Joint Pain (Arthralgia) Side Effect
Arthralgia means a pain localized to a joint. Arthralgia is a symptom, not a disease.
Main drug classes reported to cause joint pain are:
- statins (mainly lipophilic)5 may cause joint damage, joint pain, and myalgia
- bisphosphonates
- fluoroquinolones (arthralgia begins after an average of 3 days of therapy and resolves an average of 7.5 days after cessation)7
- corticosteroids (degree of arthralgia depends on dosage and duration of therapy)8
- retinoids14
- vaccines
- oral iron
| Drug | Incidence |
|---|---|
| Abelcet | |
| Abilify | < 1% |
| Accupril | 0.5% to 1% |
| Accuretic | 0.5% to 1% |
| Aceon | 0.3% to 1.1% |
| Actimmune | 2% |
| Actiq | > 1% |
| Activella | |
| Adalat CC | < 1% |
| Advair Diskus | 1% to 3% |
| Advate | 23.3% |
| Advicor | |
| Aggrenox | 5.5% |
| Agrylin | 1% to 5% |
| Aldara | 0.9% |
| Aldoclor | |
| Aldoril | |
| Alferon N | 3% to 10% |
| Alendronate (Fosamax®)2 | 0.4% to 6% |
| Aloprim | < 1% |
| Aloxi | < 1% |
| Altoprev | 5% |
| AmBisome | 1% to 10% |
| Ambien | 4% |
| Amerge | Infrequent |
| Anzemet | Rare |
| Apokyn | > 5% |
| Aranesp | 11% to 13% |
| Arava | 1% |
| Aredia | 11.5% to 26% |
| Arimidex | 2% to 13% |
| Aromasin | 2% to 5% |
| Asacol | 5% |
| Atacand | > 0.5% |
| Atorvastatin (Lipitor®) | < 5.1% |
| Augmentin | |
| Avalide | |
| Avandamet | 5% |
| Avapro | < 1% |
| Avelox | 0.1% to 3% |
| Avonex | 9% |
| Axert | Rare |
| Azasan | < 1% |
| Azmacort | |
| Beconase | |
| Benicar | > 1% |
| Benicar | > 0.5% |
| Betaseron | 31% |
| Bextra | 0.1% to 1.9% |
| Bicillin | |
| Blocadren | < 1% |
| Busulfex I.V. | 13% |
| Caduet | 0.1% to 5.1% |
| Calcium Disodium Versenate | |
| Campral | |
| Captopril | 4% to 7% |
| Carbatrol | |
| Carvedilol (Coreg®) | 1% to 6% |
| Ceclor | |
| Ceftin | 0.1% to 1% |
| Celebrex | 0.1% to 1.9% |
| Celexa | 2% |
| CellCept | 3% to 20% |
| Cialis | < 2% |
| Climara | 1% to 5% |
| Clinoril | < 1% |
| Clomid | |
| Clonidine (Catapres®) | 6% |
| Clopidogrel (Plavix®)6 | 6.3% |
| Clorpres | 0.6% |
| Clozapine | < 1% |
| Clozaril | < 1% |
| Colazal | 4% |
| CombiPatch | 6% |
| Combivent | < 2% |
| Combivir | 5% |
| Comvax | |
| Concerta | |
| Copaxone | 24% |
| Copegus | 22% |
| Cosopt | |
| Coumadin | |
| Covera-HS | < 2% |
| Cozaar | < 1% |
| Crinone | 8% |
| Crixivan | |
| Cubicin | 0.9% |
| Cuprimine | |
| CytoGam | < 5% |
| Cytovene | Rare |
| Dalmane | |
| Demadex | 1.8% |
| Depacon | 1% to 5% |
| Depakene | 1% to 5% |
| Depakote | 1% to 5% |
| Depo-Provera | 1% to 5% |
| Desferal Vials | |
| Detrol | 2.3% |
| DiaBeta | |
| Didronel | |
| Diovan | 1% to 3% |
| Dipentum | 4% |
| Dolobid | < 1% |
| Dostinex | 1% |
| Doxil | < 1% |
| DynaCirc | 0.5% to 1% |
| Elidel | < 1.5% |
| Eligard | < 3.4% |
| Eloxatin | 7% to 10% |
