Arava

Arava (leflunomide) is an FDA-approved medication primarily used to treat rheumatoid arthritis (RA) in adults. It functions as a disease-modifying antirheumatic drug (DMARD) that suppresses the immune system to reduce inflammation and prevent joint damage. Available in tablet form, Arava is prescribed in various dosages and may also be used off-label for psoriatic arthritis and juvenile idiopathic arthritis (JIA). Monitoring liver function and blood cells is essential during treatment due to potential serious side effects, including liver damage and lowered immunity. You can buy Arava (leflunomide) online from Canada with a valid prescription from your doctor.

Arava, known generically as leflunomide, is an essential treatment for adults with active rheumatoid arthritis (RA), an autoimmune disorder that primarily affects the joints. As a disease-modifying antirheumatic drug (DMARD), Arava helps to diminish the overactive immune responses, thereby reducing inflammation and tissue damage in RA patients. It is available in tablet forms of 10 mg, 20 mg, and 100 mg strengths.

The typical treatment regimen starts with a higher loading dose to rapidly achieve effective drug levels, followed by a maintenance dose tailored to individual patient needs based on their liver and bone marrow function. While Arava is primarily used for RA, it also finds off-label use in managing psoriatic arthritis and juvenile idiopathic arthritis, offering broader therapeutic applications.

Arava treatment requires careful monitoring due to its potential to cause significant side effects, such as liver enzyme elevations and severe infections. Regular blood tests are crucial to check liver function and blood cell counts. Given its risks, Arava is not advised during pregnancy, and both men and women should use effective contraception during and after treatment as specified by healthcare guidelines. Engaging and informed discussions with healthcare providers are vital to optimize treatment outcomes with Arava.

• Arava is an FDA-approved medication designed to treat adults with active rheumatoid arthritis (RA).
• While not officially approved for these conditions, Arava is also used off-label to manage other forms of arthritis, including:
  • Psoriatic Arthritis
  • Juvenile Idiopathic Arthritis (JIA)

What Are the Forms & Strengths of Arava?

Arava comes in the form of tablets that you take by mouth and is available in these three following strengths:

• Arava 10 mg tablets
• Arava 20 mg tablets
• Arava 100 mg tablets

What Is the Typical Dosage of Arava?

The dosage of Arava prescribed by your doctor will vary based on several personal health factors. These include your risk for liver or bone marrow issues, how your body reacts to the medication, and any other health conditions you might have. Initially, when you start treatment with Arava, your doctor might prescribe a higher dose for the first three days—this is known as a loading dose. This higher dose helps to quickly increase the level of Arava in your body, allowing the medication to start acting more swiftly.

After this initial phase, your doctor will adjust your dose to a smaller, daily amount that suits your specific needs. The goal is to find the lowest possible dose that still effectively manages your condition. It's crucial to follow the dosage instructions provided by your doctor, as they will tailor the amount based on your individual response to the treatment and your medical profile.

Dosage for Rheumatoid Arthritis

• Adult Dosage for Rheumatoid Arthritis (RA):
  • Standard Dosage: The typical dose for treating rheumatoid arthritis in adults is 20 mg of Arava once daily. This is the highest dose recommended per day.
  • Adjustments for Side Effects: If you experience side effects from Arava, your doctor may reduce your dose to 10 mg each day to alleviate these issues.
  • Initial Dose for Quick Effect: To make the medication work faster, your doctor might start you with a higher dose of 100 mg daily for the first three days of treatment. After this initial period, they will reduce it to a suitable ongoing dose.
• Dosage Based on Risk of Serious Side Effects:
  • Low Risk: If you have a low risk of developing serious side effects, such as liver or bone marrow issues, you might start with 100 mg daily for three days. Afterward, the dose will be adjusted to a maintenance level of 20 mg daily.
  • High Risk: For those at high risk for serious side effects, the dose is consistently set at 20 mg daily, without an initial higher dose.

[Note: Remember, these recommendations may vary from person to person. Discuss it with your doctor, and they'll customize your dosage accordingly.]

