiratory tract infections, such as a sore throat or blocked nose.

Common

• Oral thrush (candidiasis)
• Fungal skin infections, such as athlete's foot
• Ear infections
• Cold sores (herpes simplex)
• Gastroenteritis
• Inflamed hair follicles (folliculitis)
• Headache
• Rash, dermatitis or eczema
• Acne
• Injection-site reactions, such as redness, swelling or pain
• Feeling tired (fatigue).

Uncommon

• Reduced levels of certain white blood cells (neutropenia)
• Fungal infections affecting the skin or mucous membranes, including the oesophagus
• Conjunctivitis
• Inflammatory bowel disease.

Serious allergic reactions, including anaphylaxis, have been reported with IL-17 inhibitors. Seek urgent medical attention if you develop symptoms of a serious allergic reaction, such as swelling of the face, lips, tongue or throat, difficulty breathing or severe dizziness.

Because bimekizumab affects part of the immune system, your doctor will check for infections and other relevant health problems before and during treatment.

How do I get bimekizumab?

Bimekizumab is available on prescription and is normally started and monitored by a healthcare professional experienced in treating psoriatic arthritis.

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Bimekizumab is known commercially as Bimzelx and is marketed in the UK by UCB Pharma Ltd

Reviewed: August 2026
Version ID: 2/BIM/PAT/08/26

Adalimumab is a biologic medicine used to treat psoriatic arthritis. It is also used to treat a number of other inflammatory conditions, including rheumatoid arthritis and plaque psoriasis.

It belongs to a group of medicines called TNF-alpha (TNF-α) inhibitors. Adalimumab is available in several biosimilar brands as well as the original brand, Humira.

How does it work?

Adalimumab blocks the action of a protein called tumour necrosis factor-alpha (TNF-α).

TNF-α is one of the chemical messengers involved in inflammation. Too much TNF-α can contribute to inflammation in the joints and skin in conditions such as psoriatic arthritis and psoriasis.

By blocking TNF-α, adalimumab reduces inflammation. This can help improve symptoms such as joint pain, swelling and stiffness and can also improve psoriasis affecting the skin

Who can get it?

Adalimumab is available on prescription for adults with active psoriatic arthritis. It can be used on its own or in combination with other medicines, including methotrexate. Adalimumab should not be used in people with an active tuberculosis infection or another serious infection, and it should not be used in people with moderate or severe heart failure. It is also contraindicated in people with hypersensitivity to adalimumab or any of the ingredients.

Your doctor will check for infections, including tuberculosis, before treatment and will consider your medical history before prescribing adalimumab.

People with certain neurological conditions, including multiple sclerosis or other demyelinating disorders, require particular caution when treatment with a TNF inhibitor is considered.

How is it used?

Adalimumab is given as an injection under the skin (subcutaneous injection). Many people can learn to administer the injection themselves at home.

For adults with psoriatic arthritis, the usual dose is:

40 mg every other week.

Adalimumab is normally continued for as long as it is controlling the condition and remains appropriate. Your doctor will regularly assess how well the treatment is working.

The dose used for plaque psoriasis is different from the dose used for psoriatic arthritis, so patients should follow the dosing instructions provided for their particular condition.

What are the side effects?

Because adalimumab affects part of the immune system, it can increase the risk of infections.

Common side effects include:

• respiratory tract infections
• headaches
• abdominal pain
• nausea
• diarrhoea
• rash
• itching
• injection-site reactions, such as redness, swelling or pain
• muscle or bone pain
• increased levels of liver enzymes seen in blood tests.

Other side effects can include changes in blood counts and allergic reactions.

Serious infections can occur, including tuberculosis and serious bacterial, fungal or viral infections. Patients should tell their doctor if they develop signs of a serious infection, such as persistent fever, feeling very unwell or a persistent cough.

Rarely, TNF inhibitors have been associated with neurological disorders, heart failure or certain cancers. Your doctor will discuss the risks and benefits of treatment with you.

Pregnancy and breastfeeding

If you are pregnant, planning to become pregnant or breastfeeding, tell your doctor.

Adalimumab can be used during pregnancy when clinically needed. It can also be used during breastfeeding. Your doctor will discuss whether treatment should be continued during pregnancy and whether any changes are needed around the time of delivery.

How do I get adalimumab?

Adalimumab is available on prescription and is generally initiated and monitored by a specialist.

NICE recommends adalimumab and other TNF inhibitors as treatment options for eligible people with active psoriatic arthritis. The choice of biologic depends on factors such as previous treatment, other conditions and whether psoriasis is also present.

.

Adalimumab is known commercially as:

Reviewed: August 2026
Version ID: 2/ADA/PAT/08/26

Certolizumab pegol is a biologic medicine used to treat active psoriatic arthritis in adults when previous treatment with disease-modifying antirheumatic drugs (DMARDs) has not worked well enough. It can be used together with methotrexate or on its own when methotrexate is not appropriate or is not tolerated.

It belongs to a group of medicines called TNF-alpha (TNF-α) inhibitors.

How does it work?

Certolizumab pegol blocks the action of a protein called tumour necrosis factor-alpha (TNF-α).

TNF-α is a chemical messenger involved in inflammation. Excessive TNF-α activity contributes to inflammation in conditions such as psoriatic arthritis and psoriasis.

By blocking TNF-α, certolizumab pegol reduces inflammation. This can help reduce joint pain, swelling and stiffness and improve physical function and quality of life.

Who can get it?

Certolizumab pegol is available on prescription for adults with active psoriatic arthritis.

It is not licensed for the treatment of psoriatic arthritis in children.

The NHS use of certolizumab pegol is subject to clinical criteria and specialist assessment. NICE recommends certolizumab pegol as an option for eligible adults with active psoriatic arthritis.

How is it used?

Certolizumab pegol is given as an injection under the skin (subcutaneous injection).

For adults with psoriatic arthritis, the recommended starting treatment is:

• 400 mg (two 200 mg injections) at weeks 0, 2 and 4.
• This is followed by 200 mg every 2 weeks.

Alternatively, after the starting doses, 400 mg every 4 weeks can be considered as a maintenance treatment.

Your doctor will decide which dosing schedule is most appropriate for you. Treatment is normally started and monitored by a specialist.

What are the precautions and side effects?

Because certolizumab pegol affects part of the immune system, it can increase the risk of infections.

Before treatment, you will normally be assessed for tuberculosis (TB) and other infections. People with active TB or another serious infection should not normally start treatment until the infection has been treated.

Tell your doctor if you develop symptoms of an infection during treatment, such as persistent fever, cough or feeling unusually unwell. Treatment may need to be temporarily stopped if you develop a serious infection.

Your doctor may also check for hepatitis B before treatment where appropriate, as TNF inhibitors can cause hepatitis B to reactivate in people who have previously been infected.

Certolizumab pegol should not normally be used in people with moderate or severe heart failure. Tell your doctor if you have heart failure or develop new or worsening symptoms such as increasing breathlessness or swelling of the legs.

Other conditions may require particular caution, including certain neurological disorders, blood disorders, liver problems and a history of cancer. Your doctor will assess your individual risks before treatment.

Possible side effects include:

• infections, including respiratory infections
• headache
• nausea
• fever
• rash and other skin reactions
• itching
• injection-site reactions, such as pain, redness or swelling
• high blood pressure
• weakness or tiredness
• changes in blood cell counts
• changes in liver blood tests
• sensory disturbances, such as tingling or numbness.

Serious allergic reactions can occur but are uncommon. Seek medical attention if you develop swelling of the face, lips, tongue or throat, difficulty breathing or severe dizziness.

Rarely, TNF inhibitors can cause lupus-like reactions, serious infections, blood disorders or neurological problems. Tell your doctor about any new or unexplained symptoms.

Pregnancy and breastfeeding

Certolizumab pegol has an important advantage compared with some other biologic medicines because very little of the medicine crosses the placenta.

It can be used during pregnancy when clinically necessary, and it can also be used while breastfeeding. Your doctor will discuss whether treatment should be continued during pregnancy.

If certolizumab pegol is given during pregnancy, particularly later in pregnancy, tell the baby's healthcare professionals because this may affect the timing of certain live vaccines for the baby.

How do I get certolizumab pegol?

Certolizumab pegol is available on prescription and is normally started and monitored by a specialist.

NICE recommends certolizumab pegol as an option for eligible adults with active psoriatic arthritis when other treatments have not worked adequately or cannot be tolerated.

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Certolizumab pegol is known commercially as Cimzia® and is marketed in the UK by UCB Pharma Ltd.

Reviewed: August 2026
Version ID: 2/CER/PAT/08/26

Etanercept is a biologic medicine used to treat psoriatic arthritis and some other inflammatory conditions. It belongs to a group of medicines called tumour necrosis factor (TNF) inhibitors.

For adults with active and progressive psoriatic arthritis, etanercept may be considered when previous treatment with disease-modifying antirheumatic drugs (DMARDs) has not worked well enough. NICE recommends TNF inhibitors such as etanercept for people who have active peripheral arthritis and have not responded adequately to at least two standard DMARDs.

How does it work?

Etanercept blocks the action of a protein called tumour necrosis factor-alpha (TNF-α). TNF-α is one of the chemical messengers involved in inflammation.

By blocking TNF-α, etanercept reduces inflammation. This can help improve the pain, swelling and stiffness associated with psoriatic arthritis and can help reduce the progression of joint damage.

Who can get it?

Etanercept is available on prescription and treatment should be started and supervised by a specialist experienced in treating inflammatory diseases.

For adults with psoriatic arthritis, it is used when previous DMARD treatment has not worked adequately.

Etanercept can also be prescribed for some children and young people with inflammatory conditions, including juvenile idiopathic arthritis, psoriatic arthritis and severe plaque psoriasis, depending on their age and circumstances.

How is it used?

Etanercept is given as an injection under the skin (subcutaneous injection). Some people can be taught to inject themselves at home.

Psoriatic arthritis

The recommended dose is:

• 25 mg twice a week, or
• 50 mg once a week.

Treatment should be reviewed if there is no adequate response after about 12 weeks. NICE recommends discontinuing treatment if an adequate response to PsA treatment criteria has not been achieved at 12 weeks.

Plaque psoriasis
For adults, the recommended dose is 25 mg twice a week or 50 mg once a week. In some circumstances, 50 mg twice a week can be used for up to 12 weeks before reducing the dose. Treatment should normally be stopped if there is no response after 12 weeks.

Like all medicines that affect the immune system, etanercept can increase the risk of infections.

Common side effects can include:

• infections, including upper respiratory tract infections
• headache
• itching or rash
• injection-site reactions such as redness, itching, pain or swelling
• fever
• nausea
• dizziness
• cough or other respiratory symptoms.

More serious infections can occasionally occur. Before and during treatment, patients may need monitoring for infections such as tuberculosis and hepatitis B.

Rarely, serious allergic reactions, blood disorders, demyelinating disorders, heart failure or certain cancers can occur. Patients should seek medical advice if they develop symptoms of a serious infection or other concerning symptoms.

How do I get etanercept?

Etanercept is available on prescription and is normally initiated and supervised by a specialist.

Etanercept is available in the UK under several brand names, including:

Reviewed: August 2026
Version ID: 2/ETA/PAT/08/26

Golimumab is a biologic medicine used to treat active and progressive psoriatic arthritis in adults when previous treatment with DMARDs has not worked well enough. It belongs to a group of medicines called TNF inhibitors (TNF blockers). It can be used on its own or together with methotrexate.

How does it work?

Golimumab blocks the action of a protein called tumour necrosis factor-alpha (TNF-α). TNF-α is one of the chemical messengers involved in inflammation.

By blocking TNF-α, golimumab reduces inflammation. This can help reduce the pain, swelling and stiffness associated with psoriatic arthritis and can help reduce progression of joint damage.

Who can get it?

Golimumab is available on prescription and treatment should be started and supervised by a specialist experienced in treating inflammatory diseases.

For psoriatic arthritis, it is used in adults with active and progressive disease when previous DMARD treatment has not worked well enough. NICE recommends golimumab as an option for active and progressive psoriatic arthritis when the relevant criteria for TNF-inhibitor treatment are met.

How is it used?

Golimumab is given as an injection under the skin (subcutaneous injection). After appropriate training, some people can give themselves the injection at home.

For psoriatic arthritis, the usual dose is:

50 mg once a month, on the same date each month.

If you weigh more than 100 kg and have not had an adequate response after three or four doses, your doctor may consider increasing the dose to 100 mg once a month. The increased dose is associated with a higher risk of some serious adverse reactions.

Treatment should be reviewed if there is no evidence of benefit after approximately 12–14 weeks (3–4 doses).

What are the side effects?

Like other medicines that block TNF, golimumab can increase the risk of infections.

Very common side effects may include:

• upper respiratory tract infections, such as sore throat, runny nose and hoarseness.

Common side effects may include:

• bacterial infections
• viral infections, including influenza and cold sores
• superficial fungal infections
• bronchitis
• sinusitis
• anaemia
• dizziness
• headache
• high blood pressure
• abnormal liver-function blood tests
• depression
• difficulty sleeping
• stomach pain or indigestion
• constipation
• rash and itching
• hair loss
• weakness
• numbness or tingling
• injection-site reactions, such as redness, itching, pain, bruising or swelling.

More serious but less common effects include serious infections, tuberculosis, pneumonia, hepatitis B reactivation, serious allergic reactions, blood disorders, heart failure, demyelinating disorders and certain cancers. Patients should seek medical advice promptly if they develop symptoms of a serious infection or other concerning symptoms.

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Golimumab is available on prescription and is known commercially as Simponi. It is manufactured in the UK by Janssen-Cilag Ltd (a Johnson & Johnson company).

Reviewed: August 2026
Version ID: 2/GOL/PAT/08/26

Guselkumab is a biological medicine used to treat moderate to severe plaque psoriasis and active psoriatic arthritis in adults.

How does it work?

Guselkumab works by blocking the action of a protein in the immune system called interleukin-23 (IL-23).

IL-23 is involved in causing inflammation. In people with psoriasis or psoriatic arthritis, blocking IL-23 can help reduce inflammation and improve symptoms.

Guselkumab belongs to a group of medicines called IL-23 inhibitors.

What is it used for?

Plaque psoriasis

Guselkumab is used to treat moderate to severe plaque psoriasis in adults when other treatments have not worked well enough, are not suitable or cannot be tolerated.

It may be offered when psoriasis is having a significant effect on the skin and quality of life.

Psoriatic arthritis

Guselkumab can be used to treat active psoriatic arthritis. It may help reduce joint swelling, tenderness and stiffness, and can also improve psoriasis affecting the skin and nails.

It can be used on its own or alongside methotrexate.

How is it used?

Guselkumab is given as an injection under the skin.

The usual schedule is:

• One injection at week 0.
• One injection at week 4.
• One injection every 8 weeks after that.

For some people with psoriatic arthritis who are at higher risk of joint damage, the specialist may recommend an injection every 4 weeks.

The injection may be given by a healthcare professional. After suitable training, you may be able to inject it yourself or have a carer give it to you.

Your healthcare team will explain how and when to use guselkumab.

What are the side effects?

Like all medicines, guselkumab can cause side effects, although not everyone gets them.

Possible side effects include:

• Colds and other upper respiratory tract infections.
• Redness, swelling or discomfort where the injection is given.
• Joint pain.
• Stomach discomfort.
• Feeling tired.

Because guselkumab affects the immune system, it may make it harder for your body to fight infections.

Tell your healthcare team if you develop an infection, particularly if you have a fever, a persistent cough or feel unusually unwell.

Serious allergic reactions are uncommon. Seek urgent medical help if you develop swelling of the face, lips, mouth or throat, difficulty breathing or a severe, widespread rash.

Before starting guselkumab

Your specialist will check whether guselkumab is suitable for you before treatment begins.

Tell your healthcare team if you:

• Have an infection or frequently get infections.
• Have tuberculosis, or have been in contact with someone who has tuberculosis.
• Have a history of serious allergic reactions.
• Are pregnant, planning to become pregnant or breastfeeding.
• Are taking any other medicines, including other biological medicines.
• Are due to have any vaccinations.

Treatment may need to be delayed if you have an active infection.

Pregnancy and breastfeeding

If you are pregnant, planning to become pregnant or breastfeeding, speak to your specialist before starting or continuing guselkumab.

There is limited information about the use of guselkumab during pregnancy and breastfeeding. Your healthcare team can discuss the possible benefits and risks with you.

How do I get it?

Guselkumab is a prescription-only medicine and should be used under the supervision of a healthcare professional experienced in treating psoriasis or psoriatic arthritis.

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Guselkumab is known commercially as Tremfya and is marketed in the UK by Janssen Biotech, Inc.

Reviewed: September 2026
Version ID: 1/GUS/PAT/09/26

Infliximab is a biologic medicine used to treat active and progressive psoriatic arthritis in adults when previous disease-modifying antirheumatic drugs (DMARDs) have not worked well enough. It belongs to a group of medicines called TNF inhibitors.

How does it work?

Infliximab is a monoclonal antibody that blocks a protein called tumour necrosis factor-alpha (TNF-α). TNF-α is one of the chemical messengers involved in inflammation.

By blocking TNF-α, infliximab reduces inflammation. This can help reduce the pain, swelling and stiffness associated with psoriatic arthritis and can help improve physical function.

Who can get it?

Infliximab is available on prescription for adults with active and progressive psoriatic arthritis when previous treatment with DMARDs has not worked well enough.

It is usually given in combination with methotrexate. However, it can be used on its own if methotrexate is not tolerated or is not suitable.

How is it used?

Infliximab is given by intravenous infusion, usually in a hospital or specialist treatment centre.

The usual dose for psoriatic arthritis is:

• 5 mg for each kilogram of body weight given by infusion
• a further dose at 2 weeks
• another dose at 6 weeks
• then every 8 weeks.

The initial infusions are normally given over about 2 hours. If you have tolerated at least three initial infusions without problems, later infusions may sometimes be given over at least 1 hour. You will be monitored during and after the infusion for possible reactions.

Treatment is normally reviewed to make sure it is working. NICE recommends stopping treatment if there has not been an adequate response after 12 weeks.

What are the side effects?

Like all medicines, infliximab can cause side effects, although not everyone will experience them.

Very common:

• Upper respiratory tract infections, such as sore throat or a runny nose.

Common side effects can include:

• viral infections
• headache
• dizziness or vertigo
• nausea
• abdominal pain
• indigestion
• diarrhoea
• skin reactions or itching
• tiredness
• infusion-related reactions
• reactions at the injection or infusion site
• changes in liver enzymes shown by blood tests.

Infliximab can affect the immune system and increase the risk of infections. Serious infections, including tuberculosis, pneumonia, sepsis and other opportunistic infections, have been reported. Patients are screened for tuberculosis before treatment and monitored for infections during and after treatment.

Infusion-related allergic reactions can occur during or after treatment. These can occasionally be serious. If you develop symptoms such as difficulty breathing, swelling, chest discomfort, severe dizziness or a widespread rash, seek medical attention immediately.

Other important but less common risks include hepatitis B reactivation, heart failure, blood disorders, lupus-like reactions, demyelinating disorders and certain cancers.

How do I get infliximab?

Infliximab is a prescription-only medicine (POM) and treatment is initiated and supervised by specialist healthcare professionals experienced in treating inflammatory diseases.

Marketed by

Infliximab is known commercially as:

Reviewed: September 2026
Version ID: 2/INF/PAT/09/26

Ixekizumab is a biological medicine used to treat adults with active psoriatic arthritis. It belongs to a group of medicines called interleukin-17A (IL-17A) inhibitors.

It may be used alone or together with methotrexate. In the UK, NICE recommends ixekizumab for certain adults with active psoriatic arthritis when other disease-modifying antirheumatic drugs (DMARDs) have not worked well enough, or when TNF-alpha inhibitors are unsuitable or have not worked. Treatment should be assessed after 16 weeks to make sure it is providing a clear benefit.

How does it work?

Ixekizumab is a monoclonal antibody that blocks the activity of a protein called interleukin-17A (IL-17A). IL-17A is involved in the inflammation that occurs in conditions such as psoriatic arthritis.

By blocking IL-17A, ixekizumab reduces inflammation. This can improve symptoms such as joint pain, swelling and stiffness and can also improve psoriasis. It may also help prevent or slow further damage to the joints.

Who can get it?

Ixekizumab is available on prescription for adults with active psoriatic arthritis who meet the appropriate treatment criteria.

It can be used on its own or together with methotrexate.

NICE recommends ixekizumab for people who have had an inadequate response to other DMARDs, who have not responded adequately to a TNF-alpha inhibitor, or when TNF-alpha inhibitors are unsuitable.

How is it used?

Ixekizumab is given as an injection under the skin (subcutaneous injection).

For psoriatic arthritis without moderate-to-severe plaque psoriasis:

• The first dose is 160 mg (two 80 mg injections).
• This is followed by 80 mg every 4 weeks.

For people with psoriatic arthritis who also have moderate-to-severe plaque psoriasis, the dosing regimen is different:

• 160 mg initially.
• Then 80 mg at weeks 2, 4, 6, 8, 10 and 12.
• After week 12, 80 mg every 4 weeks.

Treatment should be reviewed at 16 weeks. NICE recommends continuing treatment only when there is clear evidence of a response.

What are the side effects?

Like all medicines, ixekizumab can cause side effects, although not everybody gets them.

Very common side effects may include:

• Upper respiratory tract infections, such as a sore throat or stuffy nose
• Injection-site reactions, such as redness or pain

Common side effects may include:

• Fungal infections, such as athlete's foot
• Pain in the back of the throat
• Cold sores (herpes simplex infections)

Uncommon side effects may include:

• Oral thrush
• Influenza
• Runny nose
• Bacterial skin infections
• Hives (urticaria)
• Conjunctivitis
• Low levels of white blood cells (neutropenia)
• Low platelet count (thrombocytopenia)
• Eczema
• Rash
• Swelling of the face, lips, mouth or throat (angioedema)
• Symptoms of inflammatory bowel disease, such as abdominal pain, diarrhoea, weight loss or blood in the stool

Ixekizumab can increase the risk of infections. Patients should tell their doctor if they develop signs of a serious infection.

Serious allergic reactions can also occur. Seek urgent medical attention if there is difficulty breathing or swallowing, or swelling of the face, lips, tongue or throat.

How do I get ixekizumab?

Ixekizumab is available on prescription and is normally initiated and monitored by a specialist.

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Ixekizumab is known commercially as Taltz® and is marketed in the UK by Eli Lilly and Company Ltd.

Reviewed: September 2026
Version ID: 2/IXE/PAT/09/26

Secukinumab is a biological medicine used to treat active psoriatic arthritis (PsA). It belongs to a group of medicines called interleukin-17 (IL-17) inhibitors.

Secukinumab may be used when other treatments have not worked well enough or have not been tolerated. It can be used on its own or together with methotrexate. NICE recommends secukinumab as one of the biological or targeted treatments that may be considered for adults with active psoriatic arthritis when previous DMARD treatment has not controlled the condition adequately.

How does it work?

Secukinumab is a monoclonal antibody that specifically blocks a protein called interleukin-17A (IL-17A).

IL-17A is involved in the inflammation that occurs in psoriatic arthritis. By blocking IL-17A, secukinumab reduces inflammation and can help improve symptoms such as joint pain, stiffness and swelling. It can also improve other features of psoriatic arthritis, including psoriasis affecting the skin and nails, and can help improve physical function.

Who can get it?

Secukinumab is available on prescription and is normally prescribed by a specialist.

For adults, it is licensed for active psoriatic arthritis when previous disease-modifying antirheumatic drug (DMARD) treatment has not worked well enough. It can be used alone or in combination with methotrexate.

Secukinumab should not normally be given if you have a clinically important active infection. Your doctor will also consider your medical history, including any history of tuberculosis or inflammatory bowel disease, before starting treatment.

How is it used?

Secukinumab is given as an injection under the skin (subcutaneous injection). You may be taught to inject it yourself, or a healthcare professional or trained caregiver may give the injection.

For most adults with psoriatic arthritis, the recommended dose is:

• 150 mg at weeks 0, 1, 2, 3 and 4
• followed by 150 mg every 4 weeks.

For people with psoriatic arthritis who have had an inadequate response to a TNF-alpha inhibitor, the recommended dose is:

• 300 mg at weeks 0, 1, 2, 3 and 4
• followed by 300 mg every 4 weeks.

A dose of 300 mg is also recommended for people with psoriatic arthritis who have moderate to severe plaque psoriasis. For some other patients, the dose may be increased from 150 mg to 300 mg depending on their response to treatment.