| Elspar | |
| Emtriva | 3% to 5% |
| Enalapril (Vasotec®)10 | 0.5% to 1% |
| Enbrel | |
| Engerix-B | < 1% |
| Epivir-HBV | 7% |
| Epivir | 5% |
| Epogen | Rare |
| Epoprostenol (Flolan®) | 6% to 84% |
| Eskalith | |
| Estrasorb | |
| Estring | 3% |
| EstroGel | |
| Estrogens, conjugated (Cenestin®, Premarin®) | 9.4% to 25% |
| Etretinate (Tegison®) | |
| Evoxac | 3.7% |
| Exelon | > 2% |
| Factive | 0.1% to 1% |
| Famvir | 1.3% to 1.5% |
| FazaClo | < 1% |
| Femara | 6% to 16% |
| Femtrace | |
| Ferrlecit | > 1% |
| Floxin | < 1% |
| Fludara | 1% |
| Fluticasone (Flovent®)3 | 1% to 19% |
| Forteo | 10.1% |
| Fortovase | < 2% |
| Gamimune N | |
| Gamunex | 4% |
| Gastrocrom | Rare |
| Gengraf | 1% to 6% |
| Genotropin Lyophilized Powder | |
| Geodon | |
| Gleevec | 25% to 40% |
| Glucotrol | < 3% |
| HIVID | < 1% |
| Havrix | < 1% |
| Hectorol | 4.9% |
| Herceptin I.V. | 6% |
| Humatrope Vials and Cartridges | 10.8% to 17.3% |
| Hycamtin | 0.2% to 0.9% |
| Hytrin | < 1% |
| Hyzaar | |
| Imitrex | Infrequent |
| InFeD | |
| Infergen | 43% to 51% |
| Intal Inhaler | Infrequent |
| Intron A | < 19% |
| Invirase | < 2% |
| Isoptin | < 1% |
| Isotretinoin (Accutane®)13 | 16% |
| Jantoven | |
| K-Phos | Less frequent |
| Kadian | < 3% |
| Kaletra | < 2% |
| Keflex Pulvules | |
| Keppra | > 1% |
| Kineret | 6% |
| Klonopin | Infrequent |
| Lamictal | 2% |
| Lariam | Infrequent |
| Lescol | 1.3% to 4% |
| Leukine | 11% to 21% |
| Leustatin | 5% |
| Levaquin | 0.1% to 1% |
| Levitra | < 2% |
| Levothroid | |
| Levoxyl | |
| Lexapro | Frequent |
| Lofibra | |
| Lotensin | < 1% |
| Lupron Depot | |
| Lupron | < 5% |
| M-M-R II | |
| Matulane | |
| Maxalt | Infrequent |
| Menostar | 12% |
| Meridia | 5.9% |
| Meruvax II | |
| Metadate | |
| Mevacor | 0.5% to 1% |
| Miacalcin | 3.8% |
| Micardis | > 0.3% |
| Midamor | < 1% |
| Minocycline | |
| Mirapex | 1% |
| Mirtazapine (Remeron®)12 | may be induced by enhanced 5HT1-mediated neurotransmission |
| Mobic | 0.5% to 5.3% |
| Moduretic | < 1% |
| Myfortic | 3% to < 20% |
| Namenda | > 2% |
| Nasonex | > 2% |
| Navelbine | < 12% |
| Neoral | 1% to 6% |
| Neulasta | 15% to 72% |
| Neupogen | Infrequent |
| Nexium | < 1% |
| Nipent | 3% to 10% |
| Noroxin | |
| Norvasc | 0.1% to 1% |
| Norvir | < 1.7% |
| Nutropin | |
| Oncaspar | 1% to 5% |
| Ontak Vials | 8% |
| Orthoclone OKT3 | < 1% |
| Orthovisc | 12.6% |
| PEG-Intron | 23% |
| Paxil | 2% |
| Pediarix | |
| Pegasys | 28% |
| Pentasa | < 1% |
| Pepcid | Infrequent |
| Pepcid | Infrequent |
| Periostat | 6% |
| Permax | 1.6% |
| Phenytek | |
| Photofrin | 31% |
| Pletal | < 2% |
| Pneumovax | Rare |
| Prandin | 3% to 6% |
| Pravastatin (Pravachol®) | Rare |
| Premarin | |
| Premphase | 7% to 13% |
| Prempro | 7% to 13% |
| Prevacid | < 1% |