Arava is a medication used for treating arthritis, and there are several important steps and checks involved in its use to ensure safety and effectiveness:

• Initial Tests: Before starting Arava, your doctor might conduct tests to ensure you don't have tuberculosis or any other infections, as Arava can affect your immune system.
• Following Prescription Guidelines:
  • Always follow the instructions on your prescription label carefully. Your doctor has the authority to adjust your dose when necessary, so never alter the dose on your own.
  • Avoid using the medication in larger or smaller amounts or for longer than recommended.
• Regular Monitoring:
  • Your blood pressure needs regular monitoring throughout the treatment.
  • Arava can reduce the number of blood cells that fight infections and help your blood clot, so frequent blood tests are crucial. Depending on these test results, your doctor might temporarily stop your treatment with Arava.
  • Your liver function must also be checked regularly due to the risk of liver damage. Your treatment may be paused or stopped depending on how your liver is responding.
• After Stopping Arava:
  • Once you stop taking Arava, you might need specific treatments to help your body remove the drug quickly. Without this drug elimination process, Arava could remain in your body for up to two years.
  • If you plan to become pregnant after stopping Arava, going through the drug elimination procedure is essential to ensure the drug is completely cleared from your body.
• Using Multiple Medications:
  • Arthritis treatment often involves a combination of different drugs. Make sure to use all medications as your doctor instructs.
  • Always read the medication guide or patient instructions provided with each drug.
  • Do not change your doses or medication schedule without consulting with your doctor.

[Note: Your doctor will decide the right amount for you based on your condition, following guidelines and studies on the drug. They'll adjust it as needed over time.]

Arava works by targeting rheumatoid arthritis (RA) at its source—the immune system. In RA, the immune system mistakenly attacks the joints and other healthy tissues, causing inflammation and symptoms like pain and swelling. Over time, this inflammation can damage tissues and worsen symptoms. Arava belongs to a class of medications known as disease-modifying anti-rheumatic drugs (DMARDs), which help control this overactive immune response and reduce inflammation.

While traditional DMARDs like Arava are chemical-based, newer DMARDs, known as biologics, are made from living cells and target specific parts of the immune system more precisely. By reducing inflammation, Arava can help alleviate symptoms of RA, prevent further joint damage, and maintain your ability to perform daily activities. It’s important to discuss with your doctor how Arava fits into your overall treatment plan and how it can help manage your condition effectively.

What Are the Side Effects of Arava?

Arava can lead to both mild and serious side effects. While the list provided here includes some common reactions to the medication, it's not exhaustive. For a more comprehensive understanding of what you might experience while taking Arava, or for advice on managing any side effects, please consult with your doctor or pharmacist. If you find that certain side effects are particularly troublesome, your doctor might suggest discontinuing Arava. Should this occur, your doctor can provide you with an alternative treatment plan that includes a method to help your body eliminate Arava more quickly.

Common Side Effects of Arava: Like all medications, it can cause side effects. These side effects are usually temporary and may last only a few days to weeks. However, if they persist, become bothersome, or feel intense, it's important to talk to your doctor or pharmacist. Here’s what you might experience while taking Arava:

• Increased liver enzymes: This means that tests may show higher levels of certain proteins that could indicate your liver is under stress.
• Diarrhea: You might experience loose, watery stools.
• Nausea and vomiting: Feeling sick to your stomach or vomiting can occur.
• Headache: You may experience mild to severe headaches.
• Rash or itching: Skin irritations or itching might develop.
• Hair loss: You could notice losing more hair than usual.
• Weakness or low energy levels: Feeling unusually tired or weak is possible.
• Back pain: This can include mild to severe back discomfort.
• Pain in your abdomen or digestive tract area: You may feel pain or discomfort in your stomach or gut.
• Mouth ulcers: Sores inside your mouth could appear.
• Inflammation in your lungs or airways: This might feel like a persistent cough or difficulty breathing.
• Runny or stuffy nose, or sneezing: Symptoms similar to a cold can occur.
• Dizziness: You might feel lightheaded or unsteady.

