Medications for Lupus
Common "Conventional" Medications for Lupus
Non Steroidal Anti Inflammatories are commonly prescribed to relieve lupus symptoms such as ache, pain, and fever. They work by reducing the inflammation responsible for the stiffness and discomfort in your muscle, joints, and other tissues. NSAIDs are "considered" milder than many other lupus drugs and may be taken either alone to treat a mild flare or in combination with other medications.
Side effects are as follows
- Stomach pain and heartburn.
- Stomach ulcers.
- A tendency to bleed more, especially when taking aspirin. ...
- Headaches and dizziness.
- Ringing in the ears.
- Allergic reactions such as rashes, wheezing, and throat swelling.
- Liver or kidney problems. ...
- High blood pressure.
Hydroxychloroquine (Plaquenil), chloroquine (Aralen), and quinacrine (Atabrine) are medications that were originally used to prevent or treat malaria. During WWII, they found that these meds also help with symptoms of Lupus.
They improve muscle and joint pain, skin rashes, pericarditis (inflammation of the lining of the heart), pleuritis (inflammation of the lining of the lung), and other lupus symptoms such as fatigue and fever. They may also prevent lupus from spreading to certain organs, such as the kidney and central nervous system (your brain and spinal cord) and may help to reduce flares by as much as 50%. (That's great statistic!)
Plaquenil and other anti-malarials play a key role in preventing serious flares, so they are considered a “lupus life insurance.” (To me, this is a plus)
Studies have shown that Lupus patients live longer than those who do not. Anti-malarials are particularly useful in treating discoid lupus, subacute cutaneous lupus, and mouth sores associated with lupus; they are also effective in treating rheumatoid arthritis and Sjogren’s syndrome.
For more severe lupus symptoms such as kidney disease and nervous system or blood vessel involvement, you'll need a more potent alternative.
How do they work? They help to control lupus symptoms by modulating the immune system without predisposing you to infection. They can also protect against UV light and sometimes even improve skin lesions that do not respond to treatment with topical therapy (ointments).
Lastly, if you are positive for antiphospholipid antibodies, such as the lupus anticoagulant and anticardiolipin antibodies, you may experience a decreased likelihood of blood clots. For me, its an overall win.
Synthetic cortisone meds are commonly used to decrease risks of Lupus fast. They are most effective for reducing the swelling, warmth, pain, and tenderness associated with the inflammation of lupus. Doctors use them because they are a powerful immunosuppressant.
What I hate the most are the many unwelcome side effects, so it is usually prescribed only when other medications—specifically NSAIDs and anti-malarials—are not sufficient enough to control lupus.
Long term risk for Diabetes and Osteoporosis are reasons enough to avoid corticosteroids, but when you need them, you Need them.
Some serious side effects are:
- Water Retention
- Thin Skin
- Loss of Appetite or Increase Appetite
- Difficulty sleeping
- Increased Sweating
- Mood Swings
- Cushings Syndrome
- Growth Suppression in Kids
- Congestive Heart Failure
- Tendon Ruptures
- Moon Face
I personally hated it because of thinning of the hair, tachycardia, and the moon face (I call it fat face).
DHEA (dehydroepiandrosterone) is a mild male hormone that is effective in treating some of the symptoms of mild to moderate lupus. I love it because it's useful for people who experience hair loss (alopecia), joint pain, fatigue, and cognitive dysfunction (e.g., difficulty thinking, memory loss, distractibility, difficulty in multitasking). DHEA can also be effective against osteoporosis. However, it's not approved by the FDA (which to me doesn't mean much).
Some side effects of DHEA are; acne, facial hair growth, oily skin, and excessive sweating. In addition, DHEA can lower the production of HDLs (“good” cholesterol) in some women.
DHEA can raise estrogen in postmenopausal women so if this applies to you, routine cancer checks like PAP smears and mamograms.