Your doctor will assess your response to treatment. The UK product information states that a clinical response is usually achieved within 16 weeks and treatment should be reconsidered if there has been no response by then.

What are the side effects?

Like all medicines, secukinumab can cause side effects, although not everyone will experience them.

Very common side effects may include:

• upper respiratory tract infections, such as a sore throat or blocked or runny nose.

Common side effects may include:

• cold sores (oral herpes)
• diarrhoea
• runny nose
• fungal infections such as athlete's foot
• headache
• nausea

Uncommon side effects may include:

• oral thrush
• low levels of white blood cells (neutropenia)
• infections affecting the lower respiratory tract
• inflammation or infection of the outer ear
• conjunctivitis
• itchy rash or hives
• inflammatory bowel disease or worsening of existing inflammatory bowel disease.

Seek medical advice promptly if you develop symptoms of a serious infection, such as persistent fever, a cough that does not go away, shortness of breath, or painful, red and swollen skin.

A serious allergic reaction is uncommon but requires immediate medical attention. Symptoms can include difficulty breathing or swallowing, swelling of the face, lips, tongue or throat, dizziness or a severe itchy rash.

Tell your doctor if you develop persistent abdominal pain, diarrhoea or blood in your stools, as these can be symptoms of inflammatory bowel disease.

How do I get secukinumab?

Secukinumab is available only on prescription and is normally initiated and supervised by a specialist.

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Secukinumab is known commercially as Cosentyx® and is marketed in the UK by Novartis.

Reviewed: September 2026
Version ID: 2/SEC/PAT/09/26

Ustekinumab is a biological medicine used to treat active psoriatic arthritis in adults when previous disease-modifying antirheumatic drugs (DMARDs) have not worked well enough. It can be used on its own or in combination with methotrexate.

Ustekinumab is also used to treat psoriasis and some inflammatory bowel diseases.

How does it work?

Ustekinumab is a monoclonal antibody that targets two proteins involved in inflammation, called interleukin-12 (IL-12) and interleukin-23 (IL-23).

By blocking these proteins, ustekinumab reduces inflammation. This can help improve symptoms of psoriatic arthritis, including joint pain, stiffness and swelling, and can improve physical function and quality of life. It can also help reduce the progression of damage to the joints.

Who can get it?

Ustekinumab is available on prescription for adults with active psoriatic arthritis when previous non-biological DMARD treatment has not worked well enough.

NICE recommends ustekinumab for active psoriatic arthritis when TNF-alpha inhibitors are unsuitable or when the person has already been treated with one or more TNF-alpha inhibitors.

It can be used alone or together with methotrexate.

How is it used?

Ustekinumab is given as an injection under the skin (subcutaneous injection).

For psoriatic arthritis, the usual dose is:

• 45 mg initially
• 45 mg four weeks later
• then 45 mg every 12 weeks

For people weighing more than 100 kg, the recommended dose is 90 mg initially, followed by 90 mg four weeks later and then every 12 weeks.

You may be taught how to give the injection yourself, or it may be administered by a healthcare professional.

Treatment should be reviewed regularly. Consideration should be given to stopping treatment if there has been no response by 28 weeks.

What are the side effects?

Like all medicines, ustekinumab can cause side effects, although not everybody gets them.

Common side effects (may affect up to 1 in 10 people):

• upper respiratory tract infections, such as sore throat and blocked or runny nose
• headache
• tiredness
• dizziness
• diarrhoea

• itching

• back, muscle or joint pain
• redness or pain where the injection is given

Uncommon side effects (may affect up to 1 in 100 people):

• injection-site reactions such as bruising, swelling, hardness or itching
• depression
• blocked or stuffy nose
• facial palsy (weakness of one side of the face)
• certain changes in psoriasis, including pustular psoriasis

Serious infections can occur, although they are uncommon. Tell your doctor promptly if you develop symptoms of a serious infection, such as persistent fever, a cough that does not go away, or feeling unusually unwell.

Ustekinumab can rarely cause serious allergic reactions. Seek urgent medical attention if you develop swelling of the face, lips, mouth or throat, difficulty breathing or swallowing, or severe dizziness.

How do I get ustekinumab?

Ustekinumab is available on prescription and is normally initiated and monitored by a specialist.

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Ustekinumab is known commercially as Stelara and is marketed in the UK by Janssen Ltd

A number of ustekinumab biosimilars are now available, including Imuldosa, Otulfi, Pyzchiva, Steqeyma, Uzpruvo and Wezenla.

Reviewed: September 2026
Version ID: 2/UST/PAT/09/26

This page is for reference only as this product is now discontinued

Adcortyl injection contains triamcinolone acetonide, a corticosteroid (steroid) medicine. It is given by injection to reduce inflammation, pain and swelling in joints and other areas.

For psoriatic arthritis, corticosteroid injections may sometimes be used to treat inflammation and pain in an individual joint. NICE recommends considering local corticosteroid injections for some people with psoriatic arthritis, particularly when only one joint is affected.

How does it work?

Psoriatic arthritis causes inflammation around and within joints. This inflammation can lead to pain, swelling and stiffness.

Triamcinolone is a corticosteroid that reduces inflammation. When injected into or around an affected joint, it can reduce the inflammatory response and help relieve pain and swelling.

Who can have it?

Adcortyl IA/ID Injection is a prescription-only medicine used in adults and children in appropriate circumstances.

How is it used?

Adcortyl IA/ID Injection is given by a healthcare professional as an injection into a joint, tendon sheath or bursa. It is not intended to be taken by mouth or given by other routes.

The dose depends on the size of the joint and the severity of the inflammation.

• Smaller joints: 2.5–5 mg (0.25–0.5 ml)

• Larger joints: 5–15 mg (0.5–1.5 ml)

The injection could be repeated if symptoms returned, rather than being given at a fixed interval. Adcortyl should not be injected into the Achilles tendon.

What are the side effects?

Like all medicines, corticosteroid injections can cause side effects. Because the medicine is injected into a particular area, side effects are often local, although some steroid can be absorbed into the bloodstream.

You may experience:

• temporary pain or discomfort at the injection site
• a temporary increase in pain or inflammation after the injection
• thinning or indentation of the skin around the injection site
• changes in skin colour around the injection site
• infection in the joint or injection site, although this is uncommon.

Repeated or high-dose steroid treatment can sometimes cause effects elsewhere in the body, such as increased blood glucose, changes in blood pressure, mood changes and suppression of the body's own steroid production.

Seek medical advice promptly if you develop severe or increasing pain, redness, swelling, fever or feel unwell after an injection, as these can be signs of infection.

How do I get a corticosteroid injection?

Corticosteroid injections are given by an appropriately trained healthcare professional. Your rheumatology team or doctor will consider whether an injection is suitable based on which joints are affected, the severity of your symptoms and your other treatments.

For people with psoriatic arthritis, local corticosteroid injections may be used alongside other treatments when appropriate. They are generally intended to provide symptom relief rather than replace treatments that control the underlying disease.

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Adcortyl  Injection was marketed by Bristol Myers Squibb. The UK product is now discontinued.

Reviewed: August 2026
Version ID: 2/ADC/PAT/08/26

Betamethasone is a corticosteroid  medicine. Corticosteroids are similar to hormones naturally produced by the adrenal glands and have an important role in controlling inflammation and the immune system.

Betamethasone is a strong corticosteroid that can be taken by mouth to reduce inflammation in a number of conditions. It may sometimes be used for a short period to help control a flare of inflammatory disease.

How does it work?

Inflammation is part of the body's immune response. It can cause symptoms such as pain, swelling, heat and stiffness.

Betamethasone works by reducing the activity of the immune system and the release of substances that cause inflammation. This reduces inflammation and can help improve symptoms.

Betamethasone is much more potent than the corticosteroids naturally produced by the body. Because of this, treatment can cause side effects, particularly when higher doses are used or treatment continues for a long time.

Who can have it?

Betamethasone soluble tablets are available on prescription.

They can be used in adults and, when clinically appropriate, in children. The dose for children is based on their age, size, condition and response to treatment and should be decided by a doctor.

How is it used?

The dose depends on the condition being treated, how severe it is and how well you respond to treatment. The aim is to use the lowest effective dose for the shortest possible time.

The following doses are given as a guide:

Adults

• Short-term treatment: usually 2–3 mg daily for the first few days, followed by a gradual reduction in the dose.
• Rheumatoid arthritis: usually 0.5–2 mg daily, with the lowest effective dose used for longer-term treatment.
• Other inflammatory conditions: usually 1.5–5 mg daily for one to three weeks, followed by a gradual reduction when appropriate.

Betamethasone soluble tablets can be dissolved in water before taking them or swallowed whole.

If you have been taking betamethasone for a long time

Do not stop taking betamethasone suddenly unless your doctor tells you to. After prolonged treatment, the body may reduce its own production of corticosteroids, so the dose usually needs to be reduced gradually.

Your doctor may also give you specific instructions about what to do if you become unwell, have an infection or need surgery while taking steroids.

What are the side effects?

Like all medicines, betamethasone can cause side effects. The risk depends on the dose and how long you take it.

Possible side effects of corticosteroid treatment include:

• increased appetite and weight gain
• indigestion or stomach problems
• difficulty sleeping
• changes in mood, including feeling low, anxious or unusually excited
• increased blood sugar, which can be particularly important if you have diabetes
• increased risk of infections
• thinning of the skin and easier bruising
• muscle weakness
• thinning of the bones (osteoporosis), particularly with longer-term treatment
• changes in vision, including cataracts or increased pressure in the eye
• changes in menstrual periods
• slower growth in children and adolescents with prolonged treatment.

Long-term or high-dose treatment can also affect the adrenal glands and the body's ability to produce its own corticosteroids.

How do I get it?

Betamethasone soluble tablets are prescription-only medicines. Your doctor or specialist will decide whether they are appropriate for you and what dose you need.

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Betamethasone is marketed in the UK by Roma Pharmaceuticals Ltd.

Reviewed: September 2026
Version ID: 2/BET/PAT/09/26

Deflazacort is a corticosteroid medicine. Corticosteroids are similar to hormones naturally produced by the adrenal glands and help control inflammation and the immune system.

Deflazacort is a systemic corticosteroid, which means it works throughout the body. It can be used to treat a range of inflammatory and autoimmune conditions, including some forms of arthritis.

For people with psoriatic arthritis, corticosteroids may sometimes be used for a short period to help control significant inflammation or a flare. However, they are not usually used as a long-term treatment for psoriatic arthritis.

How does it work?

Inflammation is part of the body's immune response. It can cause symptoms such as pain, swelling and stiffness.

Deflazacort reduces inflammation by suppressing the activity of the immune system and reducing the release of substances that cause inflammation.

Because deflazacort affects the immune system throughout the body, it can also increase the risk of infections and cause other steroid-related side effects, particularly when higher doses are used or treatment continues for a long time.

Who can have it?

Deflazacort is a prescription-only medicine and can be used in adults and children when prescribed by a doctor.

The dose for children is based on their body weight and the condition being treated.

How is it used?

The dose depends on the condition being treated, how severe it is and how well you respond to treatment.

The aim is to use the lowest effective dose for the shortest possible time.

Adults

For most conditions, including rheumatoid arthritis, the usual maintenance dose is 3–18 mg taken by mouth once daily.

For more serious conditions, a higher starting dose may be needed. The current product information states that doses of up to 120 mg a day may sometimes be required initially.

For an acute asthma attack, doses of 48–72 mg a day may be needed initially, followed by a gradual reduction once the attack is controlled.

Children

The dose for children is calculated according to body weight and the condition being treated. Your doctor will decide the appropriate dose.

For some inflammatory conditions, including chronic arthritis, the dose may be in the range of 0.25–1 mg/kg body weight each day.

Stopping treatment

If you have been taking deflazacort for a prolonged period, do not stop it suddenly unless your doctor tells you to.

The body can reduce its own production of corticosteroids during treatment. The dose may therefore need to be reduced gradually to allow the adrenal glands to recover.

Even after a shorter course, gradual withdrawal may sometimes be necessary, particularly if you have had repeated courses of steroids or previously taken steroids for a long time.

What are the side effects?

Like all medicines, deflazacort can cause side effects. The risk generally increases with higher doses and longer treatment.

Possible side effects of corticosteroid treatment include:

• increased appetite and weight gain
• indigestion, nausea or stomach problems
• fluid retention and an increase in blood pressure
• increased blood sugar, which can be particularly important if you have diabetes
• increased risk of infections
• thinning of the skin and easier bruising
• muscle weakness
• thinning of the bones (osteoporosis) and an increased risk of fractures with longer-term treatment
• acne and increased hair growth
• difficulty sleeping
• headaches, dizziness or vertigo
• changes in mood, including feeling depressed, unusually excited or restless
• menstrual changes
• suppression of the body's natural production of corticosteroid hormones
• slower growth in children and adolescents with prolonged treatment.

Rarely, corticosteroids can cause more serious psychological effects or worsen existing mental health conditions.

How do I get it?

Deflazacort is available only on prescription. Your doctor or specialist will decide whether it is appropriate for you and what dose you need.

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Deflazacort is known commercially as Calcort and is marketed in the UK by Neon Healthcare Ltd.

Reviewed September 2026
Version ID: 2/DEF/PAT/09/26

Hydrocortisone acetate is a corticosteroid medicine. Corticosteroids are similar to hormones naturally produced by the adrenal glands and help control inflammation.

Hydrocortisone acetate can be given as an injection into a joint or into the tissues around a joint to reduce inflammation, pain and swelling.

For some people with psoriatic arthritis, a corticosteroid injection may be used when one or a small number of joints are particularly inflamed. It is usually intended to provide short-term relief and is not a treatment that controls psoriatic arthritis throughout the body.

How does it work?

Psoriatic arthritis causes inflammation in and around the joints. This can result in pain, swelling, stiffness and difficulty moving the affected joint.

Hydrocortisone acetate reduces the activity of the immune system and the release of substances that cause inflammation. When it is injected into an affected joint or surrounding tissue, it can reduce inflammation and help relieve pain and improve movement.

Although the injection is given locally, some of the corticosteroid can be absorbed into the bloodstream. The amount absorbed depends on factors such as the dose, the number of injections and where the injection is given.

Who can have it?

Corticosteroid injections are prescription-only treatments and are given by an appropriately trained healthcare professional.

Your doctor or rheumatology team will decide whether an injection is appropriate. Factors such as which joints are affected, how active the inflammation is and your other medical conditions and treatments will be taken into account.

How is it used?

Hydrocortisone acetate is given by injection into an affected joint or into the tissues around a joint, depending on the condition being treated.

The dose is decided by the healthcare professional and depends on the size of the joint, the severity of the inflammation and the area being treated.

There is no single dose that is suitable for everyone. Your doctor will determine the appropriate amount and whether further injections are needed.

Corticosteroid injections are generally used to provide short-term relief of inflammation and symptoms. They do not replace disease-modifying treatments used to control psoriatic arthritis and reduce the risk of joint damage.

What are the side effects?

Like all medicines, corticosteroid injections can cause side effects. These may be local to the injection site or, because some steroid can enter the bloodstream, may affect other parts of the body.

Possible side effects include:

• temporary pain or discomfort after the injection
• temporary worsening of pain or swelling
• pain, redness or swelling at the injection site
• thinning or changes in the skin around the injection site
• changes in skin colour around the injection site
• an increased risk of infection.

Repeated injections or high doses may increase the amount of steroid absorbed into the bloodstream. This can sometimes cause steroid-related effects such as:

• increased blood glucose
• increased blood pressure
• fluid retention
• changes in mood or sleep
• suppression of the body's natural production of corticosteroids
• thinning of the bones (osteoporosis) with prolonged or repeated exposure.

How do I get it?

Corticosteroid injections are given by a healthcare professional. Your GP, rheumatology team or another appropriately trained clinician can advise whether an injection is suitable for you.

The number and frequency of injections will depend on your individual circumstances.

Marketed by

Hydrocortisone is marketed in the UK by Sovereign Medical Ltd and is known commercially as Hydrocortistab

Reviewed: September 2026
Version ID: 2/HYD/PAT/26

This page is for reference only as this product is now discontinued

Kenalog contains the active ingredient triamcinolone acetonide, which belongs to a group of medicines called corticosteroids (steroids). When given as an injection into a joint, it can help reduce inflammation and relieve pain, swelling and stiffness.

How does it work?

Triamcinolone is a corticosteroid that reduces inflammation. Injecting it into or around an affected joint can help reduce the inflammation causing pain, swelling and stiffness.

Corticosteroids also affect the immune system and can be used to treat a wide range of inflammatory conditions.

Who can get it?

Kenalog was used in adults and children aged 6 years and over, depending on the condition being treated and the site of the injection.

For joint problems, it was used for conditions such as rheumatoid arthritis and osteoarthritis where there was an inflammatory component.

For people with psoriatic arthritis, a corticosteroid injection may sometimes be used to provide short-term relief, particularly when inflammation is affecting one joint.

How is it used?

Kenalog was given as an injection by a healthcare professional.

When injected into a joint, the dose depended on the size of the joint and the condition being treated. The healthcare professional giving the injection would decide on the appropriate dose.

The injection may provide relief for a period of time, but the length of benefit varies between people. Steroid injections treat inflammation and symptoms but do not control the underlying psoriatic arthritis.

What are the side effects?

Side effects following an injection into a joint are uncommon, but may include:

• temporary pain or discomfort around the injection site
• a temporary increase in pain or inflammation, sometimes called a post-injection flare
• skin thinning or changes in skin colour around the injection site
• dizziness or flushing
• infection at the injection site
• temporary increases in blood glucose levels, particularly in people with diabetes.

Repeated injections into the same joint may increase the risk of joint damage. Injections around tendons also need to be given carefully because tendon damage or rupture can occur.

If the joint becomes increasingly painful, hot or swollen after an injection, or you develop a fever, seek medical advice as this may indicate an infection.

How do I get it?

Kenalog Intra-articular/Intramuscular Injection was a prescription-only medicine and was administered by a healthcare professional.

It is now listed as discontinued in the UK. If a corticosteroid injection is considered appropriate, your healthcare professional can advise which currently available preparation is suitable.

Marketed by

Kenalog Intra-articular/Intramuscular Injection was previously marketed in the UK by Bristol-Myers Squibb Pharmaceuticals Ltd.

The product is currently listed as discontinued in the UK.

Reviewed: September 2026
Version ID: 2/KEN/PAT/09/26

Methylprednisolone is a corticosteroid medicine that can be given by injection to reduce inflammation. When injected into or around a joint, it can help relieve pain, swelling and stiffness caused by inflammatory joint conditions.

How does it work?

Methylprednisolone works by reducing inflammation and suppressing some of the activity of the immune system.

When it is injected into a joint or the tissues around a joint, it can reduce local inflammation and provide relief from pain and swelling.

How quickly it works varies between people. Some people notice an improvement within a few days, although the response can vary depending on the condition being treated.

Who can get it?

Methylprednisolone injection is available on prescription and may be used in adults and children, depending on the condition being treated.

Depo-Medrone can be given by injection into a joint for conditions including rheumatoid arthritis and osteoarthritis with an inflammatory component. It can also be injected into tissues around a joint, such as bursae or tendon sheaths, for certain inflammatory conditions.

For people with psoriatic arthritis, a corticosteroid injection may sometimes be used to provide short-term relief from symptoms, particularly when inflammation is affecting one or a small number of joints.

If you are pregnant or breastfeeding, tell your doctor before having the injection. Your doctor will consider the potential benefits and risks before recommending treatment.

How is it used?

Methylprednisolone injection is given by a healthcare professional.

For an injection into a joint, the dose depends on the size of the joint and the severity of the condition. For Methylprednisolone, the recommended doses range from 4–10 mg for small joints to 20–80 mg for large joints such as the knee, ankle or shoulder.

After an injection, you may be advised to avoid overusing the treated joint for a short period. Follow the advice given by the healthcare professional who gives you the injection.

What are the side effects?

Most people do not have serious problems following a joint injection, but side effects can include:

• temporary pain or discomfort at the injection site
• a temporary increase in pain or inflammation, known as a post-injection flare
• skin thinning or a change in skin colour around the injection site
• flushing or dizziness
• temporary changes in blood glucose levels, particularly in people with diabetes
• infection in the joint or at the injection site, although this is uncommon.

Because some methylprednisolone can be absorbed into the bloodstream after a joint injection, other steroid-related effects can occasionally occur. The risk is greater with repeated injections or higher doses.

If the injected joint becomes increasingly painful, hot or swollen, or you develop a fever or feel unwell, seek medical advice promptly. These can be signs of an infection.

How do I get it?

Methylprednisolone injection is a prescription-only medicine and is given by a healthcare professional.

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Methylprednisolone is known commercially as Depo-Medrone and is marketed in the UK by Pfizer Ltd

Reviewed: September 2026
Version ID: 2/MET/PAT/09/26

Prednisolone is a corticosteroid medicine that reduces inflammation. It can be given by injection to help relieve inflammation and symptoms affecting joints and the tissues around them.

Corticosteroid injections may sometimes be used in people with inflammatory arthritis, including psoriatic arthritis, to provide short-term relief from pain, swelling and stiffness.

How does it work?

Prednisolone works by reducing inflammation and suppressing some of the activity of the immune system.

When a corticosteroid is injected into or around a joint, it can act locally to reduce inflammation and improve symptoms.

The length of time it takes to work and how long the benefit lasts varies from person to person.

Corticosteroids can also be given by injection into a muscle when a systemic (whole-body) effect is needed for certain inflammatory or allergic conditions.

Who can get it?

Prednisolone injection may be prescribed for adults and children, depending on the condition being treated.

Your doctor will consider your age, medical history, other medicines and the area being treated before recommending an injection.

How is it used?

Prednisolone injection is given by a healthcare professional.

When an injection is given into or around a joint, the amount used depends on the joint or area being treated and the individual circumstances. Your healthcare professional will decide on the appropriate dose.

If the medicine is being given by intramuscular injection for a condition requiring systemic corticosteroid treatment, the dose and duration will depend on the condition being treated.

After a joint injection, you may be advised to rest or avoid strenuous activity involving the joint for a short period. Follow the advice given by the healthcare professional who gives you the injection.

What are the side effects?

Most people do not experience serious problems following a local corticosteroid injection. Possible side effects include:

• temporary pain or discomfort at the injection site
• a temporary increase in pain or inflammation, sometimes called a post-injection flare
• skin thinning or a change in skin colour around the injection site
• flushing or dizziness
• temporary changes in blood glucose levels, particularly in people with diabetes
• infection at the injection site or in the joint, although this is uncommon.

Some of the medicine may be absorbed into the bloodstream. Steroid-related effects are more likely with repeated injections, higher doses or when corticosteroids are also being taken in other forms.

If you develop increasing pain, warmth or swelling in the injected joint, or develop a fever or feel unwell, seek medical advice promptly as this could indicate an infection.

How do I get it?

Prednisolone injection is a prescription-only medicine and is given by a healthcare professional.

A corticosteroid injection can provide short-term relief from inflammation and symptoms, but it does not control the underlying psoriatic arthritis. If you have ongoing or progressive joint inflammation, you may need disease-modifying treatment such as a DMARD.

Marketed by

Prednisolone is available on prescription. It is known commercially as Deltastab and is marketed in the UK by Amdipharm Plc

Reviewed: September 2026
Version ID: 2/MET/PAT/09/26

Anakinra is a Disease modifying antirheumatic drug that belongs to the group of medicines which are known as Interleukin-1 antagonists.

How does it work?

Anakinra blocks the action of a protein called interleukin-1 (IL-1).

IL-1 is one of the substances involved in causing inflammation in the body. By blocking it, anakinra can reduce inflammation and help improve symptoms such as pain, swelling and stiffness.

Who can have anakinra?

In the UK, anakinra is licensed to treat:

• rheumatoid arthritis in adults when methotrexate alone has not worked well enough
• some rare inflammatory conditions
• Still's disease, including systemic juvenile idiopathic arthritis and adult-onset Still's disease.

Your specialist will decide whether anakinra is suitable for you.

If you have both psoriasis and psoriatic arthritis, your rheumatology team will consider both conditions when choosing treatment.

How is it used?

Anakinra is usually given as an injection under the skin once a day.

Kineret comes in a pre-filled syringe. Your healthcare professional can show you how to give the injection yourself.

The usual injection sites are:

• the front of the thighs
• the abdomen, avoiding the area around the navel.

Try to use a different area each time to help prevent soreness.

Someone else, such as a carer or healthcare professional, can give the injection if necessary.

The usual dose for rheumatoid arthritis is 100 mg once a day, but the dose can be different for other conditions.