Serious Side Effects of Arava: It can sometimes cause serious side effects as well. So, it’s crucial to be aware of these so you can get help quickly if they occur. Always contact your doctor immediately if you experience any serious side effects, and call 911 or your local emergency services if symptoms seem life-threatening. Here’s a detailed look at some potential serious side effects from taking Arava:

• Nerve damage: You may experience unusual sensations like tingling, burning, or sharp pain, numbness, muscle weakness, and increased sensitivity when touched. These symptoms could indicate nerve damage.
• High blood pressure: While not common, symptoms such as headaches, dizziness, fatigue, nosebleeds, or shortness of breath can occur if your blood pressure rises.
• Lung inflammation and scarring: Watch for symptoms like a persistent cough, difficulty breathing, or wheezing, as these might suggest problems with your lungs.
• Severe skin reactions: Conditions like Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) can manifest as blisters, fever, flu-like symptoms, and red, peeling skin. These require immediate medical attention.
• Severe drug rash (DRESS): This serious reaction can cause fever or flu-like symptoms, itchy or reddened skin, a rash, and swollen lymph glands.
• Lowered immunity and serious infections: Arava can weaken your immune system, making you more susceptible to infections, which can be severe.
• Bone marrow problems: This can affect your blood cell levels, leading to further health complications.
• Allergic reactions: Be alert for signs of an allergic reaction such as swelling, rash, itching, or difficulty breathing.
• Liver problems: Symptoms such as yellowing of the skin or eyes (jaundice), severe nausea, or upper stomach pain can indicate liver issues.
• Fetal harm: If used during pregnancy, Arava can harm the fetus, so it is not recommended for pregnant women.

[Note: Remember, this list may not cover all possible side effects. Always consult with your healthcare giver for medical advice about side effects.]

• Arava and Pregnancy: Arava carries significant risks during pregnancy and should not be used if you are pregnant or planning to become pregnant. This medication can cause severe harm to an unborn baby, and it has a strict warning (a boxed warning) from the Food and Drug Administration (FDA). This is the most serious kind of warning on prescription drugs, emphasizing potential dangers.
  • Before and During Treatment: If you're using Arava, you must use reliable birth control to avoid pregnancy. This should continue for two years after you stop taking the medication, as its effects can linger in the body.
  • Starting Arava: You should only begin taking Arava after a negative pregnancy test, verified by your doctor, to ensure you are not pregnant.
  • If Pregnancy Occurs: If you become pregnant while taking Arava or within two years after stopping it, notify your doctor immediately. Your doctor will prescribe a treatment to help remove the drug’s active components from your body more quickly to reduce potential harm.
  • Pregnancy Registry: If you use Arava during pregnancy, it’s important to register with the Arava pregnancy registry. This helps track and share information on the health outcomes of mothers and babies exposed to the drug during pregnancy, which aids in understanding the associated risks and benefits.
  • Effects on Fertility: The impact of Arava on fertility is uncertain. It is advised that women who want to conceive and men who want to father a child should not use Arava due to potential risks.
• Breastfeeding Considerations with Arava: The impact of Arava (leflunomide) on breastfeeding is not fully understood. It is not clear if it passes into breast milk or how it might affect a breastfeeding infant or breast milk production. However, due to the potential risk of serious harm to a breastfed child, it is advised not to breastfeed while taking this medication. If you are currently breastfeeding or plan to breastfeed while using Arava, it's crucial to discuss this with your doctor. Your doctor can suggest safe and appropriate ways to feed your baby during this time.
• Arava and Birth Control: Key Guidelines: Arava is not safe during pregnancy as it could cause significant harm to an unborn baby. Consequently, effective birth control is recommended before starting Arava, throughout the treatment period, and for two years after you have stopped the treatment to ensure any remaining effects of the drug do not affect a pregnancy.
  • For Men Using Arava: The effect of Arava on male fertility and reproductive health is not well documented, but the drug’s byproduct, teriflunomide, is present in semen. Men should discuss birth control options with their doctor:
    • If you do not wish to father a child, use reliable contraception with your partner.
    • If you intend to father a child, consult with your doctor about stopping Arava. Your doctor might prescribe a treatment to expedite the removal of the drug from your system, making it safer to attempt conception.
  • For Women Using Arava: Women of childbearing potential must test negative for pregnancy before starting Arava. Reliable birth control must be used before treatment, during, and for two years after ending Arava treatment. If you suspect you might be pregnant at any point during this period, contact your doctor immediately. For women planning to become pregnant after stopping Arava, your doctor might prescribe a treatment to quickly eliminate the drug’s byproducts from your body. Continue using birth control until testing confirms low and safe levels of the drug in your system.

What Are the FDA Boxed Warning for Arava?

Arava (leflunomide) comes with the highest level of warnings from the Food and Drug Administration (FDA), known as boxed warnings. These warnings are issued to highlight potential dangerous effects associated with the medication.

