The active ingredient of brand name Plaquenil and generic hydroxychloroquine are the same. In the United States, the manufacture of prescription drugs is highly regulated and the manufacturer is required, by federal law, to guarantee the integrity of their product, for both brand name and generic formulation.
DMARDs for Arthritis Q & A
Enbrel (etanercept) is not made of fetuses. However, the protein is entirely human and produced by recombinant DNA technology.
Many patients complain of headache and fatigue when taking methotrexate so you are not unique. We recommend that all patients on MTX receive folic acid at a dose of at least 5 mg/week (we ususally use 1 mg/day). Folic acid is often very helpful in managing these complaints. Sometimes we use an even stronger form of folic acid called leukovorin given 12 and sometimes 24 hours after methotrexate that also seems to help with headache, fatigue, nausea, and hairloss which sometimes occur with methotrexate.
Many DMARD options are avaialble to treat RA including methotrexate, Arava (leflunomide), sulfasalazine, and biological agents. Many of these medications require time to work (which can be several months) and require dose titration to find the efffective dose. It is Important to communicate your symptoms to your rheumatologist and telling them that you are still having these symptoms. Sometimes even higher doses of sulfasalazine are required to control symptoms. Other medication options may also be needed either alone or in combination with the sulfasalazine.
Certainly there can be additive toxicities of many medications. In the case of methotrexate and Arava (leflunomide) these can be effects on the liver and on blood counts. However, there are also well documented reports of the efficacy of this combination. In general, when used in combination the blood is monitored very carefully and the doses of the agents are sometimes decreased to allow the combination to be given.
This should not be a problem to take cough medicine. But if you are having a persistent cough and you are taking TNF antagonists, it is important to have it evaluted by your physician to ensure that there is not and infection or another cause of the cough that could be related to your rheumatoid arthritis or other medications.