What are the side effects?

Like all medicines, anakinra can cause side effects, although not everyone gets them.

Injection-site reactions

The most common side effect is a reaction where the injection is given.

You may notice:

• redness
• swelling
• bruising
• itching
• pain or soreness.

These reactions are usually mild and tend to be most noticeable during the first few weeks of treatment. They often become less troublesome as treatment continues.

Infections

Because anakinra affects the immune system, it can make you more likely to develop an infection.

Contact your doctor if you develop symptoms of an infection, such as a high temperature, persistent cough or feeling generally unwell.

Anakinra should not normally be started if you have an active infection.

Changes in your blood count

Anakinra can sometimes reduce the number of white blood cells that help your body fight infections.

You will normally have blood tests before treatment and regularly during treatment to check your blood count and make sure the medicine is safe for you.

Other possible side effects

Other side effects can include:

• headache
• nausea
• skin rash
• increased cholesterol levels
• changes in liver blood tests.

If you develop unusual or persistent symptoms while taking anakinra, tell your doctor or specialist nurse.

How do I get it?

Anakinra is a prescription-only medicine. Treatment is normally started and monitored by a specialist.

You will need regular appointments and blood tests to check how well the treatment is working and whether it is causing any problems.

Marketed by

Anakinra is known commercially as Kineret and is marketed in the UK by Swedish Orphan Biovitrum Ltd

Reviewed: September 2026
Version ID: 2/ANA/PAT/09/26

Azathioprine is a type of medicine called an immunosuppressant which belongs to the group of drugs known as disease modifying antirheumatic drugs. It is used to treat severe rheumatoid arthritis

How does it work?

Azathioprine reduces the activity of the immune system by interfering with the production and growth of certain cells, including some white blood cells.

This can help reduce inflammation and the immune system's attack on healthy tissues.

Azathioprine does not work immediately. It can take several weeks or months before the full benefit of treatment is seen. It can also have a steroid-sparing effect, meaning that it may sometimes allow the dose of a corticosteroid to be reduced.

Because azathioprine suppresses the immune system, it can also reduce the body's ability to fight infections. It can affect the bone marrow, which is why regular blood tests are needed during treatment.

Who can get it?

Azathioprine can be prescribed for adults and children for a number of inflammatory and autoimmune conditions.

It is not one of the main standard DMARDs recommended by NICE for routine treatment of psoriatic arthritis. However, azathioprine may be prescribed by a specialist for particular inflammatory or autoimmune conditions when they consider it appropriate.

If you have psoriatic arthritis, your rheumatology team will choose treatment according to your symptoms, the joints affected, your other health conditions and previous treatments. NICE recommends standard DMARDs for peripheral arthritis and targeted treatments when appropriate.

How is it used?

Azathioprine is usually taken as tablets or an oral liquid once or twice a day, depending on the product and the dose prescribed.

The dose is individualised according to the condition being treated, body weight, response to treatment and other factors.

Your health care professional may start with a lower dose and increase it gradually. People with liver or kidney problems, and older people, may need particular care when the dose is selected.

Regular blood tests are important while taking azathioprine. These are used to check your blood cells and liver function and to make sure the medicine is not causing harmful effects.

Your healthcare professional may also check whether you have certain genetic differences, such as TPMT or NUDT15 deficiency, which can increase the risk of serious blood-related side effects. The results can affect whether azathioprine is suitable and what dose should be used.

Do not change your dose or stop taking azathioprine without speaking to your doctor or specialist.

What are the side effects?

Azathioprine can affect the blood and immune system, so regular monitoring is important.

Contact your health care provider if you develop:

• a fever, sore throat or other signs of infection
• unusual bruising or bleeding
• unusual tiredness or weakness
• severe nausea, vomiting or diarrhoea
• yellowing of the skin or whites of the eyes
• severe abdominal pain
• a new rash or other unexplained skin changes.

Possible side effects include:

• nausea and loss of appetite, particularly when treatment is first started
• increased susceptibility to infections
• reduced numbers of white blood cells, red blood cells or platelets
• liver problems
• hair loss
• increased sensitivity to sunlight.

Long-term treatment with azathioprine can increase the risk of certain cancers, including skin cancer and lymphoma. Good protection from the sun and regular monitoring are therefore important.

If you notice a new or changing lump, mole or patch on your skin, tell your health care provider.

How do I get it?

Azathioprine is a prescription-only medicine

You will need regular blood tests while taking it. Your healthcare professional will tell you how often these are needed.

Marketed by

Azathioprine is currently available in the UK from several manufacturers as generic products. Current UK product information includes azathioprine tablets from Tillomed Laboratories Ltd and Strides Pharma UK Ltd, as well as Jayempi 10 mg/ml oral suspension, marketed by Nova Laboratories Ltd.

Reviewed: September 2026

Version ID: 2/AZA/PAT/09/26

This page is for reference only as this product is now discontinued

Chloroquine is a medicine that can affect the immune system and reduce inflammation. It has been used as a disease-modifying antirheumatic drug (DMARD) to treat conditions such as rheumatoid arthritis and lupus.

How does it work?

Chloroquine changes the way certain cells in the immune system work. This can help reduce inflammation and the symptoms caused by inflammatory diseases.

It does not work straight away. If it is being used for an inflammatory condition, it can take several weeks or months before the full benefit is seen.

Your doctor will monitor how well it is working and may stop the medicine if it is not helping enough.

Who can get it?

Chloroquine is available on prescription, but its use for inflammatory conditions is now much less common than it was in the past.

How is it used?

The dose of chloroquine depends on the reason it is being prescribed, your age and other factors.

The old information stating that 15 mL should be taken every day should not be used. Chloroquine liquid preparations have different strengths, and the dose must be prescribed carefully.

Chloroquine can be taken with or after food if it causes stomach upset.

Do not change the dose or take extra doses unless your doctor tells you to.

What are the side effects?

Like all medicines, chloroquine can cause side effects, although not everyone will experience them.

Possible side effects include:

• headache
• feeling sick or stomach upset
• skin rashes or changes in skin colour
• hair changes or hair loss
• dizziness or changes in mood
• blurred or changed vision.

Changes to your eyesight

One of the most important risks with long-term chloroquine treatment is damage to the retina at the back of the eye.

Tell your doctor promptly if you notice changes in your eyesight, such as:

• blurred vision
• difficulty seeing colours
• changes in your field of vision
• difficulty reading or seeing clearly.

You may need regular eye checks if you take chloroquine for a long period.

Other important side effects

Rarely, chloroquine can affect the blood, muscles, nerves or heart.

Seek medical advice if you develop unusual bruising or bleeding, severe muscle weakness, changes in your heartbeat, fainting or other worrying symptoms.

Chloroquine can also interact with other medicines. Always tell your doctor or pharmacist about any medicines you are taking.

How do I get it?

Chloroquine is a prescription medicine. Your doctor will decide whether it is appropriate for your particular condition and will advise you about the correct dose and monitoring.

Marketed by

Chloroquine was known commercially as Nivaquine Syrup and was marketed in the UK by Sanofi Aventis.

Reviewed: September 2026
Version ID: 2/CHL/PAT/09/26

Ciclosporin belongs to the group of drugs known as disease modifying antirheumatic drugs and it is a type of medicine called a cytotoxic antimetabolite.

Ciclosporin can also reduce inflammation in the joints. However, it is not usually one of the first-choice disease-modifying treatments for psoriatic arthritis (PsA). Your rheumatology team may consider other DMARDs or targeted treatments depending on which parts of your PsA are affected and how active your disease is.

If you have both psoriasis and psoriatic arthritis, the choice of treatment may need to take both conditions into account.

Ciclosporin can work relatively quickly, so it may sometimes be useful when psoriasis needs to be brought under control quickly.

How does it work?

Psoriatic arthritis and psoriasis are both linked to an overactive immune system.

Ciclosporin reduces the activity of some immune cells called T cells. This can reduce inflammation.

For psoriasis, this can improve redness, scaling and thickness of the skin.

For psoriatic arthritis, reducing inflammation may help with pain, swelling and stiffness in the joints. However, ciclosporin is not normally used as a first-choice treatment for PsA and it is not suitable for everyone.

Ciclosporin does not cure psoriasis or psoriatic arthritis. It controls inflammation while you are taking it.

Who can get it?

Ciclosporin is available on prescription and is normally prescribed and monitored by a specialist.

For psoriasis, it may be considered when:

• psoriasis is severe and needs treatment with a medicine that works throughout the body
• other treatments have not worked
• other treatments are not suitable
• psoriasis needs to be brought under control quickly.

If you have active psoriatic arthritis, your rheumatology team will consider which treatment is most appropriate for your joints as well as your skin.

How is it used?

Ciclosporin is usually taken twice a day. The dose is worked out according to your body weight and may be adjusted depending on how well it works and whether you have side effects.

For severe psoriasis, the usual starting dose is 2.5 mg for each kilogram of body weight each day, divided into two doses. If necessary, the dose may be increased, but should not normally exceed 5 mg/kg per day.

Ciclosporin is generally used for a limited period rather than as a long-term treatment. NICE recommends using the lowest effective dose and generally not using ciclosporin continuously for more than one year, unless the disease is severe or unstable and other treatment options cannot be used.

Monitoring while taking ciclosporin

You will need regular checks while taking ciclosporin. These usually include:

• blood pressure
• kidney function
• blood tests to check your general health, including liver function and cholesterol.

This monitoring is important because ciclosporin can affect the kidneys and increase blood pressure.

Your doctor or pharmacist will also need to know about any other medicines, supplements or herbal remedies you take because ciclosporin can interact with a number of medicines.

Do not change the dose or stop taking ciclosporin without speaking to your doctor.

What are the side effects?

Not everyone gets side effects, and some are more likely with higher doses.

Common side effects can include:

• increased blood pressure
• changes in kidney function
• headache
• trembling or shaking
• increased hair growth
• swollen or overgrown gums
• nausea, vomiting or diarrhoea
• stomach discomfort
• muscle cramps or muscle pain
• tiredness
• increased cholesterol or other fats in the blood.

Because ciclosporin reduces the activity of the immune system, you may be more likely to develop infections.

Less common but more serious side effects can affect the kidneys, liver or nervous system.

Long-term treatment with medicines that suppress the immune system can also increase the risk of some cancers, particularly certain skin cancers and lymphomas. People taking ciclosporin for psoriasis should avoid excessive unprotected exposure to sunlight and should not have PUVA or UVB treatment at the same time unless specifically advised by their specialist.

Tell your doctor if you develop an infection, unusual bruising or bleeding, a significant change in your urine, severe headache, confusion or problems with your eyesight.

How do I get it?

Ciclosporin is available only on prescription and is normally prescribed and monitored by a specialist.

Marketed by

Ciclosporin is known commercially as Neoral oral solution and is marketed in the UK by Novartis Pharmaceuticals ltd.

Reviewed: September 2026
Version ID: 2/CIC/PAT/09/26

Hydroxychloroquine is a medicine belonging to a group of medicines called disease-modifying antirheumatic drugs (DMARDs).

It is used to treat some inflammatory conditions, including rheumatoid arthritis and lupus. It is not normally used to treat psoriatic arthritis (PsA).

Hydroxychloroquine can sometimes make psoriasis worse. For this reason, it is generally avoided in people who have psoriasis or psoriatic arthritis unless a specialist feels that the benefits of treatment outweigh the risks.

If you have both psoriasis and PsA, your rheumatology team will consider both conditions when choosing your treatment.

How does it work?

Hydroxychloroquine changes the way the immune system works. It reduces some of the activity involved in inflammation.

This can help reduce symptoms such as joint pain, swelling and stiffness in conditions such as rheumatoid arthritis.

However, hydroxychloroquine does not have a usual role in treating PsA because of the risk of making psoriasis worse.

Who can get it?

Hydroxychloroquine is available on prescription.

It is licensed for adults with rheumatoid arthritis and lupus, and for some children with juvenile idiopathic arthritis and lupus. It is also used for some skin conditions that are caused or made worse by sunlight.

If you have psoriasis or PsA, tell your doctor before starting hydroxychloroquine.

How is it used?

Hydroxychloroquine is taken as tablets, usually with food or a glass of milk.

The dose depends on the condition being treated and your body weight. The recommended maximum is 6.5 mg per kilogram of ideal body weight each day, with adult doses generally being 200 mg, 300 mg or 400 mg daily depending on the product and individual circumstances.

Hydroxychloroquine does not work immediately. It can take several weeks before you notice an improvement.

For rheumatic diseases, treatment is normally stopped if there has been no improvement after six months.

Your doctor will decide the dose that is right for you. Do not change the dose yourself.

What are the side effects?

Most people do not experience serious side effects, but hydroxychloroquine can cause problems with the eyes and these need to be taken seriously.

Possible side effects include:

• nausea, stomach pain or other digestive problems
• headache or dizziness
• skin rashes or changes in skin colour
• hair loss
• muscle weakness
• changes in vision.

Eye problems

In rare cases, hydroxychloroquine can damage the retina, the light-sensitive part of the eye. The risk is greater with higher doses and longer treatment.

You should have appropriate eye monitoring while taking hydroxychloroquine. Current UK guidance recommends retinal monitoring after five years of treatment, although monitoring may be needed earlier if you have particular risk factors.

Tell your doctor promptly if you notice:

• blurred or reduced vision
• difficulty reading
• changes in your field of vision
• unusual changes in your eyesight.

Do not ignore changes in your vision.

How do I get it?

Hydroxychloroquine is a prescription-only medicine.

Current UK products include 200 mg and 300 mg hydroxychloroquine sulfate tablets.

Marketed by

Hydroxychloroquine is marketed in the UK by Sanofi Aventis and is known commercially as Plaquenil

Reviewed: September 2026
Version ID: 2/HYD/PAT/09/26

Leflunomide

Leflunomide is a disease-modifying antirheumatic drug (DMARD) used to treat moderate to severe active rheumatoid arthritis and active psoriatic arthritis in adults.

It can help reduce inflammation, pain, swelling and stiffness, and may help slow the progression of joint damage.

How does it work?

Leflunomide is an immunomodulatory medicine. It reduces the activity of certain immune cells involved in inflammation. This helps to control the overactive immune response associated with rheumatoid arthritis and psoriatic arthritis.

Because leflunomide affects the immune system, it can increase the risk of infections. Some infections may be serious. Tell your doctor if you develop an infection, or if you have symptoms such as a persistent cough, fever or feeling generally unwell.

Leflunomide is removed from the body very slowly and can remain in the blood for many months after the last dose. If necessary, a treatment called a washout procedure can be used to remove it more quickly. This may be important if a serious side effect occurs, or if pregnancy is being planned.

The effects of leflunomide are not usually noticed immediately. Improvement may begin after around 4 to 6 weeks, although the full benefit may take several months.

Who can get it?

Leflunomide is intended for adults with active rheumatoid arthritis or psoriatic arthritis.

Treatment should be started and supervised by a specialist experienced in treating these conditions. It may not be suitable for people with certain liver, kidney, blood or immune-system problems, or for those with a serious infection.

Leflunomide must not be taken during pregnancy because it may seriously harm an unborn baby. People who could become pregnant should discuss effective contraception and pregnancy planning with their healthcare professional.

How is it used?

Leflunomide is taken as tablets.

• Swallow the tablet whole with a glass of water.
• It can be taken with or without food.
• Take it at the same time each day, as prescribed.
• Do not change the dose or stop treatment without speaking to your healthcare professional.

The usual maintenance dose is 10 mg or 20 mg once daily, depending on the condition and the individual response. A loading dose may sometimes be prescribed at the start of treatment, but this is not always used because it can increase the risk of side effects.

What are the side effects?

Not everyone experiences side effects. Possible side effects include:

• Diarrhoea, nausea or other stomach and bowel problems
• Abdominal pain
• Headache
• Dizziness
• Tiredness or weakness
• Loss of appetite or weight loss
• Hair thinning or hair loss
• Dry skin or rash
• Mouth ulcers or inflammation of the mouth
• Increased blood pressure
• Changes in liver-function blood tests
• Changes in blood-cell counts
• Tingling or altered sensation in the hands or feet

Important safety information

Leflunomide can affect the liver, blood cells, lungs and immune system. Regular blood tests are needed to monitor treatment. These usually include:

• Liver-function tests
• Full blood count
• Kidney-function tests, where appropriate
• Blood-pressure checks

Contact your healthcare professional promptly if you develop:

• A sore throat, fever or repeated infections
• Unexplained bruising or bleeding
• Yellowing of the skin or eyes
• Severe or persistent diarrhoea, vomiting or weight loss
• A widespread rash, skin blistering or sores in the mouth
• A persistent cough or breathlessness
• New or worsening numbness, tingling or weakness

Seek urgent medical advice if you develop breathing difficulties, a severe skin reaction or symptoms of a serious infection.

How do I get it?

Leflunomide is available on prescription. It is usually initiated by a rheumatology specialist, with ongoing monitoring arranged through specialist care or a shared-care service.

Marketed by

Leflunomide is known commercially as Arava and is marketed in the UK by Sanofi-Aventis Ltd.

Reviewed: September 2026
Version ID: 2/LEF/PAT/09/26

Methotrexate belongs to a group of medicines known as disease-modifying antirheumatic drugs (DMARDs). It is also an antimetabolite medicine that can affect the growth and activity of cells.

Methotrexate is used to treat several conditions, including:

• Rheumatoid arthritis
• Psoriatic arthritis
• Severe psoriasis
• Juvenile idiopathic arthritis
• Some cancers
• Other inflammatory or immune-related conditions, when prescribed by a specialist

For inflammatory conditions, methotrexate helps reduce disease activity and inflammation. It is not the same as the higher-dose chemotherapy treatment used for cancer, although it is the same medicine.

How does it work?

Methotrexate reduces the activity of the immune system and helps control inflammation. In inflammatory arthritis and psoriasis, it can reduce symptoms such as pain, swelling, stiffness and skin inflammation.

The exact way it works in inflammatory conditions is not fully understood. Its effects are thought to include changes in immune-cell activity and the release of inflammatory substances.

Methotrexate does not work immediately. Some people begin to notice an improvement after several weeks, but it may take several months to achieve the full benefit.

Because methotrexate can affect healthy cells as well as cells involved in disease, it must be taken carefully and monitored regularly.

Who can have it?

Methotrexate may be prescribed for adults and children when clinically appropriate. The dose and formulation depend on the person’s age, condition, body size, kidney and liver function, and response to treatment.

It may be used for:

• Rheumatoid arthritis
• Psoriatic arthritis
• Severe psoriasis
• Juvenile idiopathic arthritis
• Certain cancers
• Other conditions requiring specialist treatment

Methotrexate may not be suitable for people with certain blood, liver, kidney or immune-system problems. It is also unsuitable during pregnancy for most indications and should not be used when breastfeeding unless specifically advised by a specialist.

Tell your doctor if you have an infection, liver disease, kidney problems, a blood disorder, a history of lung disease, or if you drink alcohol regularly. You should also tell your doctor about all medicines and supplements you take.

How is it used?

Methotrexate is available as tablets, oral liquid and injections given under the skin or, in some circumstances, into a muscle or vein.

For inflammatory conditions, methotrexate is usually taken or given once a week on the same day each week.

The dose is individualised. Treatment is often started at a low dose and adjusted according to the condition being treated, response to treatment, blood-test results and side effects.

Commonly used weekly doses for inflammatory conditions are within the range prescribed by the rheumatology or dermatology team. The maximum dose depends on the condition, formulation and clinical circumstances.

If you are using tablets or oral liquid, follow the instructions on the dispensing label carefully. Oral liquid formulations may come with a specific measuring device, which should be used to ensure the correct dose.

Methotrexate is usually prescribed with folic acid. Folic acid helps reduce some side effects, such as mouth ulcers, nausea and changes in blood-cell counts. It should be taken on the days advised by your healthcare professional.

Do not change your methotrexate or folic acid dose without speaking to your prescriber or pharmacist.

What are the side effects?

Common side effects may include:

• Feeling sick or being sick
• Stomach pain or indigestion
• Diarrhoea
• Loss of appetite
• Headache or dizziness
• Tiredness or weakness
• Mouth ulcers
• Hair thinning or hair loss
• Skin rash or increased sensitivity to sunlight

These effects may improve as your body adjusts to treatment. Tell your healthcare professional if they are troublesome or persistent.

Methotrexate can affect the blood, liver, kidneys, skin and lungs. It can also make you more susceptible to infections.

Contact your healthcare professional promptly if you develop:

• A sore throat, fever, chills or other signs of infection
• Unusual bruising or bleeding
• Severe tiredness, paleness or weakness
• Yellowing of the skin or eyes
• Persistent nausea, vomiting or loss of appetite
• Severe abdominal pain
• A new or worsening skin rash
• Mouth or throat ulcers
• Changes in urination

Methotrexate can rarely cause inflammation or scarring of the lungs. Seek urgent medical advice if you develop a persistent dry cough, chest pain, difficulty breathing or unexplained breathlessness.

Seek urgent medical attention if you develop severe breathing difficulties, facial or tongue swelling, a severe skin reaction, coughing or vomiting blood, black stools, or other symptoms that suggest a serious reaction.

Monitoring

Regular blood tests are essential during methotrexate treatment. These usually monitor:

• Full blood count
• Liver function
• Kidney function

The tests are needed more frequently when treatment is first started or when the dose is changed. Once treatment is stable, monitoring may be less frequent, according to the schedule advised by your healthcare team.

You should not miss monitoring appointments. Treatment may need to be paused or stopped if blood-test results are abnormal or if serious side effects develop.

Avoid excessive alcohol because it may increase the risk of liver damage. Check with your healthcare professional before having vaccinations, particularly live vaccines.

Pregnancy, contraception and fertility

Methotrexate can cause serious harm to an unborn baby and must not normally be used during pregnancy.

People who could become pregnant should discuss effective contraception and pregnancy planning with their healthcare team. Men and women should follow the contraception advice provided for their particular treatment.

If you become pregnant while taking methotrexate, contact your specialist team promptly for advice. Do not stop prescribed treatment without medical guidance unless instructed to do so.

Methotrexate may temporarily affect sperm production. Discuss fertility and family-planning plans with your specialist before starting treatment.

How do I get methotrexate?

Methotrexate is available only on prescription. It is usually started and monitored by a rheumatology, dermatology, paediatric or other specialist team, although ongoing prescribing and monitoring may be shared with primary care.

Methotrexate is known commercially as Jylamvo which is marketed in the UK by Intrapharm, Maxtrex which is marketed in the UK by Pfizer Ltd, Methofill which is marketed in the UK by Accord,  Methotrexate oral solution which is marketed in the UK by Rosemont Pharmaceuticals Limited,  Metoject which is marketed in the UK by Medac, Nordimet which is marketed in the UK by Nordic and Ziatal which is marketed in the UK by Nordic.

Reviewed: September 2026
Version ID: 2/MET/PAT/09/26

Penicillamine is a medicine that belongs to a group of drugs called disease-modifying antirheumatic drugs (DMARDs). It has historically been used to treat severe, active rheumatoid arthritis when other treatments have not worked or have not been tolerated.

How does it work?

Penicillamine has different actions depending on the condition being treated.

In rheumatoid arthritis, it helps reduce abnormal immune activity and inflammation. This may improve symptoms such as joint pain, swelling and stiffness. It works slowly and may take several months before the full benefit is noticed.

Penicillamine can also bind to certain metals, including copper and lead. This process, called chelation, helps the body remove these metals when treatment is medically necessary.

Who can have it?

Penicillamine may be prescribed for selected adults and children by a specialist. The appropriate age and dose depend on the condition being treated.

Before treatment, your doctor will assess your medical history and may arrange blood and urine tests. Penicillamine may not be suitable for people with certain kidney, blood, liver or immune-system problems, or for those who have previously had a serious reaction to the medicine.

Tell your doctor if you are pregnant, planning a pregnancy or breastfeeding, or if you take other medicines or supplements.

How is it used?

Penicillamine is taken by mouth as tablets or capsules, depending on the product available.

The dose varies considerably according to the condition being treated. For rheumatoid arthritis, treatment is usually started at a low dose and increased gradually under medical supervision. The dose may then be adjusted according to response and side effects.

It may take several months to assess whether the medicine is helping. Do not increase, reduce or stop the dose without speaking to your prescriber.

Penicillamine is often taken on an empty stomach, as directed by the prescriber or pharmacist. It may need to be taken separately from certain medicines, minerals or supplements because these can affect its absorption.

What are the side effects?