• Risk to Pregnancy: Arava poses a significant risk if used during pregnancy. It can cause severe harm to an unborn baby. Therefore, it is crucial that you do not use Arava if you are pregnant or planning to become pregnant. Ensure a negative pregnancy test before starting the medication and use effective birth control during treatment and for two years after ceasing the medication to prevent pregnancy.

Liver Health Concerns: Arava can also lead to serious liver problems, which in some cases may be fatal. This risk increases if you combine Arava with other medications that can harm the liver, like acetaminophen. If you have existing severe liver disease, you should not use Arava. Your doctor will conduct liver function tests before and during your treatment to monitor for signs of liver damage. Symptoms of liver problems may include nausea, unusual bleeding or bruising, fatigue, pain in the upper right abdomen, yellowing of the skin or the whites of your eyes, dark urine, or flu-like symptoms. If you experience liver issues while on Arava, your doctor will stop the treatment and may provide a specific treatment to quickly clear the drug's byproducts from your body.

Before you start taking Arava, it's crucial to discuss your complete health history with your doctor. This medication may not be suitable for everyone, especially if you have certain health conditions.

• Immune System and Infections: If you have a weakened immune system, bone marrow issues, or chronic infections, Arava might increase your risk of severe infections. The drug can impact your ability to fight infections and affect your blood cell counts, which are crucial for preventing bleeding and fighting infections. Make sure to inform your doctor if you experience frequent infections, unusual bruising, severe fatigue, or if you have tuberculosis.
• Lung Health: Arava can cause inflammation or scarring in the lungs (known as interstitial lung disease), which can be serious or even fatal. If you have a history of lung disease or start experiencing symptoms like coughing or difficulty breathing while on Arava, contact your doctor immediately. They might stop the medication and offer an alternative treatment to remove its active byproduct from your system quicker.
• Blood Pressure: Since high blood pressure can occur with Arava use, your doctor will monitor your blood pressure regularly throughout your treatment.
• Cancer Risks: While cancer wasn't reported in Arava's clinical studies, other medications that suppress the immune system, like Arava, have been linked to a higher risk of certain types of cancer, such as lymphoma. Share your cancer history with your doctor before starting treatment.
• Allergic Reactions: If you have had an allergic reaction to Arava or any of its components, you should avoid taking it. Your doctor can suggest alternative medications that might be safer for you.

Pregnancy and Breastfeeding: Arava is harmful if used during pregnancy or while trying to conceive and can cause serious harm to an unborn baby. It is essential to use effective birth control before, during, and for two years after stopping Arava. The drug's safety during breastfeeding has not been established, and it could potentially harm a nursing child.

If you happen to forget a dose of Arava, take it as soon as you remember. However, if your next scheduled dose is near, just skip the missed dose and continue with your regular dosing schedule. Do not take extra doses to make up for the missed one. If you're worried about missing doses, consider setting reminders using your phone, a reminder app, or a kitchen timer to help keep you on track.

[Note: If you have missed a dose of your medication and are unsure about when to take the next one, immediately consult your doctor or pharmacist.]

Taking more Arava than prescribed can be dangerous and lead to severe side effects. Never exceed the dosage your doctor has recommended. Symptoms of an overdose might include diarrhea, abdominal pain, a drop in white or red blood cells, and elevated liver enzymes. If you suspect an overdose, contact your doctor immediately for advice. You can also reach out to the American Association of Poison Control Centers at 800-222-1222 for immediate guidance. If your symptoms feel life-threatening, call 911 or head to the nearest emergency room without delay.

[Note: If you consumed more than the recommended dose, get medical help right away, or call the Poison Help line at 1-800-222-1222.]

Arava should be kept at room temperature, around 77°F (25°C). Make sure to store the tablets in a tightly closed container to protect them from light. If you find yourself with leftover Arava after your treatment is complete, it's crucial to dispose of the medication correctly. This is not just to ensure safety and prevent accidental ingestion by children or pets, but also to avoid environmental contamination. Proper disposal of medications like Arava helps maintain safety in your home and community.

[Note: Discuss with your healthcare professional about the proper disposal of any unused medicine and any questions you may have regarding its storage.]