| Prevpac | < 1% |
| Priftin | 2.5% |
| Prilosec | < 1% |
| Prinivil | 0.3% to 1% |
| Prinzide | |
| ProSom | Rare |
| Prochieve | 8% |
| Procrit | < 11% |
| Prograf | 3% to 15% |
| Proleukin | 6% |
| Prometrium | 21% |
| Protonix | > 1% |
| Protopic | > 1% |
| Provigil | < 1% |
| Quetiapine (Seroquel®)11 | Infrequent |
| Rabies Vaccine RavAvert | Common |
| Raloxifene (Evista®) | 10.7% to 15.5% |
| Rapamune | 25% to 31% |
| Ramipril (Altace®)10 | < 1% |
| Raptiva | |
| Rebetol | 15% to 34% |
| Rebetron | 29% to 33% |
| Recombivax | < 1% |
| Relenza | < 1.5% |
| Relpax | Infrequent |
| Remicade | 13% |
| Renagel | 12.1% |
| Repronex | |
| Requip | > 1% |
| Rescriptor | |
| Retrovir | |
| Reyataz | 1% to 4% |
| Ribavirin | 20% to 33% |
| Rifater | Frequent |
| Rrifabutin (Mycobutin®)15 | |
| Rilutek | 1.6% to 5.1% |
| Risedronate (Actonel®)2 | 11.5% to 32.8% |
| Risperidone (Risperdal®)11 | 2% to 3% |
| Ritalin | |
| Rituxan | 0.3% |
| Roferon-A | 47% to 51% |
| Rosuvastatin (Crestor®)4 | > 2% |
| Rowasa | 2.09% |
| Salagen | < 1% |
| Sandimmune | Rare |
| Sandostatin | 1% to 4% |
| Sandostatin LAR Depot | 5% to 15% |
| Sculptra | |
| Septra | |
| Serevent Diskus | 1% to 3% |
| Simulect | 3% to 10% |
| Singulair | |
| Simvastatin (Zocor®) | |
| Sonata | Frequent |
| Soriatane | 10% to 25% |
| Strattera | > 2% |
| Stromectol | 9.3% |
| Sular | < 1% |
| Sustiva | < 2% |
| Symbyax | 3% to 5% |
| Quinupristin/dalfopristin (Synercid®)8 | < 1% more likely to occur in patients with chronic liver disease, patients receiving cyclosporine or mycophenolate |
| Tagamet | Rare |
| Tambocor | < 1% |
| Targretin | |
| Tarka | 0.3% to 1.7% |
| Tasmar | > 1% |
| Taxotere | 3.4% to 9.2% |
| Tegretol | |
| Tequin, | < 0.1% |
| Terbinafine (Lamisil®)1 | |
| Teveten | 2% |
| Thalomid | |
| Tikosyn | > 2% |
| Timentin | |
| Timolide | |
| Timolol GFS | |
| Timoptic | |
| Tindamax | |
| Topamax | Frequent |
| Toprol | |
| Trasylol | 1% to 2% |
| Tricor | |
| Trileptal | |
| Trisenox | 33% |
| Trizivir | 5% |
| Truvada | |
| Twinrix | < 1% |
| Uniretic | < 1% |
| Univasc | < 1% |
| Uroqid-Acid No.2 | |
| VFEND | < 1% |
| Valcyte | < 5% |
| Valtrex Caplets | 1% to 6% |
| Varivax | > 1% |
| Vaseretic | 0.5% to 2% |
| Velcade | 26% |
| Venlafaxine (Effexor®) | 1% to 10% |
| Verelan PM | < 2% |
| Viagra | > 2% |
| Vicoprofen | < 1% |
| Videx | |
| Vioxx | 0.1% to 1.9% |
| Viracept | < 2% |
| Viramune | 2% to 6% |
| Visudyne | 1% to 10% |
| Vivelle | |
| Vytorin | |
| WinRho SDF | |
| Xalatan | 1% to 2% |
| Xanax | 2.4% |
| Xifaxan | < 2% |
| Xolair | 8% |
| Zantac | Rare |
| Zaroxolyn | |
| Zegerid | < 1% |
| Zenapax | 2% to 5% |
| Zetia | 3.8% |
| Zevalin | 7% |
| Ziagen | |
| Zofran | 2% |
| Zoladex | > 1% |
| Zoloft | Infrequent |
| Zometa | 5% to 21% |