DHEA should be monitored by a health care provider. It's often sold as a dietary supplement, but because they are not regulated by FDA it can be ineffective. The dosage is also important and should be prescribed for you.
Imuran is an anti-inflammatory immunosuppressive that can prevent joint damage and disability in people with lupus, rheumatoid arthritis, and other conditions. Imuran is "steroid sparing", which means that it may allow for a reduction of the amount of steroid being taken.
Imuran modulates our overactive immune response (specifically, white blood cells [WBCs], or leukocytes). Important to note that it may take 6-12 weeks to notice its effects. It has fewer side effects than other immunosuppressants so it is prescribed more often for us Lupus patients.
Some common side effects are: Nausea and vomiting, stomach pain and diarrhea. Taking the medication with food may help to reduce these symptoms.
Less common side effects include liver test abnormalities, hepatitis (inflammation of the liver), pancreatitis (inflammation of the pancreas, a gland behind the stomach, that can cause abdominal pain), or an allergic reaction that can seem like the flu.
For us Lupus patients, we are always choosing the lesser of the two evils. While Imuran is effective in treating severe Lupus symptoms, long term use of this medication does increase risk of cancer. The use of this drug should aim to minimize risk and maximize benefits.
Routine visits to your doctor with labs are important during Imuran therapy. Contact your doctor ASAP if you have the following symptoms: fever, a new rash, easy bruising or bleeding, or signs of infection.
Celcept (Mycophenolate mofetil)
Cellcept is used specially for those with Lupus who have Kidney involvement. It targets an enzyme in the body—a protein responsible for certain chemical reactions—that is important in the formation of DNA in your cells. As a result, Cellcept impairs the function of your immune system. The does will depend on your weight, you'll be given a higher does to start and then lowered as your symptoms improve.
Cellcept is also a steroid sparing drug so it's likely your doctor will decrease your steroid dosage.
The most common effects include stomachache, nausea, vomiting, and/or diarrhea. Headache, dizziness, sleeplessness, and tremors (involuntary muscle movements) may also occur. Skin rashes can arise but are less common. Because Lupus also tends to cause rash, it's hard to determine if the rash is from Cellcept or Lupus.
Cellcept can also reduce the number of cells, WBC, RBC, and platelets in your blood, which may make you more tired and cause easy bruising or gastrointestinal bleeding (bleeding in your gut). It's important to check your blood regularly, every 3 months to monitor your status.
Blood tests are typically checked frequently during the first several months of taking this medication and less often as more time passes.
If you are pregnant, may become pregnant, or are breast-feeding, your doctor will strongly recommend that you stop taking Cellcept due to the risk of birth defects.
Be sure to notify your doctor immediately if you experience easy bruising or bleeding, persistent or bloody diarrhea, trouble breathing, fever, or any sign of infection.
On a side note, FDA issued an alert regarding a possible link between Cellcept and a serious neurological disease called multifocal leukoencephalopathy (PML). But PML is also independently associated with conditions of severe immune deficiency, such as AIDS, cancer, lupus, and the immunosuppression that can be involved in the treatment of those conditions.
Finally, although immunosuppressive medications are effective in the treatment of lupus, your doctor can discuss with you the risks and benefits of your treatment involving Cellcept and other medication.
I've been on Cellcept three different times due to kidney involvement first time for 18 months, second time 12 months and third time for only 6 months. It was taken in conjunction with cytoxan and steroids the first two times and the third time, the treatment for the same condition was a lot less toxic in dose and duration.
I had a successful pregnancy after the first treatment and remain in remission living a productive life.
Cyclosporine (Neoral, Sandimmune, Gengraf)
Cyclosporine a potent medication that blocks the function of cells in your immune system called T-lymphocytes, or “T-cells.” It is now also prescribed for those that have kidney involvement caused by lupus (kidney nephritis)
Ironically, cyclosporine can be toxic to the kidneys, so your doctor won't resort to this unless you don't respond to Cellcept . It can also relieve pain, swelling, and stiffness due to lupus arthritis.
