Lupus Treatment Options: Lupus Medications

Lupus Medications

Lupus manifests differently in each patient (Please see: How Lupus Can Affect The Body,) requiring varying treatment options for each individual depending on the signs and symptoms that are presenting. It is also important to understand that the treatment protocol may change once or perhaps several times during a lupus sufferer’s lifetime. The goals of both patient and physician remain constant: To prevent and treat lupus flares, and to prevent lupus and associated medications from damaging your body over time.

Accurately following the regimen prescribed by your physician is vital, as well as discussing with your medical caregiver(s) any questions or concerns that may arise. We recognize that there are also alternative treatments to biomedicine (medicine based on the application of the principles of the natural sciences and especially biology and biochemistry) and pharmaceutical drugs, but for this blog we will only be covering the topic of pharmaceutical lupus medications. You can read about alternative medications in our blog on the topic: Alternative Treatments.

Some Common Lupus Medications

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Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDS or anti-inflammatory medications may relieve some lupus symptoms by reducing the inflammation responsible for the stiffness and discomfort in your muscle, joints, and other tissues. They can also lower fevers. Because NSAIDs are milder than many other lupus drugs, they may be taken either alone to treat a mild flare or in combination with other proscribed medications. Side effects can include stomach upset and fluid retention. People with lupus may have a higher risk of liver or kidney damage from NSAIDs. Newer prescription NSAIDs, called COX-2 inhibitors, do cause less stomach upset but carry an increased risk of heart attack. * Here is a list of some common NSAIDs:

Aspirin is a pain reliever and an anti-inflammatory that was one of the first medications approved for lupus treatment. Because high doses of aspirin can cause many side effects, it’s commonly used in lupus today only in low doses to reduce the risk of blood clots — a common complication of lupus.
Over-the-counter NSAIDs, such as naproxen (Aleve) and ibuprofen (Advil, Motrin, others), may be used to treat pain, swelling and fever associated with lupus.
Prescription NSAIDs are stronger forms of the over-the-counter versions. Some potential side effects of these NSAIDs include stomach bleeding, kidney problems and an increased risk of heart problems. *

Antimalarial drugs

Antimalarial drugs are medications commonly used to treat malaria can help control lupus. Side effects can include stomach upset and, very rarely, damage to the retina of the eye. *

Plaquenil (hydroxychloroquine) This drug was once used mainly to treat malaria. For reasons not yet completely understood, it can also suppress the immune response in lupus. Plaquenil is used to treat fatigue, pain, skin rashes, and inflammation, especially around the lungs. It is one of the most frequently used medications for lupus because studies show that it may prevent lupus flares and kidney damage. Many lupus patients will stay on Plaquenil for many years and perhaps indefinitely. Side effects may include stomach upset and in rare instances, damage to the retina of the eye.

*If you are on Plaquenil, be sure to have a routine annual eye exam.

Corticosteroids

Prednisone and other types of corticosteroids can counter the inflammation of lupus. Corticosteroids often produce several long-term side effects — including weight gain, bruising easily, thinning of the bones (osteoporosis), high blood pressure, diabetes and increased risk of infection. The risk of side effects increases with higher doses and longer term therapy. *

Steroids such as Prednisone- Steroids (synthetic cortisone medications) are medications related to cortisol, your body’s natural anti-inflammatory hormone. They are typically fast and effective in the reduction of swelling, warmth, pain, and tenderness associated with the inflammation that lupus causes. Steroids are the most common medicines used to treat lupus flares. Because steroids often have many side effects, they should only be used as long as they are needed, and in the lowest effective dosage. Coming off steroids suddenly can be dangerous, so always follow your doctor’s orders carefully when stopping this drug. Serious side effects of steroids can include infection, diabetes, high blood pressure, and bone damage. *

Immunosuppressants

Immunosuppressants are drugs that suppress the immune system, and may be helpful in more serious cases of lupus or cases where the lupus is very active. Potential side effects may include an increased risk of infection, liver damage, decreased fertility and an increased risk of cancer. Here is a list of some of the immune suppressing drugs:

Belimumab(Benlysta)- the newest approved treatment for some lupus patients can reduce lupus symptoms. Side effects can include fatigue, nausea, and diarrhea, mild pain in your arms and legs, or mild cold symptoms. *
CellCept(mycophenolate mofetil)- CellCept is another immune suppressor that is used for lupus kidney involvement. It is being used more now as a replacement for Cytoxan. Recent studies have shown that CellCept works as well as Cytoxan but has less severe side effects; unlike Cytoxan, CellCept does not cause infertility. *
Cyclosporine- This drug is used in transplant surgeries that can also be effective in severe cases of lupus. Cyclosporine (modified) is also used alone or with methotrexate (Rheumatrex) to treat the symptoms of rheumatoid arthritis (arthritis caused by swelling of the lining of the joints) in patients whose symptoms were not relieved by methotrexate alone. Side effects can include high blood pressure, and tenderness of the gums.
Cytoxan(cyclophosphamide)- This is a cancer treatment drug that can also be given to suppress the immune system. It is used for severe lupus with kidney involvement. Side effects can be serious or include an increased risk of some cancers, bladder damage, hair loss, and infertility. *
Imuran(azathioprine)- This drug is commonly used to suppress the immune system during transplant surgery and for lupus kidney disease. Imuran can produce serious side effects including infection, anemia, and increased cancer risk. *
Methotrexate(Trexall)- This drug also suppresses the immune system. Side effects can include decreased blood counts, mouth sores, organ damage, nausea, and fever. *
DHEA- This is a mild male hormone that is effective in treating some of the symptoms of mild to moderate lupus, including 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.

Medications for skin conditions related to lupus

Acute cutaneous, sub-acute cutaneous, and chronic cutaneous lupus can cause various forms of rashes on the skin. To learn more about these conditions and the butterfly rash, please read our blog, Lupus Butterfly Rash and Malar Rash. Medications for the skin may include the below listing depending on the type of rash:

Sunscreens- Sunscreens with SPF 30 or higher, protective clothing, and avoiding sun exposure for those with photo-sensitivity, as well as prescribed topical medications for rashes. Some of these topical medications can work well for some people may not function as well for others. Some treatments can have long-term side effects. More research is needed to determine which treatments are safest and most effective for skin rash.
Steroidal creams- Application of steroidal creams prescribed by the doctor helps in reducing the inflammation involved in case of malar rash and may even provide relief from itching, should that occur. These creams may cause dilated blood vessels and should be used cautiously on the face.
Drugs- Non-steroidal drugs which are both anti-malarial and anti-inflammatory in nature are prescribed to treat lupus malar or butterfly rash. Moreover, disease modifying anti-rheumatic drugs (DMARDs) and Immunosuppressive drugs are recommended for severe malar rash. They help in treating the disease well and also prevent the recurrence of the disease.
Alternative home remedies for soothing skin- Besides these medications, one can also treat malar rash at home by applying vitamin E oil, olive oil, cod oil, and even a pinch of baking soda on the affected area since it reduces the irritation and pain involved. One may take a bath using oatmeal ingredients in warm water and may also apply fresh Aloe Vera gel on the affected area so to allow the fast and effective healing of the butterfly rash.

*This is not a complete list of side effects for each medication listed and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Trials and Other Things to Consider

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Finding the most effective treatment for each individual patient evolves over time through working at maintaining a balance between preventing flares and the potentially life-threatening organ damage they can cause, while maintaining quality of life and minimizing the side effects that can come from various medications.

This balance can only come from a constant monitoring of (and keeping good record of) the disease activity as well as recording any side effects that may be stemming from the medication(s). Clearly and regularly communicate with your medical provider about your responses to the medications. This will help you and your physician devise the optimum course of action and make necessary adjustments to reach the best possible balance between lessoning your lupus symptoms and the side effects of medication.

Although there is currently no cure for lupus, today’s medications can be very effective in helping people with lupus live longer, healthier lives, and new research holds hope for the future. The Lupus Research Institute and its National Coalition of state and local lupus organizations is dedicated to finding new and safer options for treating and preventing systemic lupus. Participation of people with lupus in clinical research is the way to make this a reality. For the latest lupus trials, follow these suggested links:

Do your part- don’t be a passive patient. Learn as much as you can about lupus and work closely with your medical team. Studies show that taking an active role in your lupus care really helps. So be your own best advocate!

Author: Karrie Sundbom

All images unless otherwise noted are property of and were created by Kaleidoscope Fighting Lupus. To use one of these images, please contact us at [email protected] for written permission; image credit and link-back must be given to Kaleidoscope Fighting Lupus.

All resources provided by us are for informational purposes only and should be used as a guide or for supplemental information, not to replace the advice of a medical professional. The personal views expressed here do not necessarily encompass the views of the organization, but the information has been vetted as a relevant resource. We encourage you to be your strongest advocate and always contact your healthcare practitioner with any specific questions or concerns.

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