Munson Health
 
Medications for Systemic Lupus Erythematosus

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by Polsdorfer R
 
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

  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:
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 ).

Clinical Trials of New Drugs

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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