Dosing depends on your body weight (usually 2.5 milligrams [mg] per kilogram [kg] per day). The dose will typically be increased based on how you respond and how well your body tolerates the drug.
Here's the side effects: about 25% of people taking cyclosporine develop high blood pressure (hypertension). Due to its toxicity, it can cause uric acid build up in your urine (a state known as hyperuricemia). Sometimes this buildup of uric acid can cause gout, a condition that causes intense swelling in one of the joints, often the the big toe. Good thing is that these symptoms are not permanent, they go away when you stop the drug.
Other common side effects include headaches, stomach pain, vomiting, diarrhea, and swelling in your hands or feet. Less common side effects include tremors, increased hair growth, muscle cramps, and numbness or tingling in your hands and feet (neuropathy). Some of you may experience swelling of the gums while taking cyclosporine.
As with all other in its class, it can increase your chance of developing cancer, especially skin cancer. In addition, try to stay out of the sun and make sure to wear sunscreen when you do go outside.
PREGNANCY: It can cause severe complications during pregnancy such as premature labor and high blood pressure and fluid retention in your baby. Don't take it if you are pregnant or plan to be pregnant. Also, don't take while breast-feeding, since it can be passed to your baby through breast milk.
Cyclosporine also interacts with other drugs:
- Heart and blood pressure medications: diltiazem (Cardizem, Tiazac), nicardipine (Cardene), verapamil (Calan, Covera-HS, Isoptin, Verelan), “potassium sparing diuretics” amiloride (Midamor), spironolactone (Aldactone) and triamterene (Dyrenium)
- Cholesterol lowering medications: lovastatin (Mevacor) and simvastatin (Zocor)
- Antibiotics and antifungals: clarithromycin (Biaxin), erythromycin, naficillin, fluconazole (Diflucan), intraconazole (Sporanox), ketoconazole (Nizoral), and rifampin (Rifadin, Rimactane)
- Anti-seizure (anti-epileptic) medications: carbamazepine (Tegretol), phenobarbital (Solfoton), and phenytoin (Dilantin)
- Antidepressants: nefazadone (Serzone) and the selective serotonin reuptake inhibitors (SSRIs) such as paroxitine (Paxil), fluoxetine (Prozac), and sertraline (Zoloft)
- Human immunodeficiency virus (HIV) protease inhibitors: indinivir (Crixivan), saquinavir (Fortovase, Invirase), ritonavir (Norvir), and nelfinavir (Viracept)
- Others: allopurinol (Lopurin, Zyloprim), bromocryptine (Parlodel), androgens (male hormones), estrogens (female hormones), danazol (Danocrine), metoclopramide (Reglan), methylprednisolone, octreotide, ticlopidine (Ticlid), cimetidine (Tagamet), methoxsalen (Oxsoralen), coal tar (Balnetar, Zetar), trioxsalen (Trisoralen)
So be sure to tell your doctor everything you are taking to prevent above interactions.
Disease Modifying Anti-Rheumatic Drugs (DMARDs)
Methotrexate is commonly prescribed for treatment of rheumatoid arthritis, and it is used in lupus patients to relieve joint pain and swelling of poly-arthritis (arthritis involving multiple joints).
It was used to treat cancer and psoriasis but in the late 1980s, it was approved by the FDA for the treatment of arthritis and since then it was used for this purpose.
Methotrexate works by interfering with folic acid production, which is a building block for cellular growth in your body. It results in hindering the growth of certain immune cells. This medication is also steroid-sparing so you can utilize the two in conjunction while limiting steroid usage.
Because it interferes with folic acid production, your doctor will most likely recommend folate supplements as the side-effects are commonly due to folic acid deficiency, including mouth sores (stomatitis). Other side effects may include nausea, vomiting, and an increased risk for abnormal liver function tests. It can be toxic to your liver so you should not drink alcohol while taking methotrexate; drinking while on this medication can cause irreversible damage to your liver.
