If you’re living with rheumatoid arthritis (RA), you likely take multiple medications every day. Taking these medications as prescribed can help slow the progression of RA and reduce disease activity. It can also help minimize side effects from treatment. Therefore, it is crucial to know when and how to take each of your medications.

This article discusses the evidence-based strategies for timing your RA medication dosages, organized by your treatment options:

• Disease-modifying anti-rheumatic drugs (DMARDs)
• Corticosteroids
• Nonsteroidal anti-inflammatory drugs (NSAIDs)

Here, we provide suggestions for taking your medications properly. However, you should always follow the treatment plan prescribed by your rheumatologist and instructions given by your pharmacist.

Timing DMARDs

DMARDs are drugs that affect the way the immune system works. They help slow the progression of joint damage and inflammation caused by RA. Categories include conventional, biologic, and targeted synthetic DMARDs. Your timing and dosage of DMARDs depend on the type of DMARD, the specific medication, and your doctor’s instructions.

Conventional DMARDs

Conventional DMARDs affect your entire immune system, treating the autoimmune effects of RA throughout the body. Conventional DMARDs include:

• Methotrexate (sold as Trexall and Otrexup)
• Leflunomide (Arava)
• Hydroxychloroquine (Plaquenil)
• Sulfasalazine (Azulfidine)

To maximize your medication’s effectiveness (how well it works), DMARDs should be taken at certain times during the day.

Methotrexate

Methotrexate is the most common DMARD used to treat RA. It is taken at a dose between 10 milligrams (mg) and 25 mg each week. It is one of the safest drugs used to treat RA if taken properly. While taking methotrexate, you should undergo regular blood tests to monitor your blood counts and identify risks of infection.

One study assessed how well the body absorbed methotrexate when taken at different times of the day. The study found no differences in medication effectiveness in participants who took methotrexate in the morning versus at night. Due to side effects of methotrexate, such as nausea and diarrhea, the Arthritis Foundation recommends splitting your dose and taking half in the morning and half at night. Doses should be no more than 12 hours apart.

A member of myRAteam said, “Folic acid is a must while taking methotrexate.”

Because methotrexate blocks the natural production of folate, pairing methotrexate with a folic acid supplement can help prevent the gastrointestinal side effects of methotrexate. Your health care provider will instruct you on when to take folic acid — and whether that is one 5-mg dose per week or a smaller dose once a day.

The timing of your methotrexate and folic acid regimen may look different from others’ treatment experiences. One myRAteam member said “My doctor has me on six methotrexate pills once a week and a daily folic acid pill,” while another member said that they took “eight methotrexate pills one day a week, for three years.”

Other Conventional DMARDs

Other conventional DMARDs, like leflunomide, hydroxychloroquine, and sulfasalazine are typically prescribed to be taken once or twice a day. Multiple doses should be spaced out at regular intervals.

One important warning is that sulfasalazine should never be taken on an empty stomach or with antacids. Make sure to take it with plenty of food and water. Sulfasalazine should be taken exactly every eight hours (even during the night). For all other conventional DMARDs, speak to your doctor about the best times of day to take your pills.

Biologic DMARDs

Biologic medications are a new type of DMARD. They target a specific type of immune cell, called cytokines, to reduce arthritis symptoms. Examples include:

• Abatacept (Orencia)
• Adalimumab (Humira)
• Etanercept (Enbrel)
• Certolizumab (Cimzia)
• Golimumab (Simponi)
• Infliximab (Remicade)
• Rituximab (Rituxan)

Biologic drugs can be administered by a provider as infusion therapy over 30 minutes to two hours at a health care facility. This may occur once every few weeks or months, depending on the drug types, dosages, and RA severity. Biologics can also be administered as injections.

Targeted Synthetic DMARDs

Targeted synthetic DMARDs are a new class of small molecule medications that restrict pathways inside of your immune cells, and target the proteins that trigger the immune system.

These drugs include the Janus kinase Janus kinase (JAK) inhibitors baricitinib (Olumiant), tofacitinib (Xeljanz), and upadacitinib (Rinvoq). They are usually recommended, in small doses, when methotrexate is intolerable or has not improved your condition over time. In clinical trials, they have been to significantly slow the progression of joint damage, as observed through X-rays and reported symptoms.

This class of DMARDs is usually prescribed in tablet form to be taken once or twice daily, with or without food. You may find it helpful to take these drugs with breakfast and dinner, or right as you wake up and right as you go to sleep, to create a routine.

Timing Non-DMARDS

Common non-DMARD treatments for RA include NSAIDs and corticosteroids. Timing varies for each medication.

NSAIDs

NSAIDs do not directly affect RA disease progression, but they are often used to manage symptoms alongside DMARDS. Common NSAIDs for RA include naproxen (Aleve, Naprosyn, and Naprelan) and ibuprofen (Advil).

The timing, dosage, and frequency of taking NSAIDs have to do with the severity of your symptoms and the form of the medication — controlled and delayed-release tablets are taken less frequently than traditional tablets or oral liquids. Research from an article in CreakyJoints suggests that an NSAID nighttime dose could help prevent early morning symptoms of RA, especially if that NSAID is a delayed release, and its effects may last longer.

Generally, NSAIDs should be taken right before meals on an empty stomach to achieve the best and fastest anti-inflammatory effects. Follow medical advice and instructions on the packaging to make sure that you’re not taking more than the recommended dose, and that you are taking it correctly.

Corticosteroids

Corticosteroids such as prednisone are anti-inflammatory drugs that affect the immune system. They are usually prescribed to be taken temporarily with DMARDs. They help address joint pain and other RA symptoms before DMARDs start to take effect. Long-term use of steroids is not recommended, as it’s associated with weight gain and osteoporosis.

The timing of corticosteroid administration depends on the method of administration, as it can be given orally or as an injection. To prevent RA morning stiffness, it is recommended to take oral corticosteroids in the middle of the night. Taking these drugs between 12 and 2 a.m. is much more effective in reducing daytime joint pain and stiffness than taking them between 6 and 8 a.m., as shown by multiple studies. However, the delayed-release formulations of corticosteroids allow you to take the medication at bedtime for convenience.

Tips for Taking Medications Consistently

The U.S. Food and Drug Administration (FDA), provides several tips to help you take your medications consistently and as prescribed:

• Take your medication at the same time every day to develop a routine.
• You may find it helpful to pair doses with your morning coffee or before brushing your teeth at night, but make sure to note which medications should be taken with and without food.
• Pillboxes, timer caps, and pill calendars are all evidence-based tools to help improve your consistency with taking medications. You can purchase these items online or at your local pharmacy.
• If side effects become unmanageable, make sure to have a conversation with your rheumatologist. They will help optimize your RA treatment plan to control your RA with minimal side effects.

Talk With Others Who Understand

On myRAteam, the social network for people with rheumatoid arthritis and their loved ones, more than 192,000 members come together to ask questions, give advice, and share their stories with others who understand life with RA. Here, finding ways to manage and time rheumatoid arthritis treatment while improving quality of life is a commonly discussed topic.

When do you take your RA drugs? Do you have any tips for sticking to your medication regimen? Share your experience and advice in the comments below, or start a conversation by posting on your Activities page.