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Medications for Systemic Lupus Erythematosus

Many medications are used for treatment of SLE, depending on the severity of your symptoms and side effects you have from the medications. Only the most commonly used medications are listed below. A number of medications are still considered experimental or are used less frequently, but these may be required to control your disease.
The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included. Ask your doctor if you need to take any special precautions. Use each of these medications only as recommended by your doctor, and according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.
As much as possible, doctors treating SLE avoid the use of glucocorticoids (cortisone-like drugs, steroids) because of their severe long-term side effects. However, these drugs are very effective in relieving the symptoms of SLE and will most likely be part of your treatment program at some point.
Less dangerous medications are the mainstay of controlling the symptoms of SLE as long as they are effective. Foremost on the list are the nonsteroidal anti-inflammatory drugs (NSAIDs). They, too, can cause significant side effects, but none so severe as the glucocorticoids.
Antimalarial drugs are also used for their effects on the immune system.
A fourth class of drugs used in SLE is the immune modulators . These drugs, combined with glucocorticoids, reduce the incidence of kidney failure, the most lethal complication of SLE.
Many people with SLE have skin problems, which are often treated with topical corticosteroids. Other topical treatments are also used, as well as some of the medications listed below.

Prescription Medications

Glucocorticoids (Cortisone-like Drugs, Steroids)
  • Prednisone
  • Prednisolone
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)—Higher Doses
  • Ibuprofen (Motrin, Advil)
  • Naproxen (Naprosyn, Aleve)
  • Sulindac (Clinoril)
  • Diclofenac (Voltaren)
  • Piroxicam (Feldene)
  • Ketoprofen (Orudis)
  • Diflunisal (Dolobid)
  • Nabumetone (Relafen)
  • Etodolac (Lodine)
  • Oxaprozin (Daypro)
  • Indomethacin (Indocin)
  • Celecoxib (Celebrex)
  • Hydroxychloroquine sulfate (Plaquenil)
  • Chloroquine (Aralen)
  • Methotrexate
  • Cyclophosphamide (Cytoxan)
  • Azathioprine (Imuran)
  • Mycophenolate mofetil (Cellcept)
  • Belimumab (Benlysta)
  • Rituximab (Rituxan)

Over the Counter Medications

  • Aspirin
  • Ibuprofen (Motrin, Advil)
  • Naproxen (Aleve)

Prescription Medications

Glucocorticoids (Cortisone-like Drugs, Steroids)
Common names include:
  • Prednisone (usually given as a generic)
  • Prednisolone (usually given as a generic)
For SLE, cortisone-like drugs are given in short, sometimes tapering, bursts lasting a week or two. This is done to avoid the adverse effects of prolonged treatment. These doses are often quite effective in reducing inflammation, but should not be used when the inflammation is fighting off an infection. Beyond a week or two the adverse side effects increase rapidly.
There are many complications associated with glucocorticoids. Even repetitive doses separated by significant intervals of time may eventually cause damage. Before taking a dose of a cortisone-like drug, be sure to ask your doctor if you have any reasons for avoiding it. Additionally, you may need to take calcium, vitamin D, osteoporosis and blood pressure medication, and to monitor your blood sugar levels while taking corticosteroids.
Possible side effects of glucocorticoids include:
  • Fat face, hump on the lower neck
  • Weight gain
  • High blood pressure
  • Increased susceptibility to infection
  • Bruising
  • Acne
  • Abnormal hair growth
  • Bone softening
  • Bone death
  • Cataracts in the eyes
  • Glaucoma
  • Diabetes
  • Muscle disease
  • Blood chemistry abnormalities (hypokalemia)
  • Menstrual disturbances
  • Irritability
  • Insomnia
  • Psychosis
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)—Higher Doses
Common names include:
  • Ibuprofen (Motrin, Advil, Nuprin)
  • Naproxen (Naprosyn, Anaprox, Aleve)
  • Sulindac (Clinoril)
  • Diclofenac (Voltaren)
  • Piroxicam (Feldene)
  • Ketoprofen (Orudis)
  • Diflunisal (Dolobid)
  • Nabumetone (Relafen)
  • Etodolac (Lodine)
  • Oxaprozin (Daypro)
  • Indomethacin (Indocin)
  • Celecoxib (Celebrex)
NSAIDs are widely used in the treatment of SLE, mostly for musculoskeletal complaints. While they are probably safer for long-term use than corticosteroids, they can cause serious side effects. You should remain in close contact with your doctor if you are on one of these medications.
Possible side effects of NSAIDs at high doses include:
  • Stomach problems, including ulcers and bleeding
  • Worsening of chronic conditions, such as high blood pressure, heart failure , or kidney disease
  • Kidney damage
  • Liver inflammation
  • Lightheadedness
  • Severe allergic reaction, such as hives , difficulty breathing, or swelling around the eyes
  • Increased risk of bleeding—always inform your healthcare providers that you are taking an NSAID before having any medical or dental procedures or surgeries
NSAIDs may cause an increased risk of serious cardiovascular problems, like myocardial infarction and stroke . This risk is especially important for patients with cardiovascular disease or who are have risk factors for cardiovascular disease.
Take special care with NSAIDs and aspirin if you have had peptic ulcer disease ( stomach or duodenal ulcers , or gastritis ).
Antimalarial Drugs
Common names include:
  • Hydroxychloroquine sulfate (Plaquenil)
  • Chloroquine (Aralen)
Originally used to treat malaria, these drugs modify the inflammatory response in ways that benefit SLE patients. They are not used for serious, organ-threatening disease, but rather for more moderate symptoms.
Possible side effects of antimalarials include:
  • Headache
  • Irritability
  • Lightheadedness
  • Weakness
  • Nausea
  • Vomiting
  • Diarrhea
  • Abdominal cramps
  • Loss of appetite
  • Visual disturbances
  • Rashes
  • Blood damage
  • Muscle weakness
Immune Modulators (Immunosuppressives)
Common names include:
  • Methotrexate
  • Cyclophosphamide
  • Azathioprine
  • Mycophenolate mofetil
Immune modulators suppress the immune system and reduce inflammation. These may be used when someone can't tolerate high doses of steroids. They may also help people who don't respond to steroids to control inflammation. Immune modulators reduce the body's ability to fight infection. It is important to monitor cuts, scrapes, or any small wounds for signs of infection. You may also be at a higher risk for bacterial or viral infections.
Possible side effects of cytotoxic agents include:
  • Bone marrow damage
  • Increased frequency of cancer
  • Hair loss
  • Ovary damage
  • Liver damage (Azathioprine)
  • Bladder damage (Cyclophosphamide)
Targeted B-cell Therapy
Common names include:
  • Belimumab (Benlysta)
  • Rituximab (Rituxan)
Targeted B-cell therapy is for who are receiving other standard therapies. The medication, given by IV, may reduce the number of abnormal B-cells thought to be responsible for tissue damage in autoimmune disease. The reduced action of infection-fighting lymphocytes increases your risk of bacterial or viral infections.
Possible side effects of targeted B-cell therapy include:
  • Nausea
  • Diarrhea
  • Fever
  • Insomnia
  • Depression
  • Migraine
  • Reactions during infusion, such as headache and nausea
  • Rash or hives at infusion site
  • Increased frequency of cancer