Some of you may experience gradual hair loss (alopecia), but hair usually grows back once you stop taking methotrexate. Methotrexate can increase your sensitivity to sunlight. Since many of us with lupus already experience sun sensitivity, try to limit sun exposure and be sure to wear sunscreen when going outdoors.
It's a good idea to get your liver function tests regularly. Be sure to tell your doctor if you have a history of liver disease. In some cases, lung problems, such as a continuing cough or shortness of breath, can occur while on this medication but are more common in people with preexisting lung conditions. Talk to you doctor if you experience these symptoms.
Sometimes people may have abnormal blood tests while feeling no side effects at all, so it is important to have blood tests (complete blood counts, or “CBCs”) performed every 2-3 months while taking methotrexate.
If you are pregnant, may become pregnant, or are breastfeeding, you should not take this medication because it can cause serious birth defects and complications during pregnancy. Speak to your doctor about any pregnancy plans or concerns.
Drug Interactions: methotrexate can interact with certain drugs, including the antibiotic trimethoprim (Bactrim)* and NSAIDs such as ibuprofen (Advil, Motrin) and celecoxib (Celebrex). Your doctor will work with you to determine which treatments will work best to treat your lupus symptoms with the fewest side effects.
Leflunomide is used to treat the swelling, pain, and stiffness that many of us lupus patients feel due to arthritis. It can either be prescribed alone or in combination with other treatments, such as methotrexate; it's prescribed for patients who do not respond well to methotrexate.
It works by blocking the formation of DNA in the cells of your body, including those of the immune system. In hindering the formation of DNA, leflunomide stops the body from producing the overactive immune cells that are responsible for the swelling, stiffness, and pain in your joints.
Leflunomide is usually prescribed in tablets of 10 or 20 milligrams (mg) once a day and 6-12 weeks may pass before you feel the full benefits of this medication, although your joint pain and stiffness will probably start to improve after just a few weeks.
Your doctor may prescribe a loading dose initially to optimize its effects. A loading dose is a large dose—about 100 mg—usually given once a week for three weeks in addition to your regular dose. Some doctors load you up over three days but it can cause diarrhea during the loading days.
Other side effects include nausea, indigestion, rash, or hair loss (alopecia), but these effects are less common. This medication is a burden to the liver, as 10% patients have abnormal liver function tests or decreased blood cell counts. Not only should you check your liver enzymes regularly, but alcohol is forbidden while taking this medication.
If you're pregnant, plan to be pregnant, or breastfeeding, you should talk to your physician prior to taking this medication. It is advisable to be on birth control while taking leflunomide and continue to do so until two years after leflunomide is stopped. This is because the medication remains in your body 2 years after you stop taking this medication.
Cytoxan is a cytotoxic medication is usually a last alternative for lupus patients with serious kidney problems who have not responded to other medications. While it can be taken in tablet form, more often it's given intravenously (IV) at the doctor’s office. The IV procedure usually take about 15 to 60 minutes, and a medication may be given before to reduce any nausea you may feel. Typically, Cytoxan is prescribed once a month for 6 months and then every 2 to 3 months for two years.
The side effects range from mild to severe and may be worse when the medication is taken in tablet form. Side effects include nausea and vomiting, which can sometimes be prevented with an anti-nausea medication such as ondansetron (Zofran), given prior to injection. Hair loss (alopecia) can occur, but hair usually grows back when the medication is stopped. Personally, I've felt weak with some digestive issues and did not lose hair. It's important to remember that because it's an immunosuppressant, you should always remember to wash your hands as it makes you more prone to opportunistic infections.
More serious side effects include a steep decrease in WBC, which usually occurs about 8-12 days after starting treatment. Evaluating labs is essential when on Cytoxan. In addition, Cytoxan can cause infertility in both men and women when taken for long periods of time. But an injection called leuprolide (Lupron) can be given to help protect your body against this sterility; freezing eggs before beginning treatment is also an option given to me.