Arava can potentially interact with a variety of other medications, as well as vitamins, herbs, and supplements. While no specific interactions with foods have been reported, it's important to be aware that interactions can vary in their effects. Some may reduce the effectiveness of Arava, while others could increase side effects or cause new ones.

Before starting Arava, it’s crucial to discuss all medications you're currently taking with your doctor and pharmacist. This includes anything from prescription drugs to over-the-counter products, as well as any supplements or herbal remedies. By sharing this information, your healthcare providers can help you avoid any harmful interactions.

Warfarin: Combining Arava with warfarin, a blood thinner, might lower your INR, which is a measure of how quickly your blood clots. A lower INR means your blood clots faster, which can be risky. If you are on both medications, your doctor will need to monitor your INR levels closely to adjust the dosage as necessary.

• Oral Contraceptives: Using Arava with certain birth control pills could increase the levels of hormones in your body, leading to potential side effects. This interaction is particularly true for contraceptives containing ethinylestradiol and levonorgestrel. Your doctor may need to adjust your contraceptive method or dosage, keeping in mind that effective birth control is necessary for women of childbearing age taking Arava.
• Methotrexate: Taking Arava with methotrexate, which is also used to treat rheumatoid arthritis, can raise methotrexate levels in your body, increasing the risk of severe side effects. If you are on both drugs, your doctor will monitor you for any side effects and may adjust your methotrexate dose accordingly.
• Rifampin: This antibiotic can alter the levels of Arava’s active metabolite, teriflunomide, increasing it by as much as 40%, which heightens the risk of serious side effects like liver damage. Concurrent use of Arava and rifampin is not recommended unless necessary, and if so, requires careful monitoring by your doctor.
• Certain Type 2 Diabetes Drugs: Arava can increase the levels of certain diabetes medications, such as pioglitazone and rosiglitazone, which could lead to low blood sugar levels and other complications. Your doctor might adjust your diabetes medication dosage if you need to take Arava.
• Paclitaxel: When taken with the cancer drug paclitaxel, Arava can increase its levels in your body, raising the risk of paclitaxel’s side effects. To manage this, your doctor may modify your dosage of paclitaxel and monitor your treatment closely.
• Certain Antibiotics: When taken with antibiotics like cefaclor, ciprofloxacin, or penicillin G, Arava might slow down the breakdown of these antibiotics in your body, raising their levels and potentially leading to more side effects. Your doctor may need to adjust your antibiotic dosage and will keep an eye on your treatment to manage this interaction.
• Statin Medications: Combining Arava with statins, which are used to lower cholesterol, could inhibit the breakdown of these drugs. This might lead to higher levels of statins in your body, increasing the risk of their side effects. For example, if you are taking rosuvastatin, you shouldn’t take more than 10 mg per day. For other statins like atorvastatin, pravastatin, or simvastatin, your doctor may reduce the dosage.
• Cimetidine: If Arava is taken with the antacid cimetidine, it can increase the levels of cimetidine due to reduced breakdown, enhancing the risk of side effects. To handle this, your doctor might adjust the dose of cimetidine and monitor your condition closely.
• Furosemide: Taking Arava with the diuretic furosemide can lead to higher furosemide levels in your body by slowing its breakdown, which could enhance side effects. Your doctor may need to adjust your furosemide dosage as a result.
• Ketoprofen: When used with the NSAID ketoprofen, Arava can increase ketoprofen levels by interfering with its breakdown, raising the risk of side effects. Your doctor will likely adjust your dosage of ketoprofen and monitor you to prevent problems.
• Alosetron: Interestingly, when taken with the IBS drug alosetron, Arava can increase the breakdown of alosetron, potentially making it less effective. If you are using both, your doctor might need to adjust the alosetron dosage to ensure it remains effective.
• Duloxetine: If you're taking Arava with duloxetine, an antidepressant commonly known as Cymbalta or Drizalma Sprinkle, you might experience reduced effectiveness of duloxetine. Arava speeds up the breakdown of this medication in your body. To manage this, your doctor might increase your dose of duloxetine and will keep a close watch on your treatment progress.
• Theophylline: For those using the asthma medication theophylline (available as Elixophyllin SR, Theochron, Theo-24), taking it alongside Arava could lower its effectiveness. This happens because Arava increases the rate at which your body processes theophylline. Your doctor may adjust your dose of theophylline accordingly and monitor the treatment to ensure it's still effective.
• Tizanidine: Combining Arava with tizanidine, a muscle relaxant known as Zanaflex, may reduce the levels of tizanidine in your body, making it less effective. This is due to Arava increasing the metabolism of tizanidine. To counteract this, your doctor may revise your tizanidine dosage and monitor your response to the medication closely.
• Zidovudine: When Arava is used with zidovudine, a medication used to treat HIV (marketed as Retrovir, Combivir, Trizivir), it can increase the levels of zidovudine in your body, heightening the risk of side effects. Arava accelerates the breakdown of zidovudine, leading to higher concentrations in the blood. Your doctor may need to lower your zidovudine dosage and will closely supervise your treatment to manage any potential side effects.