Possible side effects include:

• Feeling sick or being sick, particularly when treatment begins
• Loss of appetite
• Changes in taste or loss of taste
• Diarrhoea or stomach discomfort
• Skin rash, redness or itching
• Hair loss
• Mouth ulcers
• Fever or frequent infections
• Bruising or unexpected bleeding
• Muscle weakness
• Worsening joint pain or swelling

Penicillamine can sometimes affect the kidneys, liver or blood cells. Protein or blood in the urine may be detected during urine testing and may require treatment to be paused or stopped.

Rare but serious side effects can include:

• Severe blood disorders
• Kidney inflammation or other kidney problems
• Liver problems, including jaundice
• Lung inflammation or breathing difficulties
• Severe skin reactions
• Serious muscle or nerve problems

Contact your healthcare professional promptly if you develop a sore throat, fever, frequent infections, unusual bruising or bleeding, severe weakness, changes in your urine, yellowing of the skin or eyes, or a new or worsening rash.

Seek urgent medical advice if you develop difficulty breathing, facial swelling, blistering or peeling skin, or other symptoms of a serious allergic or skin reaction.

Monitoring

Regular blood and urine tests are needed, particularly when treatment is started and when the dose is increased. These tests help monitor:

• Blood-cell counts
• Kidney function
• Liver function
• Protein or blood in the urine

Your healthcare team will advise how often monitoring is required. Treatment may need to be interrupted or stopped if test results are abnormal or serious side effects develop.

How do I get penicillamine?

Penicillamine is available only on prescription.

Marketed by

Penicillamine is known commercially as Distamine and is marketed in the UK by Alliance Pharmaceuticals Ltd.

Reviewed: September 2026
Version ID: 2/PEN/PAT/09/26

Sodium aurothiomalate is a disease-modifying antirheumatic drug (DMARD) containing gold. It has historically been used to treat inflammatory arthritis, particularly rheumatoid arthritis and juvenile idiopathic arthritis.

Its use has declined because other DMARDs are generally preferred and may be more suitable. Sodium aurothiomalate is not normally used to treat psoriasis or psoriatic arthritis.

How does it work?

Sodium aurothiomalate helps reduce inflammation and may improve symptoms such as joint pain, swelling and stiffness. It works gradually and may take several months before a noticeable improvement is seen.

It does not provide immediate pain relief and is not suitable for treating sudden flares without other treatment.

Who can have it?

Sodium aurothiomalate may be considered by a specialist for selected people with inflammatory arthritis when other treatments are unsuitable or have not worked.

It may not be suitable for people with certain blood, kidney, liver or skin conditions, or for those who have previously had a serious reaction to gold treatment. Your doctor will assess your medical history and arrange appropriate tests before treatment.

It is not routinely recommended simply because someone is older. Suitability depends on the person’s overall health, other medicines and the risks and benefits of treatment.

How is it used?

Sodium aurothiomalate is given as an injection, usually into a muscle by a healthcare professional.

Treatment generally begins with a small test dose to check for an adverse reaction. If this is tolerated, the dose may be increased according to the prescribed treatment schedule.

You may be observed for a period after an injection, particularly during the early stages of treatment. Your healthcare professional will explain what to expect.

Regular monitoring is essential. Blood tests, urine tests and checks for skin reactions may be carried out before and during treatment.

What are the side effects?

Possible side effects include:

• Skin rashes, itching or inflammation
• Mouth ulcers or irritation in the mouth and throat
• A metallic taste
• Diarrhoea or other digestive problems
• Bruising or unexpected bleeding
• Changes in the menstrual cycle
• Changes in blood-cell counts
• Protein in the urine, which may indicate kidney problems

Some side effects may require treatment to be paused or stopped.

Contact your healthcare professional promptly if you develop a rash, mouth ulcers, a sore throat, fever, unusual bruising or bleeding, persistent diarrhoea, or changes in the amount or appearance of your urine.

Seek urgent medical advice if you develop a severe skin reaction, breathing difficulties, facial swelling or other symptoms suggesting a serious allergic reaction.

Monitoring

Sodium aurothiomalate can affect the blood, kidneys and skin. Regular blood and urine tests are therefore needed throughout treatment.

Your healthcare professional may advise delaying or stopping an injection if test results are abnormal or if you develop symptoms that could indicate a serious side effect.

How do I get sodium aurothiomalate?

Sodium aurothiomalate is available only on prescription and is administered by a healthcare professional, usually under the supervision of a rheumatology team.

Marketed by

It is known commercially as Myocrisin and is marketed in the UK by Sanofi Aventis.

Reviewed: September 2026
Version ID: 2/SOA/PAT/09/26

Sulfasalazine is a disease-modifying antirheumatic drug (DMARD). It is used to treat inflammatory arthritis, including rheumatoid arthritis and some forms of psoriatic arthritis (PsA).

It can help reduce inflammation, pain, swelling and stiffness. It is also used to treat certain bowel conditions, such as ulcerative colitis and Crohn’s disease.

Sulfasalazine is one of the standard DMARDs that may be considered for people with peripheral psoriatic arthritis, particularly when joints in the arms, hands, legs or feet are affected. It is not usually helpful for inflammation affecting the spine alone.

How does it work?

Sulfasalazine helps reduce the activity of the immune system and limits the inflammation that causes symptoms.

It does not work immediately. Some people begin to notice an improvement after around six weeks, although it may take several months to achieve the full benefit.

If it is not helping enough after a suitable trial, your doctor may recommend changing the dose, trying another DMARD or adding another treatment.

Who can have it?

Sulfasalazine can be prescribed for adults and, in some circumstances, children.

It may be considered for people with:

• rheumatoid arthritis
• peripheral psoriatic arthritis
• some other inflammatory arthritis conditions
• ulcerative colitis or Crohn’s disease.

It may not be suitable for people who are allergic to sulfasalazine, sulfonamides or salicylates, or for people with certain blood, liver or kidney problems.

Your doctor will check your medical history and may arrange blood tests before treatment begins.

How is it used?

Sulfasalazine is usually taken as tablets. It is also available in some liquid and other formulations.

Treatment is normally started at a low dose, which is gradually increased. This helps reduce the chance of side effects.

For inflammatory arthritis, the dose is adjusted according to how well the medicine works and how well it is tolerated. A commonly used maximum dose is 3,000 mg per day, taken in divided doses, although the dose prescribed for you may be lower.

Some tablets, such as Salazopyrin EN-Tabs, have a special coating. They should be swallowed whole and should not be crushed or chewed.

Take sulfasalazine with or after food if advised, and drink plenty of fluids during treatment.

Always follow the dose given by your doctor or pharmacist.

What are the side effects?

Like all medicines, sulfasalazine can cause side effects, although not everyone will experience them.

Common side effects include:

• nausea or feeling sick
• stomach discomfort
• loss of appetite
• headache
• dizziness
• skin rash
• fever
• hair thinning or hair loss.

These effects may improve as your body adjusts to the medicine. If they continue or are troublesome, speak to your doctor or pharmacist. Sometimes reducing the dose temporarily can help.

Blood tests and infections

Sulfasalazine can occasionally affect the blood, liver or kidneys. You will therefore need regular blood tests, particularly during the first few months of treatment.

Contact your doctor promptly if you develop:

• a sore throat
• a high temperature
• an unexplained infection
• unusual tiredness or paleness
• unexplained bruising or bleeding
• yellowing of the skin or eyes
• a new or spreading rash.

These symptoms can sometimes indicate a problem with the blood, liver or an allergic reaction. Your doctor may advise you to stop taking sulfasalazine while the cause is investigated.

Sulfasalazine can also cause increased sensitivity to sunlight. Use suitable sun protection and seek medical advice if you develop a severe rash, blistering or peeling skin.

Fertility and pregnancy

Sulfasalazine can temporarily reduce sperm count and cause infertility in some men. This effect is usually reversible, and fertility generally returns after treatment is stopped, often within a few months.

If you are planning a pregnancy, discuss this with your doctor. Sulfasalazine can affect folic acid absorption, so your doctor may recommend taking folic acid.

Do not stop treatment or make changes to your medication without medical advice.

How do I get sulfasalazine?

Sulfasalazine is a prescription-only medicine.

Your doctor or rheumatology team will monitor your progress and arrange regular blood tests to check that the medicine remains suitable for you.

Marketed by

Sulfasalazine is available under several names, including Salazopyrin EN-Tabs.

Salazopyrin EN-Tabs is marketed in the UK by Pfizer Limited.

Reviewed: September 2026
Version ID: 2/SUL/PAT/09/26

Aceclofenac belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs). It is used to relieve pain and inflammation associated with osteoarthritis, rheumatoid arthritis and ankylosing spondylitis.

Aceclofenac helps control symptoms such as pain, swelling and stiffness, but unlike disease-modifying antirheumatic drugs (DMARDs), it does not alter the underlying disease process.

How does it work?

Aceclofenac works by reducing the production of substances called prostaglandins, which are involved in pain, swelling and inflammation.

It does this by blocking enzymes called cyclo-oxygenases (COX), which are involved in prostaglandin production.

Aceclofenac can reduce pain and inflammation, but it does not suppress the immune system or slow the progression of arthritis.

As with other NSAIDs, it should generally be used at the lowest effective dose for the shortest time necessary to control symptoms.

Who can get it?

Aceclofenac is a prescription-only medicine (POM).

It is not recommended for children because there is not enough information about its use in this age group.

Aceclofenac may not be suitable for people who:

• have had an allergic reaction to aspirin or another NSAID, such as ibuprofen, naproxen or diclofenac
• have or have had stomach or intestinal ulcers or bleeding
• have severe kidney or liver problems
• have certain heart or circulation problems
• have certain types of heart failure
• have a bleeding disorder
• are pregnant or breastfeeding, unless specifically advised by a doctor.

People with asthma, high blood pressure, kidney, liver or heart problems may need particular caution and monitoring.

How is it used?

The usual adult dose is 200 mg a day, taken as:

• 100 mg in the morning
• 100 mg in the evening.

The dose may need to be reduced in people with certain liver problems.

Aceclofenac tablets should be:

• swallowed whole with plenty of water
• taken preferably with or after food
• taken exactly as prescribed.

Do not take more than the prescribed dose.

Do not take aceclofenac together with another NSAID, including ibuprofen, naproxen, diclofenac or aspirin used as an anti-inflammatory, unless specifically advised by a healthcare professional. Taking more than one NSAID increases the risk of side effects, including stomach bleeding.

What are the side effects?

Not everyone will experience side effects.

Common side effects include:

• indigestion, stomach pain or other stomach and bowel problems
• nausea or diarrhoea
• dizziness
• headache
• increased liver enzymes shown by blood tests.

Other possible side effects include:

• vomiting or constipation
• wind
• mouth ulcers
• skin rash or itching
• increased blood pressure
• changes in kidney-function blood tests
• changes in blood-cell counts
• fluid retention and swelling.

Important safety information

Like other NSAIDs, aceclofenac can occasionally cause serious problems affecting the stomach, kidneys, liver, heart or circulation.

Stomach or intestinal ulcers, bleeding or perforation can occur, sometimes without warning. The risk is higher in older people and in those with a previous history of ulcers or gastrointestinal bleeding.

Seek urgent medical advice if you develop:

• black, tar-like stools
• vomiting blood or material that looks like coffee grounds
• severe or persistent stomach pain
• difficulty breathing or swelling of the face, lips or throat
• a severe skin reaction, blistering or peeling
• yellowing of the skin or eyes
• a significant reduction in urine or new swelling of the ankles, feet or hands.

Aceclofenac can also cause fluid retention and may increase cardiovascular risk, particularly with higher doses and longer-term treatment. People with cardiovascular risk factors should discuss the benefits and risks with their doctor.

Pregnancy and breastfeeding

Aceclofenac should generally be avoided during pregnancy and breastfeeding unless specifically considered essential by a doctor.

It must not be used during the third trimester of pregnancy because NSAIDs can cause serious problems for the unborn baby and can affect labour. Use from around 20 weeks of pregnancy can also affect the baby's kidneys and the amount of amniotic fluid.

NSAIDs may also make it more difficult for some women to become pregnant.

How do I get it?

Aceclofenac is available on prescription from a doctor or other authorised prescriber.

Marketed by

Aceclofenac is available on prescription. Aceclofenac is known commercially as Preservex and is marketed in the UK by Almirall Ltd

Reviewed: September 2026
Version ID: 2/ACE/PAT/09/26

Arthrotec is a combination medicine containing two active ingredients: diclofenac sodium and misoprostol.

Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) used to relieve pain and inflammation associated with osteoarthritis and rheumatoid arthritis.

Misoprostol helps protect the stomach and upper intestine from some of the ulcer-related effects of diclofenac.

Arthrotec is particularly useful for people who need diclofenac but are at increased risk of developing an NSAID-related stomach or duodenal ulcer.

How does it work?

Diclofenac reduces the production of substances called prostaglandins, which are involved in pain, swelling and inflammation. This helps reduce the symptoms of arthritis.

However, prostaglandins also have an important protective effect on the lining of the stomach and intestine. Reducing them with an NSAID can increase the risk of stomach or intestinal ulcers and bleeding.

Misoprostol is a synthetic form of a prostaglandin. It helps protect the stomach and intestine by supporting the natural protective mechanisms of the digestive system.

The two medicines are combined in Arthrotec so that the anti-inflammatory and pain-relieving effects of diclofenac are provided alongside protection against NSAID-related gastric and duodenal ulceration. Misoprostol does not completely remove the risk of ulcers or bleeding.

Who can get it?

Arthrotec is intended for adults. Its safety and effectiveness in children under 18 have not been established.

It may be prescribed when diclofenac is needed and there is a particular need to reduce the risk of NSAID-related stomach or duodenal ulcers.

Arthrotec should not be taken by people who have:

• an allergy to diclofenac, aspirin, other NSAIDs or misoprostol
• had asthma, hives or other allergic reactions triggered by aspirin or another NSAID
• an active stomach or intestinal ulcer or bleeding
• certain serious heart, kidney or liver problems.

Pregnancy and contraception

Arthrotec must not be taken during pregnancy or when planning a pregnancy.

Misoprostol can cause miscarriage, premature labour and birth defects. Women who could become pregnant should use effective contraception while taking Arthrotec.

If you think you may be pregnant while taking Arthrotec, stop taking it and contact your doctor promptly.

How is it used?

Arthrotec is available in two strengths:

• Arthrotec 50 – 50 mg diclofenac sodium and 200 micrograms misoprostol per tablet
• Arthrotec 75 – 75 mg diclofenac sodium and 200 micrograms misoprostol per tablet.

The dose depends on the strength prescribed:

• Arthrotec 50 is usually taken one tablet two or three times a day.
• Arthrotec 75 is usually taken one tablet twice a day.

Take Arthrotec with food.

Swallow the tablets whole with a drink of water. Do not chew them, as this can affect the way the medicine is released and may increase the risk of stomach irritation.

Use the lowest effective dose for the shortest time necessary to control symptoms.

Do not take Arthrotec with another NSAID, such as ibuprofen, naproxen or diclofenac, unless specifically advised by a healthcare professional.

What are the side effects?

Not everyone experiences side effects.

The most common side effects are related to the digestive system and include:

• diarrhoea
• stomach pain or discomfort
• nausea or vomiting
• indigestion
• constipation

Other possible side effects include:

• headache
• dizziness
• tiredness
• skin rash or itching
• changes in liver-function blood tests
• changes in kidney function
• fluid retention and swelling
• changes in blood-cell counts.

Misoprostol can cause diarrhoea and abdominal cramping, particularly when treatment is first started.

Important safety information

Like other NSAIDs, diclofenac can occasionally cause serious problems including stomach or intestinal ulcers, bleeding or perforation, even in people who have not previously had stomach problems.

Seek urgent medical attention if you develop:

• black or bloody stools
• vomiting blood or material that looks like coffee grounds
• severe or persistent stomach pain
• difficulty breathing or swelling of the face, lips, mouth or throat
• a severe skin reaction, blistering or peeling
• yellowing of the skin or eyes
• a significant reduction in urine or new swelling of the feet or ankles.

Long-term treatment may require monitoring of kidney function, liver function and blood counts, particularly in people who have other health conditions or risk factors.

Arthrotec can also cause dizziness or other effects that may affect your ability to drive or operate machinery. Do not drive or use machinery if you feel affected.

How do I get it?

Arthrotec is a prescription-only medicine (POM) and is available from pharmacies on prescription.

Marketed by

Arthrotec is marketed in the UK by Pfizer Ltd

Reviewed: September 2026
Version ID: 2/ART/PAT/09/26

Aspirin belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs). It can be used to relieve pain, reduce fever and inflammation, including inflammation associated with rheumatic conditions.

Aspirin is also used at much lower doses to reduce the risk of blood clots in some people. This is a different use from taking aspirin for pain and inflammation.

How does it work?

Aspirin works by blocking enzymes called cyclo-oxygenase (COX). These enzymes are involved in the production of substances called prostaglandins, which contribute to pain, inflammation and fever.

By reducing the production of prostaglandins, higher doses of aspirin can help to relieve pain and reduce inflammation.

Aspirin also affects platelets in the blood, making them less likely to stick together. This is why low-dose aspirin is sometimes prescribed to help prevent blood clots.

Who can have it?

Aspirin can be used by adults and young people aged 16 years and over when appropriate.

Children under 16 should not normally be given aspirin unless it has been specifically advised by a doctor. This is because aspirin use in children has been associated with a rare but serious condition called Reye's syndrome, which affects the liver and brain.

Aspirin may not be suitable for people with a history of stomach ulcers or bleeding, certain types of asthma, bleeding disorders, or severe kidney, liver or heart problems.

How is it used?

The dose depends on why aspirin is being used and the particular product.

For pain and inflammation, adults may be advised to take 300–900 mg at a time, repeated according to the instructions for the product. The maximum daily dose for some preparations is 4 g.

The lowest effective dose should be used for the shortest time necessary.

Aspirin should be taken exactly as directed by your doctor, pharmacist or the instructions on the packaging.

What are the side effects?

Medicines and their possible side effects can affect individuals in different ways. The following are some of the side effects that may be associated with aspirin. Because a side effect is stated here, it does not mean that everyone taking aspirin will experience it.

• Indigestion, stomach discomfort, nausea or vomiting
• Stomach or intestinal ulcers and bleeding
• Increased tendency to bleed
• Ringing or other noises in the ears (tinnitus), particularly with higher doses
• Allergic reactions such as skin rash, swelling or breathing difficulties
• Worsening of asthma in people who are sensitive to aspirin or other NSAIDs
• Changes in blood-cell counts
• Kidney or liver problems.

Seek urgent medical advice if you develop signs of serious bleeding, such as vomiting blood or passing black or bloody stools, or if you develop a serious allergic reaction.

Taking aspirin with other medicines

Aspirin can interact with a number of medicines.

Taking aspirin with other NSAIDs, such as ibuprofen, naproxen or diclofenac, can increase the risk of side effects, particularly stomach ulcers and bleeding. They should not normally be taken together unless advised by a doctor.

Aspirin can interact with methotrexate and may increase the risk of methotrexate side effects. If you take methotrexate, check with your doctor or pharmacist before taking aspirin regularly.

There may also be an increased risk of stomach ulcers and bleeding when aspirin is taken with corticosteroids such as prednisolone or dexamethasone.

Always tell your doctor or pharmacist about any other medicines you are taking, including medicines bought without a prescription.

How do I get Aspirin?

Aspirin is available from pharmacies and other retailers in a number of preparations and strengths. Some preparations are available without a prescription, while others are prescribed for specific medical conditions.

If you need to take aspirin regularly for pain or inflammation, speak to your doctor or pharmacist to make sure it is still the most appropriate treatment.

Reviewed: September 2026
Version ID: 2/ASP/PAT/09/26

This page is for reference only as this product is now discontinued

Axorid modified release capsules contain the active ingredient ketoprofen, which is a type of medicine called a non-steroidal anti-inflammatory drug (NSAIDs) and is used to treat pain caused by rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis in patients with a previous history or who are at risk of developing NSAID associated gastric ulcers and duodenal ulcers.

How does it work?

Axorid includes a sustained release form of ketoprofen and a gastroresistant form of omeprazole, both suitable for once daily administration which works by blocking the action of a substance in the body called cyclo-oxygenase (COX). Cyclo-oxygenase is involved in the production of various chemicals in the body, some of which are known as prostaglandins. Prostaglandins are produced by the body in response to injury and certain diseases and conditions, and cause pain, swelling and inflammation. Ketoprofen blocks the production of these prostaglandins and is therefore effective at reducing inflammation and pain.

Ketocid modified release capsules are designed to release the ketoprofen slowly and continuously over several hours. This provides prolonged pain relief, so these capsules are taken once a day. The capsules must be swallowed whole to avoid damaging the modified release action.

Who can get it?

It is available on prescription for adults and children over the age of 15.

How is it used?

Take one tablet daily with or just after food. It is also recommend that a proton pump inhibitor should be also used in patients with rheumatoid arthritis or osteoarthritis

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

• GI intolerance,
• ulcerative stomatitis,
• CNS effects,
• malaise,
• fatigue,
• paraesthesia,
• hypersensitivity reactions,
• nephrotoxicity,
• abnormal liver function,
• neurological and haematological reactions.

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Axorid wasmarketed in the UK by and is marketed in the UK by Meda Pharmaceuticals Ltd

Brufen contains the active ingredient ibuprofen, which is a type of medicine called a non-steroidal anti-inflammatory drug (NSAID). Ibuprofen is used to relieve pain, inflammation and fever. It can be used to relieve symptoms associated with rheumatoid arthritis, juvenile rheumatoid arthritis, ankylosing spondylitis, osteoarthritis and other inflammatory or musculoskeletal conditions. It can also be used for mild to moderate pain, including headaches, migraine, dental pain, period pain and pain following injury or surgery.

How does it work?

Ibuprofen works by blocking enzymes called cyclo-oxygenase (COX). These enzymes are involved in producing substances called prostaglandins, which contribute to pain, swelling, inflammation and fever.

By reducing the production of prostaglandins, ibuprofen helps reduce pain and inflammation and can also lower a high temperature.

Ibuprofen is used to relieve symptoms. It does not treat the underlying cause of inflammatory arthritis and is not a disease-modifying antirheumatic drug (DMARD).

Brufen Retard tablets are sustained-release tablets designed to release ibuprofen gradually over several hours. They should be swallowed whole and must not be chewed, crushed or broken. Brufen should preferably be taken with or after food, particularly if it causes stomach irritation.

Who can get it?

Brufen is available on prescription for adults and children when appropriate. The age and weight restrictions depend on the particular ibuprofen preparation.

Brufen Retard is recommended for adults and children over 12 years of age.

Ibuprofen may not be suitable for people with a history of stomach ulcers or bleeding, certain heart, kidney or liver problems, asthma triggered by NSAIDs, or certain blood-clotting problems. It should also be avoided during pregnancy unless specifically advised by a healthcare professional.

How is it used?

The dose depends on the preparation and the condition being treated.

For Brufen 400 mg tablets, the usual dose for rheumatic conditions in adults is 1,200–1,800 mg a day in divided doses. In severe or acute conditions, the dose may temporarily be increased, up to a maximum of 2,400 mg a day.

For Brufen Retard 800 mg tablets, the usual dose for adults and children over 12 is two tablets as a single daily dose, preferably in the early evening. In severe or acute conditions, three tablets a day may be used in two divided doses.

The lowest effective dose should be used for the shortest time necessary to control symptoms.

Do not take ibuprofen at the same time as another NSAID, such as naproxen, diclofenac or aspirin, unless advised by a healthcare professional.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the more common side effects associated with ibuprofen. Because a side effect is stated here, it does not mean that everyone using the medicine will experience it.

• Indigestion, stomach pain, nausea or vomiting
• Diarrhoea or constipation
• Headache or dizziness
• Skin rash
• Changes in liver or kidney function
• Changes in blood counts

More serious side effects can include stomach ulcers or bleeding, kidney problems or a serious allergic reaction. The risk can be higher with higher doses or longer-term treatment.

Seek medical advice urgently if you develop severe stomach pain, vomit blood, pass black stools, have difficulty breathing, or develop swelling of the face, mouth or throat.

Please read the patient information leaflet for further details.

Marketed by

Brufen and Brufen Retard are marketed in the UK by Viatris. Other ibuprofen products and unbranded versions are also available.

Reviewed: September 2026
Version ID: 2/BRU/PAT/09/26

Celecoxib is a type of medicine called a non-steroidal anti-inflammatory drug (NSAID). It is a selective cyclo-oxygenase-2 (COX-2) inhibitor and is used to relieve pain, stiffness and inflammation associated with osteoarthritis, rheumatoid arthritis and ankylosing spondylitis.

