Prescription Medications for Osteoarthritis: What You Need to Know

Key Takeaways

• Prescription NSAIDs like Celebrex offer stronger relief than over-the-counter options but carry additional risks
• Duloxetine (Cymbalta) treats both pain and depression, making it useful for chronic arthritis pain
• Tramadol provides moderate pain relief but requires careful monitoring
• Opioids are generally avoided for osteoarthritis due to addiction risks and limited long-term benefits
• Medicare Part D typically covers prescription arthritis medications with prior authorization

When over-the-counter pain relievers aren’t enough to manage your osteoarthritis, your doctor may recommend prescription medications. These stronger options can provide better relief, but they also come with important considerations about side effects, costs, and long-term use.

Let’s explore what prescription medications are available for osteoarthritis and what you should know before starting them.

Prescription NSAIDs: Stronger Anti-Inflammatory Options

Prescription nonsteroidal anti-inflammatory drugs (NSAIDs) work similarly to over-the-counter options like ibuprofen, but at higher doses or with different formulations designed to reduce side effects.

Celecoxib (Celebrex)

Celebrex belongs to a class called COX-2 inhibitors, designed to reduce inflammation while being gentler on your stomach than traditional NSAIDs.

How it works: Celebrex blocks the COX-2 enzyme that causes inflammation and pain, while leaving the COX-1 enzyme alone. COX-1 helps protect your stomach lining, which is why Celebrex may cause fewer stomach problems than regular NSAIDs.

Typical dosing: 200 mg once or twice daily for osteoarthritis.

Benefits:

• Lower risk of stomach ulcers compared to traditional NSAIDs
• Once or twice daily dosing (convenient)
• Effective for moderate to severe arthritis pain
• Can be taken long-term under medical supervision

Considerations:

• May increase risk of heart attack or stroke, especially at high doses
• Can raise blood pressure
• Not suitable for people with certain heart conditions
• May interact with blood thinners
• More expensive than over-the-counter NSAIDs

Medicare coverage: Most Part D plans cover celecoxib, though many require you to try other NSAIDs first (called step therapy).

Meloxicam (Mobic)

Meloxicam is another prescription NSAID that offers longer-lasting relief with once-daily dosing.

How it works: Similar to other NSAIDs, meloxicam reduces inflammation and pain by blocking prostaglandins (chemicals that cause inflammation).

Typical dosing: 7.5 mg to 15 mg once daily.

Benefits:

• Once-daily convenience
• Available in both brand name and generic
• Generally well-tolerated
• Effective for daily arthritis management

Considerations:

• Same cardiovascular risks as other NSAIDs
• Can cause stomach upset, ulcers, or bleeding
• May affect kidney function with long-term use
• Should be taken with food

Medicare coverage: Generic meloxicam is widely covered and typically less expensive than Celebrex.

Duloxetine (Cymbalta): For Chronic Pain and Depression

Duloxetine is an antidepressant that has proven effective for chronic pain conditions, including osteoarthritis.

How it works: Duloxetine increases levels of serotonin and norepinephrine in your brain and spinal cord, which helps reduce pain signals. It’s particularly useful because chronic pain and depression often occur together.

Typical dosing: 30 mg to 60 mg once daily for osteoarthritis pain.

Benefits:

• Addresses both pain and mood concerns
• Doesn’t carry addiction risks
• May help improve sleep quality
• Particularly effective for knee osteoarthritis
• Can be used long-term safely

Considerations:

• Takes 2-4 weeks to reach full effectiveness
• Common side effects include nausea, dry mouth, and drowsiness (usually temporary)
• Should not be stopped suddenly (requires gradual tapering)
• May interact with other medications
• Not suitable for people with certain liver conditions

Who it helps most: People with chronic arthritis pain who also experience depression, anxiety, or sleep problems may benefit most from duloxetine.

Medicare coverage: Most Part D plans cover duloxetine, with generic versions typically preferred.

Tramadol: Moderate Pain Relief Option

Tramadol is a pain reliever that works differently from NSAIDs and is sometimes prescribed when anti-inflammatory medications aren’t effective or appropriate.

How it works: Tramadol changes how your body senses pain by affecting pain receptors in your brain and spinal cord. It also slightly increases serotonin and norepinephrine levels.

Typical dosing: 50 mg to 100 mg every 4-6 hours as needed, or extended-release versions once or twice daily.

Benefits:

• Doesn’t cause stomach problems like NSAIDs
• Lower addiction risk than traditional opioids
• Can be taken as needed or regularly
• Extended-release versions provide all-day relief

Considerations:

• Can cause dizziness, nausea, and constipation
• Risk of dependence with long-term use (though lower than strong opioids)
• May interact with antidepressants
• Can cause drowsiness (don’t drive until you know how it affects you)
• Requires careful monitoring by your doctor

Important note: While tramadol is considered safer than traditional opioids, it still carries risks of dependence and withdrawal. Many doctors now prefer other options for long-term arthritis management.

Medicare coverage: Medicare Part D covers tramadol, though some plans classify it as a controlled substance requiring special authorization.

Why Opioids Are Generally Avoided for Osteoarthritis

Strong opioid pain medications (like oxycodone, hydrocodone, or morphine) were once commonly prescribed for arthritis pain. Today, medical guidelines strongly discourage their use for osteoarthritis except in very specific situations.

Reasons opioids aren’t recommended:

1. High addiction risk: Opioids can lead to physical dependence, even when taken as prescribed.

2. Diminishing effectiveness: Your body builds tolerance over time, requiring higher doses for the same relief.

3. Limited long-term benefit: Research shows opioids aren’t more effective than other treatments for chronic arthritis pain.

4. Serious side effects: Constipation, drowsiness, confusion, falls, and breathing problems increase with long-term use—particularly concerning for older adults.