If you’re concerned about how other drugs might interact with Arava, or if you experience any unusual symptoms, don’t hesitate to consult your healthcare team for guidance. They can provide detailed information and support to ensure your treatment is both safe and effective.

What Are the Other Arava Interactions?

Arava is a medication used for treating certain autoimmune conditions, and while it doesn't interact with many common substances, there are still some important considerations to keep in mind:

Alcohol: Drinking alcohol can be harmful to your liver, and since Arava can also cause significant liver damage, it’s best to avoid alcohol to protect your liver health. If you're unsure about alcohol consumption while on Arava, it's a good idea to discuss this with your doctor.

Herbs and Supplements: No specific herbs or supplements have been reported to interact directly with Arava, but it's still wise to consult with your doctor or pharmacist before starting any new herbal or dietary supplements. They can help ensure that nothing you take will interfere with Arava's effectiveness or cause adverse effects.

Foods: There are no specific foods known to interact with Arava, so you generally don’t need to change your diet while on this medication. However, if you have any concerns about your diet or specific foods, discussing them with your doctor can provide personalized advice.

Lab Tests: Arava is not known to affect the results of lab tests. Nevertheless, your doctor will likely conduct regular tests to monitor your liver function and blood cell counts, both during and after your treatment, to ensure Arava is safe and effective for you. If you're worried about how Arava might affect any upcoming lab tests, make sure to talk to your doctor.

Vaccines: Because Arava can weaken your immune system, you should avoid receiving live vaccines while taking it. Live vaccines contain a weakened form of the germ they aim to protect against, which could be harmful while on Arava. Since Arava’s effects can linger in the body for up to two years after stopping treatment, consult with your doctor before getting any live vaccines during this time.

[Note: This isn't a complete list, and there could be other drugs that interact with Arava. Make sure to tell your doctor about any prescription, over-the-counter medicines, and herbal products you’re taking.]

There are several alternatives to Arava available for treating rheumatoid arthritis (RA), and finding the right one can depend on your specific health needs. These alternatives might work better for some individuals and can be used alone or alongside other treatments. For instance, some common alternatives include other disease-modifying antirheumatic drugs (DMARDs) or biologic agents, which target specific parts of the immune system to reduce inflammation and prevent joint damage. Examples of other drugs that may be used for RA include:

• Biologic DMARDs, like:
  • Humira (adalimumab)
  • Enbrel (etanercept)
  • Remicade (infliximab)
  • Orencia (abatacept)
• Traditional disease-modifying antirheumatic drugs (DMARDs), like:
  • Imuran (azathioprine)
  • Plaquenil (hydroxychloroquine)
  • Trexall (methotrexate)
  • Rasuvo (methotrexate)
  • RediTrex (methotrexate)
  • Otrexup (methotrexate)
  • Azulfidine (sulfasalazine)
  • Azulfidine EN-Tabs (sulfasalazine)
  • Sulfazine (sulfasalazine)
• Janus kinase (JAK) inhibitors, like:
  • Rinvoq (upadacitinib)
  • Xeljanz (tofacitinib)
  • Xeljanz XR (tofacitinib)
• Nonsteroidal anti-inflammatory drugs (NSAIDs), like:
  • Advil (ibuprofen)
  • Motrin (ibuprofen)
  • Aleve (naproxen)
  • Anaprox DS (naproxen)
  • Celebrex (celecoxib)
• Corticosteroids taken by mouth, like:
  • Medrol (methylprednisolone)
  • Rayos (prednisone)

[Note: Your doctor will choose what’s best for you. Don’t use any of these alternative medications without consulting your healthcare provider. Taking them by yourself may cause serious side effects.]

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