Celecoxib is used to relieve symptoms. It does not treat the underlying cause of inflammatory arthritis and is not a disease-modifying antirheumatic drug (DMARD).

Celecoxib can start to relieve pain relatively quickly, although improvement in inflammation and stiffness may take longer.

How does it work?

Celecoxib works by blocking an enzyme called cyclo-oxygenase-2 (COX-2). COX-2 is involved in producing substances called prostaglandins, which contribute to pain, swelling, inflammation and fever.

By reducing the production of these prostaglandins, celecoxib helps reduce pain and inflammation and can improve movement in conditions affecting the joints and muscles.

Celecoxib is designed to selectively block COX-2 rather than COX-1. However, like other NSAIDs, it can still cause stomach, kidney and cardiovascular side effects.

Who can get it?

Celecoxib is available on prescription for adults with osteoarthritis, rheumatoid arthritis or ankylosing spondylitis.

Your doctor will need to consider whether celecoxib is suitable if you:

• have had a stomach or intestinal ulcer or bleeding
• have heart or circulation problems, high blood pressure or other cardiovascular risk factors
• have kidney or liver problems
• have inflammatory bowel disease
• have asthma or an allergic reaction caused by aspirin or other NSAIDs
• are taking other medicines that may interact with celecoxib
• are pregnant, planning a pregnancy or could become pregnant.

Celecoxib is not normally recommended during pregnancy, particularly later in pregnancy. Your doctor will assess the risks and benefits before prescribing it.

How is it used?

Celecoxib capsules should be swallowed whole with a glass of water. They can be taken with or without food.

For osteoarthritis, the usual dose is 200 mg a day, taken either once daily or as two 100 mg doses.

For rheumatoid arthritis, the usual starting dose is 200 mg a day, divided into two doses.

For ankylosing spondylitis, the usual dose is 200 mg a day, taken once daily or in two divided doses.

The maximum recommended daily dose is 400 mg. The lowest effective dose should be used for the shortest possible time, and treatment should be reviewed regularly.

Do not take celecoxib together with another NSAID, such as ibuprofen, naproxen or diclofenac, unless specifically advised by a healthcare professional.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects associated with celecoxib. Because a side effect is stated here, it does not mean that everyone using the medicine will experience it.

• Indigestion, stomach pain, diarrhoea or nausea
• Flatulence
• Dizziness or headache
• Fluid retention or swelling of the legs and feet
• Skin rash or other allergic reactions
• Raised blood pressure
• Changes in kidney or liver function
• Infections such as upper respiratory tract infections

Like other NSAIDs, celecoxib can occasionally cause stomach ulcers or bleeding, kidney problems, serious allergic reactions and cardiovascular problems, including heart attack or stroke. The risk can increase with higher doses and longer treatment.

Seek medical advice urgently if you develop severe stomach pain, vomit blood, pass black stools, have difficulty breathing, develop swelling of the face or throat, or experience chest pain or sudden weakness.

Marketed by

Celecoxib is known commercially as Celebrex and is marketed in the UK by Viatris.

Reviewed: September 2026
Version ID: 2/CEL/PAT/09/26

Dexibuprofen is a type of medicine called a non-steroidal anti-inflammatory drug (NSAID). It is used to relieve pain and inflammation associated with osteoarthritis and other musculoskeletal conditions. It can also be used for mild to moderate pain, period pain and, in some circumstances, rheumatoid arthritis when longer-term disease-modifying treatment is not being considered.

Dexibuprofen is used to relieve symptoms. It does not treat the underlying cause of inflammatory arthritis and is not a disease-modifying antirheumatic drug (DMARD).

How does it work?

Dexibuprofen works by blocking enzymes involved in the production of substances called prostaglandins. Prostaglandins contribute to pain, swelling, inflammation and fever.

By reducing prostaglandin production, dexibuprofen helps reduce pain and inflammation and can improve movement in conditions affecting the joints and muscles.

Dexibuprofen is the pharmacologically active form (enantiomer) of ibuprofen. It has pain-relieving and anti-inflammatory effects similar to those of ibuprofen.

Who can get it?

Dexibuprofen is available on prescription for adults and children and adolescents from 8 years of age, although the strength and dose depend on age and body weight. Dexibuprofen 300 mg tablets are not suitable for children and adolescents.

Dexibuprofen may not be suitable if you:

• have had an allergic reaction to dexibuprofen, ibuprofen, aspirin or another NSAID
• have or have had a stomach or intestinal ulcer or bleeding
• have a bleeding disorder
• have severe heart, kidney or liver problems
• have active Crohn's disease or ulcerative colitis
• are taking anticoagulants or certain other medicines
• have asthma that is triggered by aspirin or other NSAIDs.

NSAIDs should be used with particular caution in older people and in people with heart, kidney or liver problems.

Dexibuprofen should not be used during the last three months of pregnancy. It should generally be avoided earlier in pregnancy unless specifically advised by a healthcare professional.

How is it used?

The dose depends on the condition being treated and the individual patient.

For osteoarthritis and rheumatoid arthritis, the recommended dose is usually 600–900 mg a day, divided into up to three doses. In acute conditions, the dose may be increased to a maximum of 1,200 mg a day.

For mild to moderate pain, the usual dose is 600 mg a day, divided into up to three doses. In acute pain, the dose may temporarily be increased to 1,200 mg a day.

The maximum single dose is 400 mg and the maximum daily dose is 1,200 mg. The lowest effective dose should be used for the shortest time necessary to control symptoms.

Children and adolescents should only receive dexibuprofen for a short time and at the lowest effective dose appropriate for their age and weight.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects associated with dexibuprofen. Because a side effect is stated here, it does not mean that everyone using the medicine will experience it.

• Indigestion or stomach pain
• Nausea, vomiting or diarrhoea
• Headache or dizziness
• Tiredness or drowsiness
• Skin rash
• Fluid retention or swelling
• Changes in kidney or liver function.

More serious side effects can include stomach ulcers or bleeding, kidney problems, serious allergic reactions and cardiovascular problems, including heart attack or stroke. The risk can increase with higher doses and longer treatment.

Seek medical advice urgently if you develop severe stomach pain, vomit blood, pass black stools, have difficulty breathing, develop swelling of the face or throat, or experience chest pain.

Do not take dexibuprofen together with another NSAID, such as ibuprofen, naproxen or diclofenac, unless specifically advised by a healthcare professional.

Marketed by

Dexibuprofen is available on prescription and is commercially known as Seractil and is marketed in the UK Strides Pharma UK Ltd.

Reviewed: September 2026
Version ID: 2/DEX/PAT/09/26

Dexketoprofen belongs to a group of medicines known as non-steroidal anti-inflammatory drugs (NSAIDs).

Dexketoprofen is used for the short-term relief of mild to moderate pain, including musculoskeletal pain, painful periods (dysmenorrhoea) and dental pain.

It helps relieve pain and inflammation but does not treat the underlying cause of a rheumatic condition.

How does it work?

Dexketoprofen works by reducing the production of prostaglandins. These are chemicals involved in pain and inflammation. By reducing their production, dexketoprofen can help relieve pain, swelling and inflammation.

Who can get it?

Dexketoprofen is prescribed for adults. It is not recommended for children and adolescents under 18 years of age.

Your doctor may need to take particular care if you:

• have kidney, liver or heart problems, high blood pressure or fluid retention
• have asthma or have previously had an allergic reaction to aspirin or another NSAID
• have, or have previously had, a stomach or bowel ulcer, bleeding or other digestive problems
• have Crohn’s disease or ulcerative colitis
• have a blood-clotting or bleeding disorder
• are elderly, as you may be more likely to experience side effects
• are dehydrated because of vomiting, diarrhoea or not drinking enough fluids
• are taking other medicines, including those bought without a prescription, herbal or complementary medicines

Tell your doctor if you are pregnant, trying to become pregnant or breast-feeding. Dexketoprofen must not be used during the last three months of pregnancy or while breast-feeding. It is not recommended when trying to conceive or during investigations for infertility.

How is it used?

The usual dose is 12.5 mg every 4–6 hours or 25 mg every 8 hours.

The maximum daily dose is 75 mg.

Older people and those with mild kidney or liver problems should usually start with a lower maximum daily dose of 50 mg.

Dexketoprofen should be taken at the lowest effective dose for the shortest time necessary. It is intended for short-term use only.

Taking it with food can reduce the risk of stomach or bowel side effects. If you have acute pain and need quicker relief, your doctor or pharmacist may advise taking it at least 30 minutes before food.

Do not take dexketoprofen with other NSAIDs unless specifically advised by your doctor.

What are the side effects?

The most common side effects include:

• nausea, vomiting, indigestion or stomach pain
• diarrhoea
• dizziness or drowsiness
• headache

Less commonly, dexketoprofen can cause stomach or bowel ulcers or bleeding, fluid retention, increased blood pressure, or changes in kidney or liver function.

Seek medical attention if you develop severe stomach pain, vomit blood, pass black stools, have difficulty breathing or swelling of the face or throat, or develop a severe skin reaction.

NSAIDs such as dexketoprofen can slightly increase the risk of heart attack or stroke, particularly with higher doses or prolonged treatment.

Marketed by

Dexketoprofen is available in the UK as Keral 25 mg film-coated tablets and is marketed by A. Menarini Farmaceutica Internazionale SRL.

Reviewed: September 2026
Version ID: 2/DET/PAT/09/26

Diclomax SR capsules and Diclomax Retard capsules contain the active ingredient diclofenac sodium, which is a type of medicine called a non-steroidal anti-inflammatory drug (NSAID).

Diclofenac is used to relieve pain and inflammation in conditions such as rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, acute gout, back pain and a range of musculoskeletal problems, including sprains, strains, tendinitis, bursitis and frozen shoulder. It can also be used for pain and inflammation following some types of surgery.

Diclofenac helps relieve pain and inflammation but does not treat the underlying cause of a rheumatic condition and is not a disease-modifying treatment.

How does it work?

Diclofenac works by reducing the production of prostaglandins. These are chemicals involved in pain, swelling and inflammation.

Diclofenac blocks an enzyme called cyclo-oxygenase (COX), which is involved in the production of prostaglandins. This reduces pain and inflammation.

Diclomax SR and Diclomax Retard are modified-release capsules. They release diclofenac gradually, providing longer-lasting pain relief.

The capsules should be swallowed whole and should not be opened, chewed or crushed.

Who can get it?

Diclomax is available on prescription for adults. It is not recommended for children.

Particular care is needed if you:

• have had a stomach or intestinal ulcer, bleeding or perforation
• have asthma or have previously had an allergic reaction to aspirin or another NSAID
• have heart or circulation problems, high blood pressure, or risk factors for cardiovascular disease
• have kidney or liver problems
• have Crohn’s disease or ulcerative colitis
• have a blood-clotting or bleeding disorder
• are elderly, as the risk of serious side effects can be greater
• are taking other medicines, including other NSAIDs, aspirin, blood thinners, corticosteroids, some antidepressants or medicines for blood pressure

Diclofenac may increase the risk of heart attack or stroke, particularly with higher doses and longer treatment. Your doctor will consider your individual risk before prescribing it.

Tell your doctor if you are pregnant, trying to become pregnant or breast-feeding. Diclofenac should not be used during the last three months of pregnancy.

How is Diclomax taken?

Diclomax SR 75 mg

Adults: One or two 75 mg capsules daily, taken as a single dose or in divided doses.

Diclomax Retard 100 mg

Adults: One 100 mg capsule daily.

Both preparations should be taken whole, preferably with or after food.

The lowest effective dose should be used for the shortest time necessary to control symptoms. The maximum recommended daily dose of diclofenac is 150 mg.

Your doctor may prescribe a proton pump inhibitor (PPI), such as omeprazole, to help protect the stomach, particularly if you have an increased risk of stomach or intestinal problems.

Do not take Diclomax with other NSAIDs unless specifically advised by your doctor.

What are the side effects?

The most common side effects include:

• indigestion, stomach pain, nausea or vomiting
• diarrhoea or constipation
• excess gas (flatulence)
• loss of appetite
• headache
• dizziness or drowsiness
• skin rash

Diclofenac can sometimes cause stomach or intestinal ulcers or bleeding. It can also cause fluid retention, increased blood pressure, and changes in kidney or liver function.

Rarely, serious allergic reactions can occur, including swelling of the face, lips, tongue or throat and difficulty breathing.

Seek urgent medical attention if you vomit blood, pass black or bloody stools, develop severe stomach pain, have difficulty breathing or swelling of the face or throat, or develop a severe skin reaction.

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Diclomax is marketed in the UK by Galen Ltd.

Reviewed: September 2026
Version ID: 2/DIC/PAT/09/26

Difflam 3% Cream contains the active ingredient benzydamine hydrochloride, which belongs to a group of medicines known as non-steroidal anti-inflammatory drugs (NSAIDs).

Difflam Cream is a topical treatment used for the short-term relief of pain and inflammation associated with sprains, strains, bruises, sore muscles and stiff joints.

How does it work?

Benzydamine works locally to reduce pain and inflammation. It reduces the production and activity of substances involved in inflammation, helping to relieve pain, swelling and tenderness.

Benzydamine also has a local anaesthetic effect, which can cause temporary numbness and provide additional pain relief at the site where the cream is applied.

Who can get it?

Difflam 3% Cream is available without a prescription for adults and children, although children should use it only as advised by a pharmacist or healthcare professional.

Do not use Difflam Cream if you are allergic to benzydamine or any of the other ingredients.

Take care when using the cream if you have previously had an allergic reaction to NSAIDs.

How is it used?

The amount of cream needed depends on the size of the area being treated. Usually, between half and one full finger-length of cream is gently rubbed into the affected area.

The cream can normally be applied three times a day.

Rub the cream gently into the affected area until it disappears.

Do not use the cream in or near the eyes, mouth, nose or genital or anal areas. Wash the area with cold water if the cream accidentally comes into contact with these areas.

Difflam Cream is intended for short-term use. If your symptoms get worse or do not improve, speak to a doctor or pharmacist.

What are the side effects?

Like all medicines, Difflam Cream can cause side effects, although not everybody will experience them.

Possible side effects include:

• itching or skin irritation
• skin redness or rash
• burning, stinging or temporary numbness where the cream is applied
• allergic reactions such as swelling or difficulty breathing

Stop using the cream and seek medical advice if you develop a severe skin reaction or signs of an allergic reaction.

Some ingredients in the cream can cause skin irritation or allergic reactions.

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Difflam is marketed in the UK by Viatris UK Healthcare Ltd 

Review date: September 2026
Version ID: 2/DIF/PAT/09/26

Eccoxolac contains the active ingredient etodolac which is a type of medicine known as a non-steroidal anti-inflammatory drug (NSAID) used to relieve pain and inflammation as seen in rheumatoid arthritis and osteoarthritis.

How does it work?

NSAIDs work by blocking the action of a substance in the body called cyclo-oxygenase. Cyclo-oxygenase is involved in producing prostaglandins, in response to injury or certain diseases. These prostaglandins cause pain, swelling and inflammation. Because NSAIDs block the production of these prostaglandins, they are effective at relieving pain and inflammation.

Cyclo-oxygenase does not only produce prostaglandins that cause inflammation. It also produces prostaglandins that have useful roles in the body. There are two different forms of cyclo-oxygenase, COX-1 and COX-2. COX-2 is the form that (among other things) produces prostaglandins that cause inflammation. COX-1 does not produce inflammatory prostaglandins, but does produce others that have useful effects, including some that are involved in maintaining a healthy stomach and intestinal lining.

Traditional NSAIDs, such as ibuprofen or diclofenac, block the action of both COX-1 and COX-2, and this is why they can sometimes cause side effects such as stomach irritation and peptic ulcers. Etodolac belongs to a new generation of NSAIDs that selectively block the action of COX-2. This means that it stops the production of inflammatory prostaglandins, without stopping the production of prostaglandins that protect the stomach and intestines. It therefore reduces pain and inflammation, but is less likely than traditional NSAIDs to cause side effects on the stomach and intestines (although such side effects are still possible).

Etodolac is used to relieve the pain of osteoarthritis and rheumatoid arthritis, which is caused by inflammation of the joints.

Who can get it?

This medicine is available on prescription for adults. Not recommended for children.

How is it used?

400-600 mg daily in two divided doses or as a single daily dose.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

• Epigastric pain,
• GI upset or bleeding,
• headache,
• dizziness,
• tinnitus,
• rash,
• angioedema.

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Eccoxolac  is marketed in the UK by Meda Pharmaceuticals Ltd.

Review Date: September 2026
Version ID: 2/ECC/PAT/09/26

Felbinac is a type of medicine known as a non-steroidal anti-inflammatory drug (NSAID). It is applied to the skin to relieve local pain and inflammation associated with rheumatic and mild arthritic pain, sprains, strains and other soft-tissue injuries.

Felbinac has been available in gel and foam preparations. The gel formulation may also be used as a coupling agent during ultrasound treatment, where applicable.

How does it work?

Felbinac works by reducing the production of substances called prostaglandins. These substances are produced by the body in response to injury and inflammation and contribute to pain, swelling and inflammation.

When felbinac is applied to the skin, it is absorbed into the underlying tissues, where it acts locally to reduce pain and inflammation.

As with other topical NSAIDs, some medicine may enter the bloodstream. The amount absorbed is generally lower than with NSAIDs taken by mouth, although absorption may increase if large amounts are used, if the gel or foam is applied over large areas, or if it is used for prolonged periods.

Who can get it?

Felbinac topical preparations have been available on prescription for adults aged 18 years and over.

They should not be used by anyone who has had an allergic reaction to felbinac, aspirin or another NSAID. Speak to a doctor or pharmacist before use if you have asthma triggered by NSAIDs, a history of stomach ulcers, kidney problems, or if you are pregnant or breastfeeding.

How is it used?

Apply the preparation to the affected area and gently rub it into the skin.

The amount and frequency depend on the formulation:

• Gel: approximately 1g applied to the affected area two to four times daily.
• Foam: apply a golf-ball-sized amount to the affected area two to four times daily.

Do not exceed the recommended maximum daily amount stated on the product information.

• Do not apply to broken, infected or irritated skin.
• Avoid contact with the eyes, mouth, nose and other mucous membranes.
• Rinse with cold water if accidental contact occurs.
• Wash your hands after applying the medicine, unless the hands are being treated.
• Do not cover the treated area with airtight or waterproof dressings, including nappies, unless advised by a healthcare professional.
• Keep felbinac foam away from naked flames, as it is inflammable.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that may be associated with topical felbinac. Experiencing a side effect does not mean that everyone using the medicine will develop it.

• Redness or mild irritation at the application site
• Itching
• Skin inflammation or dermatitis
• Tingling, numbness or altered sensation
• Skin rash or increased sensitivity to sunlight
• Rarely, allergic reactions such as wheezing, facial swelling or difficulty breathing

Stop using the medicine and seek medical advice if you develop a significant skin reaction or symptoms of an allergic reaction.

Although absorption into the bloodstream is lower than with oral NSAIDs, excessive use or application over large areas may increase the risk of systemic NSAID-related side effects.

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Felbinac is marketed in the UK by Goldshield Pharmaceuticals Ltd and is known commercially as Traxam.

Review date: September 2026
Version ID: 2/FEB/PAT/09/26

Feldene contains the active ingredient piroxicam, which belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs). It is used to relieve pain and inflammation associated with osteoarthritis, rheumatoid arthritis and ankylosing spondylitis.

Piroxicam is not usually a first-choice NSAID because it has a higher risk of serious gastrointestinal side effects and certain skin reactions compared with some other NSAIDs. It should only be prescribed after an individual assessment of the potential benefits and risks.

Piroxicam relieves symptoms such as pain and stiffness but does not alter the underlying disease process and is not a disease-modifying antirheumatic drug (DMARD).

How does it work?

Piroxicam works by blocking the action of enzymes called cyclo-oxygenase (COX). These enzymes are involved in the production of substances called prostaglandins.

Prostaglandins are produced in response to injury, illness and inflammation and contribute to pain, swelling and inflammation. By reducing prostaglandin production, piroxicam helps relieve pain and inflammation.

Piroxicam has a long duration of action, so it is usually taken once a day. Feldene capsules should be swallowed with a drink, preferably with or after food. Feldene Melt tablets are designed to dissolve quickly in the mouth and can be swallowed with saliva or water.

Who can get it?

Feldene is available on prescription for adults. Treatment should be initiated by a doctor experienced in treating inflammatory or degenerative rheumatic conditions.

It may not be suitable for people with:

• A current or previous stomach or intestinal ulcer, bleeding or perforation
• Inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis
• Severe heart failure or significant heart or circulation problems
• Kidney or liver disease
• Asthma or allergic reactions triggered by aspirin or other NSAIDs
• A previous serious skin reaction to piroxicam or another medicine

Piroxicam should not be taken with another NSAID, including ibuprofen, naproxen, diclofenac or aspirin used for pain relief. It should also generally be avoided with anticoagulants such as warfarin unless specifically directed by a specialist.

Piroxicam should not be used during the last three months of pregnancy. It is not recommended while breastfeeding unless specifically advised by a doctor. It may also affect female fertility and is not recommended for women trying to conceive.

How is it used?

The usual adult dose is:

• 20mg once daily, usually as a single dose
• Some people may be maintained on 10mg once daily
• A dose of up to 30mg daily may occasionally be prescribed, but doses above 20mg carry an increased risk of gastrointestinal side effects and should only be used under specialist supervision

The lowest effective dose should be used for the shortest time necessary. Treatment should be reviewed within 14 days, and continued treatment should involve regular reassessment.

A proton pump inhibitor, such as omeprazole, may be prescribed to help reduce the risk of stomach or duodenal ulcers in people who require NSAID treatment and are at increased gastrointestinal risk.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that may be associated with piroxicam. Experiencing a side effect does not mean that everyone taking the medicine will develop it.

• Indigestion, stomach pain, nausea, vomiting, diarrhoea, constipation or wind
• Loss of appetite or inflammation of the mouth
• Headache, dizziness, drowsiness or tiredness
• Skin rash, itching or increased sensitivity to sunlight
• Fluid retention, swelling or increased blood pressure
• Changes in kidney or liver function
• Changes in blood counts

NSAIDs, including piroxicam, can cause serious gastrointestinal complications, including ulcers, bleeding or perforation. These may occur without warning and can occasionally be fatal.

Rarely, piroxicam can cause serious skin reactions, including blistering, peeling skin or sores affecting the mouth, eyes or other mucous membranes. Stop taking the medicine and seek urgent medical advice if these symptoms occur.

Seek urgent medical attention if you develop vomiting of blood, black or tar-like stools, severe abdominal pain, swelling of the face or throat, difficulty breathing, chest pain or sudden weakness.

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Feldene is marketed in the UK by Pfizer Ltd.

Review date: September 2026
Version ID: 2/FED/PAT/09/26

Fenbid Gel contains the active ingredient ibuprofen, which belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs). It is applied to the skin to relieve local pain and inflammation associated with backache, rheumatic and muscular pain, sprains, strains and some minor joint conditions.

Fenbid Gel and Fenbid Forte Gel may be used for painful muscular and joint conditions, including sprains, strains, backache, rheumatic pain and minor arthritic conditions.

How does it work?

Ibuprofen works by blocking the action of enzymes called cyclo-oxygenase (COX). These enzymes are involved in producing substances called prostaglandins.

Prostaglandins are produced in response to injury and inflammation and contribute to pain, swelling and inflammation. By reducing prostaglandin production, ibuprofen helps relieve pain and inflammation in the area where it is applied.

When ibuprofen is applied to the skin, it is absorbed into the underlying tissues, where it acts locally. Generally, less ibuprofen reaches the bloodstream than when ibuprofen is taken by mouth. However, some absorption into the bloodstream still occurs, particularly when large amounts are applied, when used over large areas or when used for prolonged periods.

Who can get it?

Fenbid Gel and Fenbid Forte Gel are available from pharmacies. They may be suitable for adults and children aged 14 years and over, depending on the specific product.

They should not be used by anyone who has had an allergic reaction to ibuprofen, aspirin or other NSAIDs. Speak to a pharmacist or doctor before use if you have asthma that is triggered by NSAIDs, a history of stomach ulcers, kidney problems, or if you are pregnant or breastfeeding.

How is it used?

Apply the gel to the affected area and gently massage it into the skin.

The usual directions are to apply the gel three or four times a day, following the instructions on the product packaging or leaflet.