Over the Counter Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs)—Lower Doses
Common names include:
  • Aspirin
  • Ibuprofen (Motrin, Advil)
  • Naproxen (Aleve)
There are minor differences among the available agents in terms of dosing intervals, frequency of certain side effects, and other characteristics.
Possible side effects of NSAIDs at low doses include:
  • Stomach problems, including ulcers and bleeding
  • Worsening of chronic conditions, such as high blood pressure, heart failure, or kidney disease
  • Kidney damage
  • Liver inflammation
  • Lightheadedness
  • Severe allergic reaction, such as hives, difficulty breathing, or swelling around the eyes
  • Increased risk of bleeding—always inform your healthcare providers that you are taking an NSAID before having any medical or dental procedures or surgeries
NSAIDs may cause an increased risk of serious cardiovascular problems, like myocardial infarction and stroke. This risk is especially important for patients with cardiovascular disease or who are have risk factors for cardiovascular disease.
Take special care with NSAIDs and aspirin if you have had peptic disease (stomach or duodenal ulcers or gastritis).

Clinical Trials of New Drugs

There are major advances being made in SLE research. Whole new branches of medicine called molecular biology and genetic engineering are focusing on the mechanisms of immunity and inflammation. For this reason, you may want to consider participating in a clinical trial of new treatments. The government-sponsored website, Clinical Trials , maintains a listing of the trials that need volunteers.
Clinical trials are very tightly controlled experiments by the best researchers in the field. Every clinical trial is fully approved by several groups of knowledgeable health professionals for their safety and potential benefit. Each participant is informed of the risks and expected to cooperate completely with the treatment program. Some use medicines that are already on the market for other diseases, like the cytotoxic agents mentioned above. Others are brand new therapies that have been through at least two intense phases of testing—in the laboratory and on healthy human volunteers. Most clinical trials provide free care.
If you are interested, talk to your doctor about whether participating in a clinical trial is a good idea for you.

Special Considerations

Whenever you are taking a prescription medication, take the following precautions:
  • Take your medication as directed. Do not change the amount or the schedule.
  • Do not stop taking them without talking to your doctor.
  • Do not share them.
  • Know what the results and side effects. Report them to your doctor.
  • Some drugs can be dangerous when mixed. Talk to a doctor or pharmacist if you are taking more than one drug. This includes over the counter medication and herb or dietary supplements.
  • Plan ahead for refills so you do not run out.

When to Contact Your Doctor

Contact your doctor if:
  • The desired effect of your medication is not achieved
  • A side effect occurs
  • You develop new stomach symptoms

References

Handout on health: Systemic lupus erythematosus. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health%5FInfo/Lupus/default.asp. Updated August 2011. Accessed June 28, 2013.

Systemic lupus erythematosus (SLE). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what. Updated June 13, 2013. Accessed June 28, 2013.

Understanding lupus. Lupus Foundation of America website. Available at: http://www.lupus.org/webmodules/webarticlesnet/templates/new%5Flearnunderstanding.aspx?articleid=2231&zoneid=523. Accessed June 28, 2013.

12/4/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php. Hartkamp A, Geenen R, et al. Effects of dehydroepiandrosterone on fatigue and well-being in women with quiescent systemic lupus erythematosus. A randomized controlled trial. Ann Rheum Dis. 2010;69(6):1144-1147.

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