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

  • 1. van Puijenbroek EP1, Egberts AC, Meyboom RH, Leufkens HG. Association between terbinafine and arthralgia, fever and urticaria: symptoms or syndrome? Pharmacoepidemiol Drug Saf. 2001 Mar-Apr;10(2):135-42. PubMed
  • 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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