• Wash your hands after applying the gel, unless the hands are the area being treated.
• Do not apply to broken, infected or irritated skin.
• Avoid contact with the eyes, mouth and other sensitive areas.
• Do not cover the treated area with an airtight or waterproof dressing.
• Do not use more frequently or for longer than recommended.

If symptoms worsen or do not improve after the recommended period, seek advice from a pharmacist or doctor.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that may be associated with topical ibuprofen. Experiencing a side effect does not mean that everyone using the medicine will develop it.

• Skin irritation, itching, redness or rash
• Burning or stinging at the application site
• Increased sensitivity to sunlight
• Allergic reactions, including wheezing or worsening asthma
• Rarely, more serious allergic reactions such as swelling of the lips, face, throat or tongue, or difficulty breathing

Stop using the gel and seek medical advice if you develop a significant skin reaction or symptoms of an allergic reaction.

Although absorption into the bloodstream is lower than with oral ibuprofen, using excessive amounts or applying the gel over large areas may increase the risk of NSAID-related side effects, including stomach, kidney or other systemic effects.

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Fenbid Gel is marketed in the UK by Goldshield Pharmaceuticals Ltd

Review date: September 2026
Version ID: 2/FEN/PAT/09/26

Fenbid Spansules contain the active ingredient ibuprofen, which is a type of medicine called a non-steroidal anti-inflammatory drug (NSAID). Ibuprofen helps relieve pain and reduce inflammation. It may be prescribed for conditions such as rheumatoid arthritis, juvenile idiopathic arthritis, ankylosing spondylitis, osteoarthritis and other painful musculoskeletal conditions.

Ibuprofen can relieve symptoms, but it does not alter the underlying disease process and is not a disease-modifying antirheumatic drug (DMARD).

How does it work?

Ibuprofen works by blocking the action of enzymes called cyclo-oxygenase (COX). These enzymes are involved in the production of substances called prostaglandins.

Prostaglandins are produced in response to injury, illness and inflammation. They contribute to pain, swelling and inflammation. By reducing prostaglandin production, ibuprofen helps relieve pain, stiffness and inflammation.

Fenbid Spansules are modified-release capsules. They release ibuprofen gradually over several hours to provide longer-lasting relief. The capsules should be swallowed whole and must not be chewed, crushed or opened, as this may affect the modified-release action.

Who can get it?

Fenbid Spansules are available on prescription for adults. They may not be suitable for everyone, particularly people with a history of stomach ulcers or gastrointestinal bleeding, heart or circulation problems, high blood pressure, kidney or liver disease, asthma triggered by aspirin or other NSAIDs, or an allergy to NSAIDs.

They should not normally be used during the last three months of pregnancy. Speak to your doctor or pharmacist if you are pregnant, planning a pregnancy or breastfeeding.

How is it used?

The dose is prescribed according to the condition being treated and the individual’s response.

The usual adult dose is:

• Initially, two 300mg capsules daily, usually taken as one capsule twice daily.
• If necessary, the dose may be increased to three 300mg capsules daily, taken in divided doses.

Take Fenbid Spansules with or after food if they cause stomach discomfort. Use the lowest effective dose for the shortest time necessary.

Do not take Fenbid with another NSAID, such as ibuprofen, naproxen, diclofenac or aspirin for pain, unless specifically advised by your doctor.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that may be associated with ibuprofen. Experiencing a side effect does not mean that everyone taking the medicine will develop it.

• Indigestion, stomach pain, nausea or diarrhoea
• Stomach or intestinal ulcers, bleeding or, rarely, perforation
• Headache, dizziness or drowsiness
• Skin rash, itching or other allergic reactions
• Fluid retention, swelling or increased blood pressure
• Changes in kidney or liver function
• Changes in blood counts, including a reduction in platelets

Stop taking the medicine and seek urgent medical advice if you develop signs of gastrointestinal bleeding, such as vomiting blood or passing black, tar-like stools, or symptoms of a serious allergic reaction, such as swelling of the face or throat or difficulty breathing.

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Fenbid Spansules are marketed in the UK by Mercury Pharma Group Ltd. They contain ibuprofen 300mg in a modified-release capsule formulation.

Review date: September 2026
Version ID: 2/FEN/PAT/09/26

Fenoprofen is a type of medicine called a non-steroidal anti-inflammatory drug (NSAID). NSAIDs are used to relieve pain, swelling and inflammation. Fenoprofen has been used to treat pain and inflammation associated with conditions such as rheumatoid arthritis and osteoarthritis.

How does it work?

Fenoprofen works by reducing the production of substances called prostaglandins. Prostaglandins are involved in causing pain, swelling and inflammation in response to injury or disease.

By reducing the production of these substances, fenoprofen can help relieve pain and inflammation. Like other NSAIDs, it treats symptoms but does not alter the underlying course of conditions such as rheumatoid arthritis.

Who can get it?

Fenoprofen has been available on prescription for adults. It is not generally recommended for children.

How is it used?

It should be taken with or after food to help reduce stomach irritation.

The lowest effective dose should be used for the shortest possible time.

Fenoprofen should not be taken at the same time as another NSAID, such as ibuprofen, naproxen or diclofenac, unless specifically advised by a healthcare professional.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that have been associated with fenoprofen. Having a side effect listed here does not mean that everyone taking the medicine will experience it.

• Indigestion, stomach pain or other gastrointestinal problems
• Nausea or vomiting
• Headache or dizziness
• Skin rash or itching
• Allergic reactions
• Kidney or liver problems
• Changes in blood cell counts
• Stomach ulcer or bleeding

Like other NSAIDs, fenoprofen can rarely cause serious gastrointestinal, kidney, liver, allergic or cardiovascular problems. Seek medical attention if you develop signs of an allergic reaction, severe stomach pain, vomiting blood, black stools, difficulty breathing or swelling of the face or throat.

Fenoprofen can interact with a number of medicines, including blood-thinning medicines, some medicines for high blood pressure, diuretics (water tablets), lithium, methotrexate, ciclosporin and corticosteroids. Tell your doctor or pharmacist about all the medicines you are taking before starting fenoprofen.

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Fenoprofen is marketed in the UK by Typharm Ltd and is known commercially as Fenopron

Review date: September 2026
Version ID: 2/ FEP/PAT/09/26

Flurbiprofen is a type of medicine called a non-steroidal anti-inflammatory drug (NSAID). NSAIDs are used to relieve pain, swelling and inflammation. Flurbiprofen is used to treat conditions such as rheumatoid arthritis, osteoarthritis, ankylosing spondylitis and other musculoskeletal conditions.

How does it work?

Flurbiprofen works by reducing the production of substances called prostaglandins. Prostaglandins are involved in causing pain, swelling and inflammation in response to injury or disease.

By reducing the production of prostaglandins, flurbiprofen can help relieve pain and inflammation. Like other NSAIDs, it treats symptoms but does not alter the underlying course of conditions such as rheumatoid arthritis.

Who can get it?

Flurbiprofen is available on prescription for adults. It is not recommended for children under 12 years.

People who have had stomach ulcers or bleeding, heart, kidney or liver problems, asthma triggered by NSAIDs, or an allergic reaction to aspirin or other NSAIDs may not be able to take flurbiprofen. Your doctor will also consider other medicines you are taking and whether you are pregnant.

How is it used?

The usual adult dose is 150–200 mg daily, taken in two, three or four divided doses. In some people with severe symptoms or during an acute flare, the dose may be increased to 300 mg daily in divided doses.

Flurbiprofen should preferably be taken with or after food.

The lowest effective dose should be used for the shortest possible time.

Flurbiprofen should not be taken with another NSAID, such as ibuprofen, naproxen or diclofenac, unless specifically advised by a healthcare professional.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that can occur with this medicine. Having a side effect listed here does not mean that everyone taking flurbiprofen will experience it.

• Indigestion, stomach pain or other gastrointestinal problems
• Nausea or vomiting
• Headache or dizziness
• Skin rash or itching
• Fluid retention or swelling
• Changes in blood pressure
• Changes in liver or kidney function
• Changes in blood cell counts

Like other NSAIDs, flurbiprofen can sometimes cause stomach ulcers or bleeding. Rarely, serious allergic reactions, liver or kidney problems and cardiovascular problems can occur.

Seek medical attention if you develop severe stomach pain, vomiting blood, black stools, difficulty breathing, swelling of the face or throat, or other symptoms of a serious allergic reaction.

Flurbiprofen can interact with a number of medicines, including blood-thinning medicines, some medicines for high blood pressure, diuretics (water tablets), lithium, methotrexate, ciclosporin and corticosteroids. Tell your doctor or pharmacist about all the medicines you are taking before starting flurbiprofen.

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Flurbiprofen 50 mg and 100 mg tablets are marketed in the UK by Viatris.

Review Date: September 2026
Version ID: 2/FLU/PAT/09/26

Ibugel contains the active ingredient ibuprofen, which belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs). It is used to relieve pain and inflammation associated with backache, rheumatic and muscular pain, sprains, strains, neuralgia and some minor arthritic conditions.

Ibugel is available as a 5% gel and Ibugel Forte as a 10% gel.

How does it work?

Ibuprofen works by reducing the production of substances called prostaglandins. Prostaglandins are produced in response to injury or disease and are involved in causing pain, swelling and inflammation.

When ibuprofen is applied to the skin, it passes through the skin into the underlying tissues where it helps reduce pain and inflammation in the affected area. The aqueous-alcoholic gel can also have a cooling and soothing effect when applied.

Less ibuprofen reaches the bloodstream from a topical preparation than from ibuprofen taken by mouth. However, some absorption into the bloodstream can occur, particularly when large amounts are used or large areas of skin are treated.

Who can get it?

Ibugel 5% and Ibugel Forte 10% are available in the UK. The appropriate product and supply status depends on the strength and pack.

They are generally not recommended for children under 12 years unless advised by a doctor.

Ibugel should not be used by people who have previously had an allergic reaction to ibuprofen, aspirin or other NSAIDs, particularly where these medicines have caused asthma, rhinitis or urticaria.

How is it used?

Apply the gel to the affected area and massage gently into the skin until absorbed.

For Ibugel 5%, apply to the affected area up to three times a day, or as directed by a doctor.

For Ibugel Forte 10%, apply 2–5 cm of gel to the affected area up to three times a day, or as directed by a doctor. Wash your hands after application unless the hands are being treated.

Do not apply the gel to broken or damaged skin. Avoid contact with the eyes and mucous membranes.

Treatment should normally be limited to a few weeks unless your doctor advises you to continue for longer.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. Having a side effect listed here does not mean that everyone using the medicine will experience it.

Topical ibuprofen is generally well tolerated, but possible side effects include:

• Skin irritation, redness, itching or rash
• Burning or stinging at the site of application
• Increased sensitivity to sunlight
• Allergic reactions

Rarely, ibuprofen absorbed through the skin can cause effects similar to those associated with oral NSAIDs, including breathing difficulties or other allergic reactions.

Stop using the gel and seek medical advice if you develop a significant skin reaction, difficulty breathing, swelling of the face or throat, or other signs of a serious allergic reaction.

Ibugel should not be used at the same time as other NSAIDs without advice from a doctor or pharmacist.

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Ibugel and Ibugel Forte are marketed in the UK by Dermal Laboratories Ltd.

Review date: September 2026
Version ID: 2/IBU/PAT/09/26

This page is for reference only as this product is now discontinued

Ibumousse contains the active ingredient ibuprofen, which belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs). It was used as a topical treatment for pain and inflammation caused by backache, rheumatic and muscular pain, sprains, strains, neuralgia and common arthritic conditions.

Ibumousse contains ibuprofen 5% and was supplied as a mousse (foam) for application to the skin.

Please note: Ibumousse is no longer listed as a current UK product on the electronic Medicines Compendium (eMC), and appears to no longer be generally available. Current topical ibuprofen products are available in other formulations.

How does it work?

Ibuprofen works by blocking the action of cyclo-oxygenase (COX), an enzyme involved in producing substances called prostaglandins.

Prostaglandins are produced in response to injury and certain diseases and can cause pain, swelling and inflammation. By reducing the production of prostaglandins, ibuprofen helps to relieve pain and inflammation.

When ibuprofen is applied to the skin, it is absorbed into the tissues around the affected area, where it can help reduce local pain and inflammation. Less ibuprofen generally reaches the bloodstream than when ibuprofen is taken by mouth, although some absorption can still occur.

Who can get it?

Ibumousse was intended for adults, older people and children over 12 years of age. Children under 12 years were only to use it if advised by a doctor.

It should not be used by people who have previously had an allergic reaction to ibuprofen, aspirin or other NSAIDs, including some people with asthma, allergic rhinitis or urticaria triggered by these medicines.

It should not be applied to broken, damaged, infected or diseased skin.

How is it used?

Ibumousse was for application to the affected area of skin.

The usual instructions were to dispense approximately 1–2g of mousse into the palm of the hand and gently massage it into the affected area until absorbed. It could be applied three to four times a day, or as directed by a doctor.

It should not be applied near the eyes, nose or mouth. The mousse was flammable and should be kept away from flames and other sources of ignition.

Because some ibuprofen can be absorbed into the bloodstream, people taking aspirin or other NSAIDs should speak to their doctor or pharmacist before using a topical ibuprofen product.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that can occur with topical ibuprofen. Because a side effect is listed here, it does not mean that everyone using the medicine will experience it.

• Skin irritation, redness, itching or rash
• Burning or stinging at the application site
• Allergic reactions, including worsening asthma or narrowing of the airways (bronchospasm)
• Swelling of the face, lips, tongue or throat (angioedema)
• Severe allergic reactions, including anaphylaxis

Although topical ibuprofen is absorbed less into the bloodstream than ibuprofen taken by mouth, systemic side effects are possible, particularly if large amounts are used over large areas of skin.

Stop using the product and seek medical advice if you develop a significant skin reaction, breathing difficulties or swelling of the face, lips, tongue or throat.

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Ibumousse was marked by Dermal Laboratories/Diomed Developments in the UK.

Reviewed: September 2026
Version ID: 2/IBU/PAT/09/26

Ibuspray contains the active ingredient ibuprofen, which belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs). It is used to treat pain caused by backache, rheumatic and muscular pain, sprains, strains and neuralgia. It can also be used to relieve pain associated with non-serious arthritic conditions.

Ibuspray contains ibuprofen 5% and is applied directly to the skin over the painful area.

How does it work?

Ibuprofen works by blocking the action of an enzyme called cyclo-oxygenase (COX). COX is involved in the production of substances called prostaglandins.

Prostaglandins are produced in response to injury and certain diseases and can cause pain, swelling and inflammation. By reducing the production of prostaglandins, ibuprofen helps to relieve pain and inflammation.

When Ibuspray is applied to the skin, ibuprofen passes through the skin into the tissues underneath, where it acts directly on the painful area. The spray also has a soothing and cooling effect.

Less ibuprofen reaches the bloodstream from a topical preparation than from ibuprofen taken by mouth, although some absorption does occur.

Who can get it?

Ibuspray is available from pharmacies and on NHS prescription.

It can be used by adults, older people and children over 12 years of age. Children under 12 should only use Ibuspray if advised by a doctor.

Ibuspray should not be used by anyone who has previously had an allergic reaction to ibuprofen, aspirin or other NSAIDs. Particular caution is needed in people who have asthma, rhinitis or urticaria associated with these medicines.

It should not be used on broken, damaged, infected or diseased skin.

Ibuspray should not be used during pregnancy or breastfeeding.

How is it used?

Hold the bottle approximately 10–15 cm (4–6 inches) from the skin and spray over the affected area.

After every 2–3 sprays, gently massage the preparation into the skin and spread it over the area around the painful site.

Normally, 5–10 sprays (approximately 1–2 ml) are sufficient. This can be repeated three to four times a day, or as directed by a doctor. Do not use excessively.

Wash your hands after applying the spray, unless the hands are the area being treated.

Treatment should not normally continue for more than a few weeks unless advised by a doctor.

Ibuspray is flammable. Do not spray it near naked flames, cigarettes, electric heaters or other sources of ignition. Clothing, bedding and dressings that have come into contact with the product can also present a fire risk.

If you are taking aspirin or another NSAID by mouth, speak to your doctor or pharmacist before using Ibuspray, as this may increase the risk of side effects.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that can occur with Ibuspray. Because a side effect is listed here, it does not mean that everyone using the medicine will experience it.

• Skin rash, itching or irritation
• Redness or other skin reactions at the application site
• Increased sensitivity of the skin to sunlight
• Allergic reactions, including worsening asthma or narrowing of the airways (bronchospasm)
• Swelling of the lips, face, tongue or throat (angioedema)
• Rarely, more serious allergic reactions

Serious skin reactions have very rarely been reported with ibuprofen. Stop using Ibuspray and seek medical attention if you develop a severe skin rash, blistering, peeling skin or sores affecting the mouth, eyes or other mucous membranes.

Although topical ibuprofen is absorbed less into the bloodstream than ibuprofen taken by mouth, systemic side effects are possible, particularly if large amounts are used.

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Ibuspray is marketed in the UK by Dermal Laboratories Ltd.

Review date: September 2026
Version ID: 2/IBS/PAT/09/26

Lodine SR contains the active ingredient etodolac, which belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs). It is used to relieve pain, stiffness and inflammation associated with rheumatoid arthritis and osteoarthritis.

Lodine SR is a prolonged-release tablet containing 600mg of etodolac. It is a prescription-only medicine for adults.

How does it work?

Etodolac works by reducing the production of substances called prostaglandins. Prostaglandins are produced in response to injury and certain diseases and can contribute to pain, swelling and inflammation.

Etodolac inhibits cyclo-oxygenase (COX), an enzyme involved in the production of prostaglandins. It has some preference for COX-2, which is associated with inflammation, although the clinical benefit of this preferential COX-2 activity compared with other NSAIDs has not been proven.

Like other NSAIDs, etodolac can cause side effects affecting the stomach, kidneys, heart and circulation. It is used to relieve symptoms but does not treat the underlying cause of rheumatoid or osteoarthritis.

Who can get it?

Lodine SR is available on prescription for adults. It is not recommended for children.

It may not be suitable for people who have had stomach or intestinal ulcers or bleeding, severe heart, liver or kidney problems, or an allergic reaction or asthma triggered by aspirin or other NSAIDs.

People who are taking medicines that increase the risk of stomach bleeding, such as anticoagulants, antiplatelet medicines, corticosteroids or some antidepressants, should tell their doctor before taking Lodine SR.

Lodine should not be used during the third trimester of pregnancy. NSAIDs should generally be avoided during pregnancy unless specifically advised by a healthcare professional.

How is it used?

The usual adult dose is one 600mg tablet once a day.

The tablet should preferably be taken with or after food and swallowed whole with a glass of water. It should not be crushed or chewed.

If a lower dose is needed, a conventional etodolac preparation may be prescribed instead.

The lowest effective dose should be used for the shortest time necessary to control symptoms. The safety of doses above 600mg a day has not been established.

Lodine SR should not be taken at the same time as another NSAID, including aspirin used as a painkiller, unless advised by a healthcare professional.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that can occur with Lodine SR. Because a side effect is listed here, it does not mean that everyone taking the medicine will experience it.

• Indigestion, stomach pain, nausea or diarrhoea
• Headache or dizziness
• Drowsiness or tiredness
• Ringing in the ears (tinnitus)
• Skin rash or itching
• Fluid retention and swelling (oedema)
• Raised blood pressure
• Changes in kidney or liver function

NSAIDs such as etodolac can sometimes cause stomach or intestinal ulcers or bleeding, which can occasionally be serious or life-threatening. The risk is higher with increasing age, higher doses and longer treatment.

Serious allergic reactions can occur, including breathing difficulties, worsening asthma and swelling of the face, lips, tongue or throat.

Very rarely, serious skin reactions can occur. Stop taking Lodine SR and seek medical advice if you develop a severe skin rash, blistering, peeling skin or sores affecting the mouth, eyes or other mucous membranes.

Long-term or high-dose NSAID treatment may also be associated with a small increased risk of heart attack or stroke.

Marketed by

Lodine SR is marketed in the UK by Almirall Ltd

Review date: September 2026
Version ID: 2/LOD/PAT/09/26

Mefenamic acid is a type of medicine called a non-steroidal anti-inflammatory drug (NSAID). It is used to relieve pain and inflammation in conditions including rheumatoid arthritis and osteoarthritis. It can also be used for muscular and traumatic pain, such as pain following sprains, fractures and other injuries.

Mefenamic acid is available as capsules and tablets and is also available as an oral suspension.

How does it work?

Mefenamic acid works by reducing the production and effects of substances called prostaglandins.

Prostaglandins are produced by the body in response to injury and certain diseases and can cause pain, swelling and inflammation. Mefenamic acid blocks the action of cyclo-oxygenase (COX), an enzyme involved in producing prostaglandins. This helps to reduce pain and inflammation.

Mefenamic acid may also reduce the effects of prostaglandins after they have already been produced.

It provides relief from the symptoms of conditions such as rheumatoid arthritis and osteoarthritis but does not treat the underlying cause of these conditions.

Who can get it?

Mefenamic acid is available on prescription.

It can be used by adults and older people. Different formulations are available for children, including an oral suspension for children under 12 years.

Mefenamic acid may not be suitable for people who have, or have previously had, stomach or intestinal ulcers or bleeding, inflammatory bowel disease, severe heart, liver or kidney problems, or an allergic reaction to aspirin or other NSAIDs.

It should not be taken during the last three months of pregnancy and should not be taken while breastfeeding unless specifically advised by a healthcare professional.

How is it used?

The usual adult dose is 500 mg three times daily.

Mefenamic acid should preferably be taken with or after food.

The lowest effective dose should be used for the shortest time necessary to control symptoms.

Mefenamic acid should not be taken at the same time as another NSAID, including ibuprofen, naproxen or diclofenac, unless advised by a healthcare professional.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that can occur with mefenamic acid. Because a side effect is listed here, it does not mean that everyone taking the medicine will experience it.

• Indigestion, stomach pain, nausea or vomiting
• Diarrhoea
• Headache or dizziness
• Drowsiness or tiredness
• Ringing in the ears (tinnitus)
• Skin rash or itching
• Changes in liver or kidney function
• Changes in blood counts

Diarrhoea is an important side effect of mefenamic acid. It can occur soon after starting treatment or after several months of treatment. If diarrhoea develops, stop taking mefenamic acid and contact your doctor.

Like other NSAIDs, mefenamic acid can sometimes cause stomach or intestinal ulcers or bleeding, which can occasionally be serious or life-threatening.

Serious allergic reactions can occur, including breathing difficulties, worsening asthma and swelling of the face, lips, tongue or throat.

Very rarely, serious skin reactions can occur. Stop taking the medicine and seek medical advice if you develop a severe skin rash, blistering, peeling skin or sores affecting the mouth, eyes or other mucous membranes.

Long-term or high-dose treatment with NSAIDs may also be associated with an increased risk of heart attack or stroke.

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Mefenamic acid is available in the UK from several manufacturers. Ponstan Capsules 250mg and Ponstan Forte Tablets 500mg are marketed by Chemidex Pharma Ltd. Generic mefenamic acid products are also available.

Review Date: September 2026
Version ID: 2/MEF/PAT/09/26

Motifene contains the active ingredient diclofenac sodium, a non-steroidal anti-inflammatory drug (NSAID) used to relieve pain and inflammation.

It can be used for conditions including:

• rheumatoid arthritis and osteoarthritis
• ankylosing spondylitis
• acute attacks of gout
• acute musculoskeletal conditions, such as frozen shoulder, tendon inflammation, bursitis, sprains and strains
• pain following fractures or other injuries
• lower back pain
• pain and inflammation following orthopaedic, dental or other minor surgery.

How does it work?

Diclofenac works by reducing the production of substances called prostaglandins. Prostaglandins are involved in causing pain, swelling and inflammation. By reducing their production, diclofenac helps relieve pain and inflammation.

Motifene 75 mg capsules contain 75 mg of diclofenac sodium. The capsule contains two types of pellets: some release diclofenac relatively quickly, while the remainder release it more slowly. This provides both an initial and a longer-lasting effect.

The capsules are modified release and should be swallowed whole with plenty of liquid. Do not chew or open the capsules.

Who can get it?

Motifene is available on prescription for adults. Its safety and effectiveness have not been established in children and adolescents under 18 years.

Diclofenac may not be suitable for people with certain stomach, heart, kidney or liver problems, or for those who have previously had an allergic reaction to aspirin or other NSAIDs. Tell your doctor or pharmacist about any other medicines you take.

How is it used?

The usual adult dose is one 75 mg capsule once a day.

If necessary, the dose may be increased to one capsule twice a day, with the second dose taken 8–12 hours after the first. The maximum recommended daily dose of diclofenac is 150 mg.