| Zomig | Infrequent |
| Zonegran | Infrequent |
| Zosyn | < 1% |
| Zyban | 4% to 5% |
| Zyprexa | 5% |
| Zyrtec | < 2% |
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References
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- 2. Bock O, Boerst H, Thomasius FE, et al. Common musculoskeletal adverse effects of oral treatment with once weekly alendronate and risedronate in patients with osteoporosis and ways for their prevention. J Musculoskelet Neuronal Interact. 2007 Apr-Jun;7(2):144-8. PubMed
- 3. Hay CM, Spratt DI. Adrenal insufficiency in a woman secondary to standard-dose inhaled fluticasone propionate therapy.Endocrinol Diabetes Metab Case Rep. 2014;2014:130080.
- 4. Carter NJ. Rosuvastatin: a review of its use in the prevention of cardiovascular disease in apparently healthy women or men with normal LDL-C levels and elevated hsCRP levels. Am J Cardiovasc Drugs. 2010;10(6):383-400. PubMed
- 5. Campion J, Western A. Statins and joint pain. Br J Clin Pharmacol. 2008 Oct;66(4):570-1. PubMed
- 6. Agrawal S, Harburger J, Stallings G, Agrawal N, Garg J. Clopidogrel-Induced Recurrent Polyarthritis. J Investig Med High Impact Case Rep. 2013 Aug 5 PubMed
- 7. O-Lee T, Stewart CE, Seery L, Church CA. Fluoroquinolone-induced arthralgia and myalgia in the treatment of sinusitis. Am J Rhinol. 2005 Jul-Aug;19(4):395-9.PubMed
- 8. Carver PL, Whang E, VandenBussche HL, Kauffman CA, Malani PN. Risk factors for arthralgias or myalgias associated with quinupristin-dalfopristin therapy. Pharmacotherapy. 2003 Feb;23(2):159-64. PubMed
- 9. Gao HS, Wang SX, Chen LM, Li YM, Yuan SL, Jiao ZS, Hui WL, Yang Z, Zhao ZY. Analysis of relation between the usage of corticosteroid in treatment and arthralgia as a sequela of SARS patients Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2004 May;16(5):277-80. PubMed
- 10. Peppers MP. Myalgia and arthralgia associated with enalapril and ramipril. Am J Health Syst Pharm. 1995 Jan 15;52(2):203-4.
- 11. Wang TY, Tsai SJ. Risperidone and quetiapine-related arthralgia. J Clin Psychopharmacol. 2014 Apr;34(2):271-2. PubMed
- 12. Passier A, van Puijenbroek E. Mirtazapine-induced arthralgia. Br J Clin Pharmacol. 2005 Nov;60(5):570-2. PubMed
- 13. Hull PR, Demkiw-Bartel C. Isotretinoin use in acne: prospective evaluation of adverse events. J Cutan Med Surg. 2000 Apr;4(2):66-70. PubMed
- 14. Kaplan G, Haettich B. Rheumatological symptoms due to retinoids. Baillieres Clin Rheumatol. 1991 Apr;5(1):77-97. PubMed
- 15. Le Gars L, Collon T, Picard O, Kaplan G, Berenbaum F. Polyarthralgia-arthritis syndrome induced by low doses of rifabutin. J Rheumatol. 1999 May;26(5):1201-2. PubMed
Published: August 20, 2016
Last updated: December 15, 2017
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