5. Better alternatives available: Injections, physical therapy, and other treatments often provide better long-term outcomes without addiction risks.

When opioids might be considered: Short-term use (a few days) after joint surgery or for severe acute flare-ups, under close medical supervision.

Questions to Ask Your Doctor About Prescription Medications

Before starting any prescription medication for osteoarthritis, have a thorough conversation with your doctor:

About effectiveness:

• How long before I’ll notice improvement?
• What results should I realistically expect?
• What happens if this medication doesn’t work?

About safety:

• What are the most common side effects?
• What serious side effects should I watch for?
• How does this interact with my other medications?
• Are there any foods or activities I should avoid?

About your health history:

• Is this safe with my heart condition (or other conditions)?
• How will this affect my blood pressure or kidneys?
• Do I need any blood tests while taking this?

About long-term use:

• Can I take this medication indefinitely?
• What monitoring do I need?
• Are there any long-term risks I should know about?

About cost:

• Is there a generic version available?
• Will my insurance cover this?
• Are there equally effective, less expensive alternatives?

Beyond Medications: Other Treatment Options

Prescription medications are just one tool for managing osteoarthritis. Many people find better long-term results by combining medications with other treatments:

Hyaluronic acid injections: These “gel shots” can provide 6-12 months of relief by restoring cushioning fluid in your joint. Many people reduce or eliminate daily pain medications after HA injections.

Physical therapy: Strengthening muscles around your joint provides natural support and can reduce pain long-term.

Weight management: Even modest weight loss (5-10% of body weight) significantly reduces knee arthritis pain.

Assistive devices: Braces, canes, or shoe inserts can reduce joint stress during daily activities.

Corticosteroid injections: For severe flare-ups, these powerful anti-inflammatory injections provide quick (though temporary) relief.

Your doctor can help you create a comprehensive treatment plan that addresses your pain from multiple angles, potentially reducing your reliance on daily medications.

Medicare Coverage Considerations

Most prescription arthritis medications are covered under Medicare Part D (prescription drug coverage), but coverage details vary by plan:

What’s typically covered:

• Generic NSAIDs (usually preferred)
• Celecoxib (may require trying generic NSAIDs first)
• Duloxetine (generic usually preferred over brand Cymbalta)
• Tramadol (may require prior authorization)

What to expect:

• Formulary tiers: Higher tiers mean higher copays
• Prior authorization: Your doctor may need to prove other treatments failed first
• Quantity limits: Some plans limit how many pills you can get monthly
• Step therapy: Requirements to try less expensive options before approving costlier drugs

Tips for managing costs:

• Ask your doctor about generic alternatives
• Use your plan’s preferred pharmacies for lower copays
• Check if you qualify for Extra Help (Medicare’s low-income subsidy)
• Compare Part D plans during open enrollment—formularies change yearly

Making the Right Choice for Your Situation

There’s no single “best” prescription medication for osteoarthritis—the right choice depends on your specific situation:

You might be a candidate for prescription NSAIDs if:

• Over-the-counter NSAIDs help but aren’t strong enough
• You don’t have heart disease or high blood pressure
• You can take them with food to protect your stomach

Duloxetine might be right if:

• You have chronic pain affecting your mood or sleep
• You want to avoid NSAIDs due to stomach or heart concerns
• You’re willing to wait a few weeks for full effects

Tramadol might be considered if:

• NSAIDs aren’t effective or appropriate for you
• You need occasional relief for breakthrough pain
• You don’t have a history of substance dependence

You should explore non-medication options if:

• Medications aren’t providing adequate relief
• You’re concerned about side effects or long-term use
• You want to address the underlying joint problem, not just symptoms

Frequently Asked Questions

Can I take prescription and over-the-counter NSAIDs together?

No, you should not combine prescription NSAIDs like Celebrex with over-the-counter NSAIDs like ibuprofen or naproxen. Taking multiple NSAIDs together significantly increases your risk of stomach ulcers, bleeding, and cardiovascular problems without providing better pain relief.

How long can I safely take prescription NSAIDs?

With proper medical supervision and monitoring, many people take prescription NSAIDs for years. However, your doctor should regularly assess whether the benefits outweigh the risks, check your blood pressure and kidney function, and discuss whether other treatments might be more appropriate long-term.

Will I become addicted to tramadol?

Tramadol carries a lower addiction risk than traditional opioids, but dependence is still possible, especially with long-term daily use. Take it exactly as prescribed, store it securely, and discuss any concerns about dependence with your doctor. Never stop tramadol suddenly after taking it regularly—work with your doctor to taper gradually if needed.

Do I need to take duloxetine every day, or only when I have pain?

Duloxetine must be taken daily to be effective. It works by gradually changing brain chemistry, so it doesn’t provide immediate pain relief like NSAIDs. Most people notice improvement after 2-4 weeks of daily use. Skipping doses or taking it only when pain is bad won’t work.

Why won’t my doctor prescribe stronger pain medication?

Doctors now follow evidence-based guidelines showing that stronger opioid medications don’t provide better long-term results for osteoarthritis and carry significant risks of dependence, side effects, and reduced quality of life. If your current treatment isn’t working, discuss other options like injections, physical therapy, or combining different approaches rather than escalating to stronger pills.

Does Medicare cover the brand name version of Celebrex?

Most Medicare Part D plans prefer generic celecoxib over brand-name Celebrex, as they’re equivalent medications. Brand-name Celebrex will typically cost significantly more unless your doctor provides documentation that the generic doesn’t work for you. Ask your pharmacist about the cost difference before filling your prescription.

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This article is for educational purposes only and does not replace medical advice. Always consult your healthcare provider before starting, stopping, or changing any medication. Last reviewed: February 2025