Motifene should preferably be taken with or after food. Use the lowest effective dose for the shortest time needed to control your symptoms.

Do not take Motifene with other NSAIDs, such as ibuprofen, naproxen or aspirin for pain relief, unless advised to do so by a healthcare professional.

What are the side effects?

The most common side effects are related to the digestive system and may include:

• stomach pain or indigestion
• nausea or vomiting
• diarrhoea or constipation
• wind

Diclofenac can cause stomach or duodenal ulcers and bleeding. Seek urgent medical attention if you pass black, tarry stools, vomit blood or material that looks like coffee grounds, or develop severe stomach pain.

Other possible side effects include:

• headache, dizziness or drowsiness
• skin rash or itching
• swelling of the feet or ankles
• changes in blood pressure
• changes in liver or kidney function
• changes in blood test results
• ringing in the ears or changes in vision.

Serious allergic reactions can occur and may cause wheezing, difficulty breathing or swelling of the face, lips, mouth or throat.

Diclofenac can also slightly increase the risk of heart attack or stroke, particularly with higher doses and longer-term treatment. It should therefore be used at the lowest effective dose for the shortest possible time.

If you develop a severe skin rash, blistering or sores in the mouth or eyes, stop taking Motifene and seek medical advice immediately.

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Motifene is marketed in the UK by Daiichi Sankyo UK Ltd.

Review date: September 2026
Version ID: 2/MOT/PAT/09/26

Nabumetone is a non-steroidal anti-inflammatory drug (NSAID) used to reduce pain, stiffness and swelling associated with osteoarthritis and rheumatoid arthritis.

Nabumetone is a non-acidic NSAID. It is converted in the body to an active substance that reduces the production of prostaglandins, chemicals involved in pain and inflammation. Nabumetone helps control symptoms but does not alter the underlying cause of rheumatoid arthritis.

How does it work?

Nabumetone reduces the production of prostaglandins, which are involved in causing pain, swelling and inflammation.

By reducing inflammation, nabumetone can help relieve pain and stiffness and improve movement in people with osteoarthritis or rheumatoid arthritis.

Nabumetone may begin to relieve pain after the first few doses, although its full anti-inflammatory effect can take longer to develop.

Who can take nabumetone?

Nabumetone is available on prescription for adults. It is not recommended for children.

Your doctor may advise against nabumetone if you have, or have previously had, a stomach ulcer or gastrointestinal bleeding, severe heart, liver or kidney problems, or an allergic reaction to aspirin or other NSAIDs.

Nabumetone can increase the risk of stomach bleeding, kidney problems and cardiovascular problems, particularly with higher doses or long-term treatment. Your doctor will consider your individual risks and may prescribe a stomach-protecting medicine if appropriate.

How is it used?

The usual adult dose is 1 g once a day, taken at bedtime. This is two 500 mg tablets.

If symptoms are severe or persistent, your doctor may prescribe an additional 500 mg to 1 g as a morning dose. The maximum dose is generally 2 g a day.

People aged 65 and over are usually started on 500 mg once a day, and should not normally take more than 1 g a day.

Nabumetone should preferably be taken with or after food and the tablets should be swallowed whole with water.

As with other NSAIDs, the lowest effective dose should be used for the shortest time needed to control symptoms. Nabumetone should not be taken together with other NSAIDs unless specifically advised by your doctor.

What are the side effects?

The most common side effects include:

• Diarrhoea
• Constipation
• Indigestion
• Nausea
• Abdominal pain
• Flatulence
• Rash
• Swelling caused by fluid retention

Less commonly, nabumetone can cause stomach ulcers or bleeding, changes in kidney or liver function, raised blood pressure, dizziness or tiredness.

Seek urgent medical attention if you develop signs of a serious allergic reaction, vomit blood, pass black stools, or develop a severe skin reaction such as a widespread rash, blistering or peeling skin.

Long-term or high-dose treatment with NSAIDs can increase the risk of heart attack or stroke. Your doctor will take this into account when deciding whether nabumetone is suitable for you.

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Nabumetone 500 mg film-coated Tablets are currently marketed in the UK by Tillomed Laboratories Ltd.

Reviewed: September 2026
Version ID: 2/NAB/PAT/09/26

This page is for reference only as this product is now discontinued

Napratec contains the active ingredients naproxen which belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs) in one tablet plus a Cytotec tablet containing Misoprostol, a synthetic prostaglandin used to prevent gastric effects of the naproxen. Napratec is used for the treatment of acute osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.

How does it work?

It works by blocking the production of a group of chemical (prostaglandins) which the body produces in response to injury or certain diseases. These prostaglandins would otherwise go on to cause swelling, pain and inflammation.

Since prostaglandins also have a role in protecting the stomach lining, a reduction in prostaglandin levels sometimes causes gastric irritation or ulceration.

Misoprostol is a synthetic prostaglandin E1 analogue. It protects the lining of the stomach by mimicking the action of the naturally-occurring prostaglandins. Prostaglandins influence several factors involved in protection of the stomach lining. Misoprostol is used to promote peptic ulcer healing and relief of symptoms.

Misoprostol is added to the naproxen in this medicine to prevent the formation of ulcers caused by the effects of the naproxen.

Who can get it?

Available on prescription for adults.

How is it used?

You should normally take one Cytotec tablet and one naproxen tablet at the same time, twice a day with food.
Each wallet contains one week's supply of tablets. The wallet is divided into morning and evening doses and marked with the days of the week to help you remember how to take them.

What are the side effects?

All medicines can sometimes cause problems. You may get some of the following effects.

• The most common side effects are feeling or being sick, stomach pain, indigestion. Sometimes this can be a sign of an ulcer. This is unlikely to happen with Napratec. Occasionally you can get an inflammation of the bowel (symptoms may include cramp, bloating and possible diarrhoea). See your doctor if you get any of these problems for the first time.
• The Cytotec in Napratec can also cause stomach upsets and wind. Diarrhoea is the most common problem and is usually mild. You have less chance of getting diarrhoea if you take Napratec with food. If you use an antacid (something to reduce acid in the stomach) you should avoid antacids with magnesium in them as these may make diarrhoea worse. Your pharmacist can help you choose a suitable antacid. If this diarrhoea continues and causes you trouble, tell your doctor.
• Some people get skin rashes or other effects on the skin such as an increased sensitivity to sunlight, tingling and prickling feeling or bruising. If you get a rash or other skin reaction contact your doctor. Some people may get respiratory tract reactions such as asthma, bronchospasm or difficulty breathing. There have also been cases of hair loss or thinning in people taking naproxen.
• Some people also occasionally get disorders of the blood. You can become anaemic, or have problems with some types of blood cells called 'platelets' or 'granulocytes'. These problems can be picked up with blood tests.
• The Cytotec tablets occasionally can cause women to have problems with their periods. This can mean they may have heavy bleeding or bleeding between periods. Some women may have vaginal bleeding even though they have gone through the menopause.
• Some people get headaches, fatigue, drowsiness, confusion, depression, hallucinations, have trouble sleeping or concentrating or performing mental tasks.
• Some people get kidney or liver problems (these show up in their blood tests) although these are rarely serious, they can be fatal.
• Some people get dizzy or have balance problems. They may have ringing in the ears or other hearing problems. You may get swelling of the feet, ankles or hands. Very occasionally you may have problems with your sight (for example blurred vision), or with your kidneys, including passing urine with blood in it.
• Some people may develop an allergic reaction in their lungs and develop wheezing or breathlessness.
• You could also get inflammation of your blood vessels resulting in swelling of the face and/or throat, a sore mouth, mouth ulcers or meningitis (symptoms which may include neck stiffness, dislike of bright lights and a rash). These problems are rare.

Marketed by

Napratec is marketed in the UK by Pfizer Ltd.

Reviewed: September 2026
Version ID: 2/NAT/PAT/09/26

Naprosyn contains the active ingredient naproxen, which belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs) used for the treatment of acute osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.

How does it work?

Naproxen works by blocking the action of a substance in the body called cyclo-oxygenase (COX). Cyclo-oxygenase is involved in the production of various chemicals in the body, some of which are known as prostaglandins. Prostaglandins are produced by the body in response to injury and certain diseases and conditions, and cause pain, swelling and inflammation. Naproxen blocks the production of these prostaglandins and is therefore effective at reducing inflammation and pain.

Naproxen is used to relieve pain and inflammation in a wide range of musculoskeletal conditions, including various forms of arthritis, gout, muscle sprains and strains, back pain, neck pain and tendinitis. It can also be used to relieve period pain.

Naprosyn EC tablets have a special 'enteric coat' that is designed to prevent the tablet breaking down and releasing the naproxen in the stomach, and thus reduce the risk of it irritating the stomach. When the tablet reaches the intestine, the coating dissolves and the naproxen is absorbed into the bloodstream. The tablets should be swallowed whole and not broken or chewed to avoid damaging this coating.

Who can get it?

Available on prescription for adults and children over the age of 16 years.

How is it used?

For rheumatoid arthritis, osteoarthritis or ankylosing spondylitis

Take between 500mg and 1g each day in two separate doses, 12 hours apart. Where 1g per day is needed, you can take 500mg twice each day, or 1g in one single dose (morning or evening).

In some people, a larger dose of between 750mg and 1g per day may be taken to start with to control the pain. This is in patients with:

- severe night-time pain and/or morning stiffness.
- if your tablets have recently been changed from a high dose of another treatment for pain.
- osteoarthritis where pain is your main problem.

What are the side effects?

All medicines can sometimes cause problems. You may get some of the following effects.

• Rash,
• GI intolerance,
• headache,
• tinnitus,
• vertigo,
• blood dyscrasias,
• renal impairment,
• cardiovascular disorders

Read reviews or write your own

If you would like to read other people’s experience of this treatment, or have any comments to share, good or bad, you might like to go to iWantGreatCare

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Naproxen is known commercially as Naprosyn is marketed in the UK by Roche Products Ltd

This page is for reference only as this product is now discontinued

Orudis contains the active ingredient ketoprofen, a non-steroidal anti-inflammatory drug (NSAID). Ketoprofen was used to reduce pain and inflammation associated with conditions such as rheumatoid arthritis, osteoarthritis and ankylosing spondylitis.

How does it work?

Ketoprofen reduces the production of prostaglandins, chemicals involved in pain, swelling and inflammation.

By reducing prostaglandin production, ketoprofen can help relieve pain, stiffness and inflammation associated with arthritis and other musculoskeletal conditions.

Ketoprofen treats the symptoms of these conditions but does not alter the underlying disease.

Who can get it?

Orudis was available on prescription for adults.

NSAIDs such as ketoprofen are not suitable for everyone. They may not be appropriate if you have, or have previously had, a stomach ulcer or gastrointestinal bleeding, certain heart, kidney or liver problems, or an allergic reaction to aspirin or other NSAIDs.

How was it used?

The original Orudis capsules were available in different strengths. The dose depended on the formulation and the condition being treated.

The historical recommended adult dose was generally 50–100 mg twice daily, with the capsules taken with or after food to reduce the risk of stomach irritation.

The lowest effective dose was recommended for the shortest possible time.

Orudis should not have been taken together with other NSAIDs unless specifically advised by a doctor.

What are the side effects?

Like other NSAIDs, ketoprofen can cause side effects. These may include:

• Indigestion, stomach pain, nausea or diarrhoea
• Headache or dizziness
• Tiredness or drowsiness
• Skin rash or itching
• Fluid retention and swelling
• Changes in kidney or liver function
• Changes in blood cell counts

More serious side effects can include stomach ulcers or gastrointestinal bleeding, kidney problems, liver problems, severe allergic reactions and cardiovascular problems.

Rarely, serious skin reactions can occur. Stop taking the medicine and seek medical advice if you develop a severe or rapidly spreading rash, blistering or peeling skin.

Seek urgent medical attention if you vomit blood, pass black stools, develop severe breathing difficulties or swelling of the face or throat.

Marketed by

Orudis was marketed in the UK by Sanofi-Aventis.

Reviewed: September 2026
Version ID: 2/ORU/PAT/09/26

Oruvail prolonged-release capsules contain the active ingredient ketoprofen, a non-steroidal anti-inflammatory drug (NSAID). They are used to relieve pain, stiffness and inflammation associated with conditions such as rheumatoid arthritis, osteoarthritis and ankylosing spondylitis.

Oruvail capsules are prolonged-release capsules, which release ketoprofen gradually over several hours. They are available in 100 mg and 200 mg strengths.

How does it work?

Ketoprofen reduces the production of prostaglandins, chemicals involved in pain, swelling and inflammation.

By reducing prostaglandin production, ketoprofen can help relieve pain, stiffness and inflammation affecting the joints, muscles and other tissues.

Oruvail can be used for a range of painful inflammatory conditions, including rheumatoid arthritis, osteoarthritis, problems affecting the spine such as ankylosing spondylitis, lower back pain, sprains and strains.

Oruvail treats symptoms but does not alter the underlying cause of rheumatoid arthritis or other inflammatory conditions.

Because Oruvail is a prolonged-release preparation, it releases ketoprofen slowly and is normally taken once daily.

Who can get it?

Oruvail is available on prescription for adults.

It may not be suitable if you have, or have previously had, a stomach ulcer or gastrointestinal bleeding, severe heart, liver or kidney problems, or an allergic reaction to aspirin or other NSAIDs.

Particular care is needed in people aged 65 and over and in people with heart or circulation problems, asthma, Crohn's disease or ulcerative colitis.

How is it used?

The usual dose is 100 mg or 200 mg once a day, depending on your condition and your response to treatment.

The capsules should be swallowed whole with water and should not be opened, chewed or crushed, as this could affect the prolonged-release action.

Oruvail should preferably be taken with or after food.

The lowest effective dose should be used for the shortest time necessary to control symptoms.

Oruvail should not be taken with other NSAIDs unless specifically advised by your doctor.

What are the side effects?

Like other NSAIDs, Oruvail can cause side effects. These may include:

• Indigestion or stomach pain
• Nausea or vomiting
• Diarrhoea or constipation
• Headache or dizziness
• Tiredness or drowsiness
• Skin rash or itching
• Swelling caused by fluid retention

More serious side effects can include stomach ulcers or gastrointestinal bleeding, kidney or liver problems, raised blood pressure and cardiovascular problems.

Seek urgent medical attention if you vomit blood, pass black or tarry stools, develop severe breathing difficulties or swelling of the face or throat, or develop a severe skin reaction with blistering or peeling.

NSAIDs such as ketoprofen may be associated with a small increased risk of heart attack or stroke. This risk is more likely with higher doses and prolonged treatment.

Marketed by

Oruvail prolonged-release capsules are marketed in the UK by Sanofi.

Reviewed: September 2026
Version ID: 2/ORV/PAT/09/26

Pennsaid belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs). It contains the active ingredient diclofenac sodium and is used to relieve pain associated with osteoarthritis in superficial joints, such as the knee or wrist.

How does it work?

Diclofenac works by blocking the action of enzymes called cyclo-oxygenase (COX). These enzymes are involved in producing prostaglandins, chemicals that contribute to pain, swelling and inflammation.

When Pennsaid is applied to the skin, diclofenac passes through the skin into the tissues underneath. This allows it to act locally to reduce pain and inflammation.

Pennsaid is intended for osteoarthritis affecting superficial joints. There is no evidence for its use in large, deep joints covered by muscle or other soft tissue, such as the hip or spine.

Who can get it?

Pennsaid is available on prescription for adults.

It should not be used by people who have previously had an allergic reaction, asthma, breathing difficulties or other allergic symptoms after taking aspirin or another NSAID.

How is it used?

The painful joint should be washed with soap and water and allowed to dry before applying Pennsaid.

The usual amount is:

• 20 drops for a medium-sized joint, such as the wrist.
• 40 drops for a large joint, such as the knee.

The drops should be applied in small amounts over the painful joint and spread evenly without rubbing or massaging. Treatment is normally repeated four times a day, as directed by your doctor.

Pennsaid is for application to the skin only and must not be taken by mouth.

Do not apply it to broken, damaged, infected or diseased skin. Avoid contact with the eyes, mouth and other mucous membranes. Do not cover the treated area with an airtight dressing.

Wash your hands after applying Pennsaid, unless your hands are the area being treated.

Because some diclofenac can be absorbed into the bloodstream, side effects associated with NSAIDs can still occur, particularly if large areas are treated or the medicine is used for a prolonged period.

What are the side effects?

Possible side effects include:

• dry skin
• redness, itching or irritation where the medicine is applied
• skin rash or other skin reactions.

Systemic side effects, such as indigestion, stomach pain or other NSAID-related effects, are possible because some diclofenac is absorbed through the skin. The risk is generally lower than with oral diclofenac, but it is not completely eliminated.

Stop using Pennsaid and seek medical advice if you develop signs of an allergic reaction, severe skin reaction, stomach bleeding or other serious symptoms.

Do not use Pennsaid with another NSAID, such as ibuprofen, naproxen or diclofenac tablets, unless advised by a healthcare professional.

Pennsaid should not be used during pregnancy unless specifically advised by a doctor. NSAIDs should not be used during the last three months of pregnancy.

Marketed by

Pennsaid is marketed in the UK by Dimethaid International.

Reviewed: September 2026
Version ID: 2/PEN/PAT/09/26

This page is for reference only as this product is now discontinued

Tenoxicam is a non-steroidal anti-inflammatory drug which helps to reduce inflammation and to reduce the pain caused by arthritis

How does it work?

Tenoxicam works by blocking the production of some of the body chemicals that cause inflammation, pain, stiffness, tenderness, swelling and increased temperature.
By reducing inflammation in conditions affecting muscles and joints Tenoxicam helps to improve movement.
Tenoxicam can take a few weeks to help improve inflammation but can start to relieve pain after the first few doses.

Who can get it?

Not recommended for children

How is it used?

The usual daily dose for adults is 20mg, taken as a single tablet at the same time each day.
Tablets should be taken with water or other fluid.

What are the side effects?

Clinical studies have shown the following side effects can occur:

• Stomach upset
• Oedema, swelling of tissues
• Headache
• Rashes
• blood dyscrasias
• Raised liver enzymes
• visual disturbances
• hypersensitivity reactions
• plastic anaemia
• haemolytic anaemia
• hepatitis
• jaundice
• nephrotoxicity

Marketed by

Tenoxicam was available on prescription. It was known commercially as Mobiflex and was marketed in the UK by Meda Pharmaceuticals Ltd.

Reviewed: September 2026
Version ID: 2/TEN/PAT/09/26

Tiaprofenic acid is a non steroidal anti-inflammatory drug used for the treatment of rheumatoid arthritis, ankylosing spondylitis, osteoarthrosis, lumbago, acute musculo-skeletal disorders, soft tissue injuries.

How does it work?

Tiaprofenic acid helps to reduce inflammation and to reduce pain. Tiaprofenic acid works by blocking the production of some of the body chemicals that cause inflammation, pain, stiffness, tenderness, swelling and increased temperature.
By reducing inflammation in conditions affecting muscles and joints Tiaprofenic acid helps to improve movement.
Tiaprofenic acid can take a few weeks to help improve inflammation but can start to relieve pain after the first few doses.

Who can get it?

Tiaprofenic acid is available on prescription for adults. It is not suitable for children

How is it used?

• swallow the medicine whole with a glass of water
• take your medicine in its original form. You must not break, chew or crush it

What are the side effects?

Clinical studies have shown the following side effects can occur.

• GI upset
• Headache
• Drowsiness
• Rash
• Urinary frequency

Read reviews or write your own

If you would like to read other people’s experience of this treatment, or have any comments to share, good or bad, you might like to go to iWantGreatCare for Tiaprofenic acid or iWantGreatCare for Surgam.

Marketed by

Tiaprofenic acid is available on prescription and is commercial known as Surgam. It is marketed in the UK by Sanofi Aventis

Vimovo contains the active ingredients naproxen and esomeprazole and belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs). It is used in adults to relieve the symptoms of osteoarthritis, rheumatoid arthritis and ankylosing spondylitis.

Vimovo combines naproxen with esomeprazole for people who need an NSAID and are at increased risk of developing stomach or duodenal ulcers.

How does it work?

Naproxen is an NSAID that reduces pain and inflammation by reducing the production of substances called prostaglandins.

Esomeprazole is a proton pump inhibitor (PPI). It reduces the amount of acid produced in the stomach and helps reduce the risk of stomach and duodenal ulcers associated with NSAID treatment.

Vimovo helps control symptoms but does not treat the underlying cause of arthritis or replace disease-modifying treatment where this is needed.

Who can get it?

Vimovo is available on prescription for adults.

It is not recommended for children or adolescents under 18.

Vimovo may not be suitable for people with certain stomach, heart, kidney or liver problems, or for people who have previously had an allergic reaction to aspirin or other NSAIDs. Your doctor will consider your individual risks before prescribing it.

How is it used?

Swallow the tablets whole with water. Do not chew, split or crush them, as this can affect how the medicine works.

Take Vimovo at least 30 minutes before eating. Food can delay the absorption of naproxen and may reduce the protective effect of esomeprazole.

How much to take

The usual dose is one 500 mg/20 mg tablet twice a day, for as long as your doctor recommends.

Vimovo is only available as 500 mg naproxen/20 mg esomeprazole. If this dose is not suitable, your doctor may prescribe naproxen or another NSAID at a different dose, with or without separate stomach protection.

Vimovo is not intended to provide rapid relief of acute pain because the naproxen is released slowly.

Your doctor should review your treatment regularly, particularly if you take Vimovo for a long time. The lowest effective NSAID dose should be used for the shortest time necessary.

Do not take Vimovo with other NSAIDs, such as ibuprofen, diclofenac, celecoxib or etoricoxib, unless specifically advised by your doctor.

What are the side effects?

Like all medicines, Vimovo can cause side effects, although not everybody gets them.

Possible side effects include:

• Dizziness or feeling light-headed.
• Tiredness or drowsiness.
• Nausea or vomiting.
• Diarrhoea, constipation, stomach pain, indigestion, heartburn or wind.
• Swelling of the hands, feet or ankles.
• Skin rash or itching.
• Sleep disturbance.
• Increased sweating.
• Changes in vision or hearing, such as blurred vision or ringing in the ears.
• Mouth inflammation or mouth ulcers.

Because Vimovo contains an NSAID, it can sometimes cause stomach or intestinal ulcers, bleeding or perforation, even without warning symptoms. The risk is greater with higher doses, longer treatment and in people with a previous ulcer or other risk factors. The esomeprazole component reduces the risk of ulcers but does not remove it completely.

Stop taking Vimovo and seek urgent medical attention if you develop:

• Swelling of the face, lips, tongue or throat, difficulty breathing, wheezing or difficulty swallowing.
• Vomiting blood or material that looks like coffee grounds.
• Black, tarry stools or bloody diarrhoea.
• Severe or persistent stomach pain.
• A severe skin rash, blistering or peeling of the skin, or sores in the mouth, eyes or other areas.
• Yellowing of the skin or whites of the eyes, particularly with dark urine or unusual tiredness.
• Chest pain, sudden weakness or numbness, difficulty speaking or other possible signs of a heart attack or stroke.

Vimovo can also rarely cause kidney inflammation or other kidney problems. Tell your doctor if you notice a significant reduction in the amount of urine, blood in your urine, fever, rash or joint stiffness.

Long-term treatment with esomeprazole may also affect vitamin B12 or magnesium levels in some people. Long-term use of proton pump inhibitors may slightly increase the risk of certain fractures, particularly in people who already have risk factors for osteoporosis.

Marketed by

Vimovo is marketed in the UK by Grünenthal Ltd.

Reviewed: September 2026
Version ID: 2/VIM/PAT/09/26

Volsaid Retard tablets contain the active ingredient diclofenac sodium, which is a type of medicine called a non-steroidal anti-inflammatory drug (NSAID).

NSAIDs are used to relieve pain and inflammation. Diclofenac can be used for a range of musculoskeletal conditions, including rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, back pain, sprains and strains, tendinitis and other painful inflammatory conditions.

Volsaid Retard tablets are modified-release tablets, which release diclofenac gradually to provide longer-lasting relief.

How does it work?

Diclofenac works by blocking the action of enzymes called cyclo-oxygenase (COX). These enzymes are involved in producing substances called prostaglandins.

Prostaglandins are involved in pain, swelling and inflammation. By reducing their production, diclofenac helps relieve pain and inflammation.

Diclofenac helps control symptoms but does not treat the underlying cause of arthritis or replace disease-modifying treatment where this is needed.

Because Volsaid Retard is a modified-release preparation, the diclofenac is released gradually over several hours.

Who can get it?

Volsaid Retard is available on prescription for adults.

It may not be suitable for people who have had stomach ulcers or bleeding, certain heart or circulation problems, kidney or liver problems, or an allergic reaction to aspirin or other NSAIDs.

Diclofenac should be used at the lowest effective dose for the shortest time necessary, particularly in people with cardiovascular risk factors. Long-term treatment should be reviewed regularly.

How is it used?

Volsaid Retard tablets should be taken with or after food if possible.

• 75 mg tablets: one tablet once or twice daily.
• 100 mg tablets: one tablet once daily.

The tablets should be swallowed whole with water. Do not crush or chew them, as this can affect the modified-release action.

The total daily dose of diclofenac should generally not exceed 150 mg.

Do not take Volsaid Retard with other NSAIDs, such as ibuprofen, naproxen, aspirin for pain relief, celecoxib or etoricoxib, unless your doctor specifically advises you to do so.

What are the side effects?

Like all medicines, Volsaid Retard can cause side effects, although not everybody gets them.

Possible side effects include:

• Indigestion, stomach pain, nausea, vomiting, diarrhoea or constipation.
• Wind or loss of appetite.
• Headache or dizziness.
• Drowsiness or tiredness.
• Skin rash or itching.
• Fluid retention and swelling of the hands, feet or ankles.
• Changes in liver or kidney function.
• Changes in blood counts.

NSAIDs such as diclofenac can sometimes cause stomach or intestinal ulcers, bleeding or perforation, which can occasionally be serious or life-threatening.

Diclofenac may also increase the risk of heart attack or stroke, particularly with higher doses or long-term treatment. People with existing heart or circulation problems, high blood pressure or other cardiovascular risk factors may need particular care.

Seek urgent medical attention if you develop:

• Severe allergic symptoms such as swelling of the face, lips, tongue or throat, difficulty breathing or wheezing.
• Vomiting blood or material that looks like coffee grounds.
• Black, tarry stools or blood in your stools.
• Severe or persistent stomach pain.
• Chest pain, sudden weakness or numbness, difficulty speaking or other possible signs of a heart attack or stroke.
• A severe skin reaction, including blistering, peeling or sores in the mouth or eyes.
• Yellowing of the skin or whites of the eyes, particularly with dark urine or unusual tiredness.
• A significant reduction in the amount of urine or other signs of serious kidney problems.

Marketed by

Volsaid Retard is marketed in the UK by Chiesi Ltd

Reviewed: September 2026
Version ID: 2/VOL/PAT/09/26

Voltarol contains diclofenac, a type of medicine called a non-steroidal anti-inflammatory drug (NSAID). NSAIDs are used to relieve pain and inflammation.

Voltarol products are used for a range of painful conditions, including some types of arthritis, musculoskeletal pain and inflammation. Different Voltarol products contain different forms of diclofenac and are used in different ways.

How does it work?

Diclofenac works by blocking enzymes called cyclo-oxygenase (COX). These enzymes are involved in producing substances called prostaglandins.

Prostaglandins are produced by the body in response to injury and certain diseases and contribute to pain, swelling and inflammation. By reducing the production of prostaglandins, diclofenac helps relieve pain and inflammation.

Diclofenac can be used for conditions including rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, acute gout and acute musculoskeletal problems such as tendinitis, bursitis, frozen shoulder, sprains, strains and back pain. It can also be used for pain following some dental, orthopaedic and other minor surgery.

Diclofenac helps control symptoms but does not treat the underlying cause of arthritis or replace disease-modifying treatment where this is needed.

Voltarol tablets and other formulations

Voltarol Rapid 50 mg tablets contain diclofenac potassium. They are absorbed relatively quickly and are used for short-term relief of pain and inflammation. The tablets should be swallowed whole with water.

The older Voltarol enteric-coated, dispersible, SR and Retard tablets described in some older information are not currently listed as UK Voltarol tablet products on the eMC. Current UK Voltarol products also include suppositories and ampoules containing diclofenac sodium.

Who can get it?

Voltarol is available on prescription for adults, although the age and suitability of treatment depend on the particular formulation.

Diclofenac may not be suitable for people who have had stomach ulcers or bleeding, certain heart or circulation problems, kidney or liver problems, or allergic reactions to aspirin or other NSAIDs.

Systemic diclofenac should be used with particular caution in people with cardiovascular risk factors. It is contraindicated in people with established ischaemic heart disease, peripheral arterial disease, cerebrovascular disease or congestive heart failure.

How is it used?

The dose and method of taking Voltarol depend on the particular product.

For systemic diclofenac, the lowest effective dose should be used for the shortest time necessary to control symptoms.

Do not take Voltarol tablets with other NSAIDs, such as ibuprofen, naproxen, celecoxib or etoricoxib, unless your doctor specifically advises you to do so.

If you are prescribed a tablet formulation, follow the instructions supplied with your particular product. Some formulations have special coatings or modified-release properties and must be swallowed whole.

What are the side effects?

Like all medicines, Voltarol can cause side effects, although not everybody gets them.

Possible side effects include:

• Indigestion, stomach pain, nausea, vomiting, diarrhoea or constipation.
• Wind or loss of appetite.
• Headache or dizziness.
• Drowsiness or tiredness.
• Skin rash or itching.
• Fluid retention and swelling of the hands, feet or ankles.
• Changes in liver or kidney function.
• Changes in blood counts.

NSAIDs such as diclofenac can sometimes cause stomach or intestinal ulcers, bleeding or perforation, which can occasionally be serious or life-threatening.

Systemic diclofenac can also increase the risk of heart attack or stroke, particularly with higher doses and longer treatment. Your doctor will consider your cardiovascular risk before prescribing it.

Seek urgent medical attention if you develop:

• Swelling of the face, lips, tongue or throat, difficulty breathing or wheezing.
• Vomiting blood or material that looks like coffee grounds.
• Black, tarry stools or blood in your stools.
• Severe or persistent stomach pain.
• Chest pain, sudden weakness or numbness, difficulty speaking or other possible signs of a heart attack or stroke.
• A severe skin reaction, including blistering, peeling or sores in the mouth or eyes.
• Yellowing of the skin or whites of the eyes, particularly with dark urine or unusual tiredness.
• A significant reduction in the amount of urine or other signs of serious kidney problems.

Marketed by

Voltarol products are marketed in the UK by Novartis Pharmaceuticals UK Ltd. Current UK Voltarol products include Voltarol Rapid tablets, suppositories and ampoules.

Reviewed: September 2026
Version ID: 2/VOT/PAT/09/26

Axsain 0.075% cream contains capsaicin, a topical analgesic used to relieve certain types of nerve pain. It is licensed for the symptomatic relief of neuralgia associated with, or following, herpes zoster infection (post-herpetic neuralgia), once any open skin lesions have healed. It is also used for painful diabetic peripheral polyneuropathy under the supervision of a hospital consultant.

How does it work?

Capsaicin is a compound found naturally in capsicum, including chilli peppers. It acts on pain-sensing nerves in the skin. Although its precise action is not fully understood, capsaicin is thought to reduce pain signalling by depleting and preventing the re-accumulation of a chemical called substance P in peripheral sensory nerve cells.

Axsain provides symptomatic relief. It does not treat the underlying cause of nerve damage.

Who can get it?

Axsain is available on prescription for adults, including older people.

It is not suitable for use in children.

Axsain should only be applied to unbroken skin. It must not be used on broken, inflamed or irritated skin, or by anyone who is allergic to capsaicin or any of the ingredients.

How is it used?

Axsain should be applied sparingly to the affected area, usually three or four times a day, or as directed by your doctor.

• Apply only a small amount, approximately pea-sized, to the affected area.
• Rub the cream in gently until no residue remains on the skin.
• Space applications evenly throughout the day and do not apply more often than every four hours.
• Wash your hands immediately after applying the cream, unless your hands are the treated area. If treating the hands, wash them 30 minutes after application.
• Avoid contact with the eyes, mouth, nose and other mucous membranes.
• Do not use under tight bandages or dressings.
• Avoid taking a hot bath or shower immediately before or after applying the cream, as this may increase the burning sensation.
• Avoid inhaling vapours from the cream.

When used for painful diabetic peripheral polyneuropathy, Axsain should be used under the direct supervision of a hospital consultant with access to specialist resources. Treatment should initially be assessed after eight weeks and reviewed regularly before continuing.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects associated with Axsain. Experiencing a side effect does not mean that everyone using the medicine will develop it.

Axsain commonly causes a temporary burning sensation when it is applied. This may be more noticeable if:

• Too much cream is used.
• The cream is applied more than four times a day.
• The cream is applied shortly before or after a hot bath or shower.

Other possible side effects include:

• Skin irritation, redness or discomfort at the application site.
• Contact dermatitis or other local skin reactions.
• Irritation of the eyes, nose or throat if vapours are inhaled.
• Runny nose, coughing, sneezing or watery eyes.
• Rarely, breathlessness, wheezing or worsening of asthma.

Avoid contact with the eyes and seek medical advice if the condition worsens. If any side effect becomes serious, or if you notice a side effect not listed here, speak to your doctor or pharmacist.

Marketed by

Axsain 0.075% w/w Cream is marketed in the UK by Ennogen IP Ltd.

Reviewed: September 2026
Version ID: 2/AXS/PAT/09/26

Balmosa Cream is a warming pain-relieving cream containing menthol, camphor, methyl salicylate and capsicum oleoresin. It is a topical analgesic and rubefacient used for the symptomatic relief of muscular rheumatism, fibrositis, lumbago, sciatica and pain associated with unbroken chilblains.

Balmosa is an older product and may not be readily available. Check with a pharmacist about current availability and suitable alternatives.

How does it work?

Balmosa contains four active ingredients that work together to produce a cooling or warming sensation and relieve pain.

• Menthol produces a cooling sensation and has mild pain-relieving properties.
• Camphor acts as a counter-irritant and has mild local analgesic effects.
• Methyl salicylate has pain-relieving and counter-irritant properties.
• Capsicum oleoresin produces warmth and redness of the skin and may help reduce the perception of pain.

These ingredients provide symptomatic relief. They do not treat the underlying cause of a rheumatic or musculoskeletal condition.

Who can get it?

Balmosa is intended for adults and older people. It is not generally recommended for children under 12 years.

It should not be used by anyone who is allergic to any of its ingredients or who has previously experienced sensitivity to aspirin or other non-steroidal anti-inflammatory drugs.

Speak to a pharmacist or doctor before use if you are pregnant, planning a pregnancy or breastfeeding.

How is it used?

Apply the cream to the affected area and gently massage it into the skin as required.

• Use only on unbroken skin.
• Avoid contact with the eyes, mouth, nostrils and other sensitive areas.
• Do not apply to inflamed, irritated, infected or broken skin.
• Wash your hands thoroughly immediately after use, unless the hands are the treated area.
• Do not use with airtight or watertight dressings.
• Avoid exposing treated skin to excessive sunlight.
• If irritation develops, stop using the cream.

Do not apply large amounts. If the cream is accidentally swallowed, seek medical advice.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that may be associated with Balmosa. Experiencing a side effect does not mean that everyone using the medicine will develop it.

Possible side effects include:

• Skin redness, irritation, itching or rash.
• Contact dermatitis or other skin sensitivity reactions.
• A temporary sensation of warmth, burning or stinging.
• Allergic reactions, particularly in people sensitive to salicylates or other ingredients.

Stop using the cream if irritation or a rash develops. Seek urgent medical help if you experience swelling of the face, lips, tongue or throat, difficulty breathing or another serious allergic reaction.

If any side effect becomes serious, or if you notice a side effect not listed here, speak to your doctor or pharmacist.

Marketed by

Balmosa  is marketed in the UK by Galen Consumer

Reviewed: September 2026
Version ID: 2/BAL/PAT/09/26

Qutenza is a cutaneous patch containing capsaicin. It belongs to a group of medicines known as topical analgesics and is used to treat peripheral neuropathic pain in adults, either on its own or alongside other medicines for pain.

Qutenza contains a high-strength preparation of capsaicin and must be applied by a doctor or healthcare professional under the supervision of a doctor.

How does it work?

Capsaicin is a compound found naturally in capsicum, including chilli peppers.

Capsaicin initially activates pain-sensing nerves in the skin, which can cause burning and redness. Following exposure, these nerves become less sensitive to a range of painful stimuli. This process, sometimes called desensitisation, is thought to produce pain relief.

The effects on the pain-sensing nerves are generally temporary and can gradually reverse over time.

Who can get it?

Qutenza is available on prescription for adults only.

It may be used for different types of peripheral neuropathic pain, including:

• Post-herpetic neuralgia following shingles.
• Painful diabetic peripheral neuropathy.
• HIV-associated neuropathy.

Qutenza should not be used in children, as its safety and effectiveness have not been established in people under 18.

The patch must only be applied to intact, dry, non-irritated skin. It must not be applied to broken skin, the face, near the eyes or close to mucous membranes.

How is it used?

Qutenza must be applied by a doctor or healthcare professional under medical supervision.

• The most painful areas are identified and marked on the skin.
• The area is cleaned and dried before treatment.
• A topical anaesthetic or an oral painkiller may be given before application to reduce discomfort.
• Up to four patches may be applied at one time.
• Patches are left in place for 30 minutes when treating the feet and 60 minutes when treating other areas.
• Treatment may be repeated after 90 days, if necessary, when pain persists or returns.
• In some circumstances, repeat treatment before 90 days may be considered by a doctor following an individual assessment. A minimum interval of 60 days must be observed.

After the patches are removed, a cleansing gel is applied to the treated area to remove any remaining capsaicin. The area is then cleaned.

Patients may experience burning or pain during and shortly after treatment. Healthcare professionals should monitor this and provide appropriate supportive treatment if needed.

What are the side effects?

Like all medicines, Qutenza can cause side effects, although not everybody gets them. The following are some of the side effects associated with this medicine.

Very common side effects:

• Pain at the application site.
• Redness at the application site.

Common side effects:

• Burning sensation.
• Itching, bumps, blisters, swelling or dryness at the application site.
• Increased blood pressure.
• Pain in the limbs.
• Muscle spasms.
• Swelling of the limbs.

Uncommon side effects:

• Wheals or hives.
• Prickling, tingling or increased sensitivity.
• Skin inflammation, dermatitis, irritation or other skin reactions.
• Bruising at the application site.
• Reduced sensation in the limbs.
• Changes in taste.
• Eye irritation.
• Throat irritation.
• Fast heartbeat or awareness of the heartbeat.
• Temporary slowing of electrical signals through the heart.

Burns, including serious burns, have been reported following treatment with capsaicin patches. If severe pain occurs during treatment, the patch should be removed and the skin examined.

Accidental contact with capsaicin may irritate the eyes, skin, throat or airways. This can cause eye pain, coughing, sneezing or throat irritation. Anyone experiencing breathing difficulties should receive appropriate medical attention.

If any side effect becomes serious, or if you notice a side effect not listed here, speak to your doctor or pharmacist.

Marketed by

Qutenza 179 mg cutaneous patch is marketed in the UK by Grünenthal Ltd.

Reviewed: September 2026
Version ID: 2/QUT/PAT/09/26

Zacin 0.025% cream contains capsaicin, a topical analgesic used to relieve pain associated with osteoarthritis.

How does it work?

Capsaicin is a compound found naturally in capsicum, including chilli peppers.

The precise mechanism is not fully understood. Capsaicin is thought to act on pain-sensing nerves in the skin, initially causing a warming or burning sensation before reducing the ability of these nerves to send pain signals.

Capsaicin may reduce pain signalling by depleting and preventing the re-accumulation of substances involved in transmitting pain, including substance P.

Zacin provides symptomatic relief. It does not treat the underlying cause of osteoarthritis.

Who can get it?

Zacin is available on prescription for adults and older people.

It is not suitable for use in children.

Zacin should only be applied to unbroken skin. It must not be used on broken, irritated or inflamed skin, or by anyone who is allergic to capsaicin or any of the ingredients.

How is it used?

Apply a small amount of Zacin cream to the affected area four times daily, or as directed by your doctor.

• Use approximately a pea-sized amount for the affected area.
• Rub the cream gently into the skin until no residue remains.
• Space applications evenly throughout waking hours and do not apply more often than every four hours.
• Wash your hands immediately after applying the cream, unless your hands are being treated.
• Avoid contact with the eyes, mouth, nose and other sensitive areas.
• Do not apply to broken, irritated or inflamed skin.
• Do not use under tight bandages or dressings.
• Avoid taking a hot bath or shower immediately before or after applying the cream, as this may increase the burning sensation.

Pain relief usually begins during the first week of treatment and may increase with regular application over the following two to eight weeks.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects associated with Zacin. Experiencing a side effect does not mean that everyone using the medicine will develop it.

Zacin may cause a temporary burning sensation after application. This usually becomes less noticeable after several days of treatment, although it may persist in some people.

The burning sensation may be increased if:

• Too much cream is applied.
• The cream is applied more often than recommended.
• The cream is applied shortly before or after a hot bath or shower.

Other possible side effects include:

• Skin redness or irritation.
• Itching or rash.
• Contact dermatitis or other local skin reactions.
• Irritation of the eyes, nose or throat if the cream is accidentally transferred or vapours are inhaled.
• Coughing, sneezing or breathing difficulties, particularly in people with asthma.

Stop using the cream if significant irritation or a rash develops. Seek urgent medical help if you experience swelling of the face, lips, tongue or throat, or difficulty breathing.

If any side effect becomes serious, or if you notice a side effect not listed here, speak to your doctor or pharmacist.

Marketed by

Zacin 0.025% w/w Cream is marketed in the UK by Ennogen IP Ltd.

Reviewed: September 2026
Version ID: 2/ZAC/PAT/09/26

Apremilast belongs to a group of medicines called phosphodiesterase 4 inhibitors. It helps reduce inflammation and is used to treat adults with active psoriatic arthritis who have had an inadequate response to, or who have been unable to tolerate, a previous disease-modifying antirheumatic drug (DMARD).

Apremilast is also used to treat certain adults with moderate to severe plaque psoriasis and adults with Behçet’s disease who have oral ulcers. This page focuses on its use in psoriatic arthritis.

How does it work?

Apremilast works by reducing the activity of an enzyme in the body called phosphodiesterase 4 (PDE4).

PDE4 is involved in the control of inflammatory processes. By reducing its activity, apremilast helps regulate the production of inflammatory substances and can reduce inflammation associated with psoriatic arthritis.

Apremilast is a targeted treatment but is not a biological medicine. It can be used on its own or in combination with other DMARDs.

Who can get it?

Apremilast is available on prescription only (POM) and is intended for adults.

Treatment should be started by a specialist experienced in treating psoriasis or psoriatic arthritis. Your specialist will consider your symptoms, previous treatments and overall health before prescribing it.

Apremilast may not be suitable for people who are allergic to apremilast or any of its ingredients. It must not be used during pregnancy. Your doctor should also be told if you have a history of depression, suicidal thoughts or other mental health problems.

How is it used?

Apremilast is taken by mouth as tablets.

Treatment is started at a low dose, which is gradually increased over the first five days to help reduce the likelihood of side effects such as diarrhoea and nausea.

The usual adult maintenance dose is 30 mg twice daily, taken approximately 12 hours apart, usually in the morning and evening. It can be taken with or without food.

The usual dose-increase schedule is:

• Day 1: 10 mg in the morning.
• Day 2: 10 mg in the morning and 10 mg in the evening.
• Day 3: 10 mg in the morning and 20 mg in the evening.
• Day 4: 20 mg in the morning and 20 mg in the evening.
• Day 5: 20 mg in the morning and 30 mg in the evening.
• Day 6 onwards: 30 mg in the morning and 30 mg in the evening.

People with severe kidney problems may be prescribed a lower maintenance dose.

Treatment should be reviewed regularly. If there is no evidence of a beneficial response within approximately 24 weeks, your specialist may reconsider whether treatment should continue.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects associated with apremilast. Experiencing a side effect does not mean that everyone taking the medicine will develop it.

Very common side effects
(may affect more than 1 in 10 people)

• Headache, including tension headache or migraine.

Common side effects
(may affect up to 1 in 10 people)

• Upper respiratory tract infections, such as a cold, runny nose or sinus infection.
• Stomach or upper abdominal pain.
• Indigestion or acid reflux.
• Frequent bowel movements.
• Loss of appetite.
• Back pain.
• Difficulty sleeping.
• Migraine or tension headache, where not already included above.

Diarrhoea, nausea and vomiting are most likely to occur during the first few weeks of treatment. They often improve within approximately four weeks. Contact your doctor if these symptoms are severe or do not improve, particularly if you are unable to drink enough fluids.

Uncommon side effects
(may affect up to 1 in 100 people)

• Hives or nettle rash (urticaria).
• Allergic reactions.
• Weight loss.
• Bleeding from the stomach or bowel.
• Anxiety or changes in mood.
• Suicidal thoughts or behaviour.

Depression and suicidal thoughts

Apremilast has been associated with depression, suicidal thoughts and suicidal behaviour, including in people who have not previously experienced depression.

Tell your doctor promptly if you notice new or worsening depression, changes in mood or behaviour, thoughts of suicide or any other concerning mental health symptoms. Seek urgent medical help if you or someone else is in immediate danger.

Seek urgent medical attention if you develop signs of a serious allergic reaction, such as swelling of the face, lips, mouth, tongue or throat, or difficulty breathing.

If any side effect becomes serious, or if you notice a side effect not listed here, speak to your doctor or pharmacist.

Marketed by

Apremilast is known commercially as Otezla and is marketed in the UK by Amgen Ltd

Reviewed: September 2026
Version ID: 2/APR/PAT/09/26

Tofacitinib is a medicine known as a Janus kinase (JAK) inhibitor. It belongs to a group of medicines called disease-modifying antirheumatic drugs (DMARDs). It is used to treat active psoriatic arthritis in adults whose disease has not responded adequately to previous DMARD treatment or who cannot tolerate these medicines.

Tofacitinib works by blocking the activity of enzymes called Janus kinases (JAKs). These enzymes are involved in sending signals that promote inflammation. By reducing these signals, tofacitinib can help reduce inflammation, pain and swelling in the joints associated with psoriatic arthritis.

Who can get it?

Tofacitinib is available on prescription and treatment should be started and supervised by a specialist experienced in treating psoriatic arthritis.

For psoriatic arthritis, tofacitinib can be used with methotrexate or on its own if methotrexate is not tolerated or is considered inappropriate.

Because JAK inhibitors are associated with increased risks of serious infections, cardiovascular events, blood clots and some cancers, particular caution is needed in people aged 65 or over, people who currently or previously smoked for a long time, and people with cardiovascular or malignancy risk factors. In these groups, tofacitinib should only be used when there are no suitable alternative treatments.

Tofacitinib should not be used in people with an allergy to the medicine, active tuberculosis, serious infection such as sepsis, opportunistic infection, severe liver impairment, or during pregnancy or breastfeeding.

How is it used?

Tofacitinib is taken by mouth and can be taken with or without food.

For adults with psoriatic arthritis, the usual dose is:

5 mg twice a day.

The dose may need to be reduced in certain circumstances, including some people with severe kidney impairment or moderate liver impairment. Your doctor will decide whether a reduced dose is necessary.

Tofacitinib should not be taken with certain other medicines that can excessively suppress the immune system, including some biological treatments and potent immunosuppressants.

What are the side effects?

Tofacitinib affects the immune system and can increase the risk of infections. Some infections can be serious. Treatment should be interrupted if a serious infection develops until the infection is controlled.

Possible side effects include:

• Upper respiratory tract infections
• Headache
• Diarrhoea
• Nausea
• High blood pressure
• Increased cholesterol and other changes in blood fats
• Changes in blood cell counts, including anaemia or reduced white blood cells
• Increased risk of infections
• Increased risk of shingles
• Liver enzyme abnormalities

Less commonly, more serious problems can occur, including serious infections, blood clots, major cardiovascular events such as heart attack, and certain cancers. The risk of some of these problems is particularly important in older people and those with cardiovascular, smoking or cancer risk factors.

Tell your doctor urgently if you develop symptoms of a serious infection, unexplained chest pain, sudden breathlessness, swelling or pain in a leg, or other symptoms that could indicate a blood clot or cardiovascular problem.

Before and during treatment, your healthcare team will carry out appropriate checks, which may include blood tests and monitoring for infections, liver abnormalities, changes in blood counts and cholesterol.

Marketed by

Tofacitinib is known commercially as Xeljanz® and is marketed in the UK by Pfizer.

Reviewed: August 2026
Version ID: 2/TOF/PTA/08/26