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Medications for Systemic Lupus Erythematosus (SLE)

Here are some facts about drugs that can help treat SLE. Many depend on where you have problems and how bad they are. Only the most common drugs and reactions are listed. Some drugs are still being tested. Others are not used as often. But you may need them. Ask your doctor if you need to take any special steps. Use each of these drugs the way your doctor tells you to. Or, follow the fact sheet that come with them. If you have questions, call your doctor.

Doctors try not to have people use glucocorticoids (steroids). They are harsh and can cause lasting problems. But they help ease SLE. They will likely be part of your care at some point.

Drugs with less problems are used to control SLE if they are useful. Nonsteroidal anti-inflammatory drugs (NSAIDs) is one drug. But they can also cause issues, such as stomach problems.

Antimalarial drugs are also used for how they work on the immune system.

Immune modulators are a fourth class of drugs used in SLE. They may be used alone when steroids are not working. They may also be used with glucocorticoids if you have kidney issues. They help lower the risk of kidney failure.

Many people with SLE have skin problems. These are often treated with corticosteroids you put on to your skin. Other methods are also used, as well as some of the drugs listed below.

Some people with SLE have antiphospholipid antibody syndrome and are at risk for blood clots. They may need long term care with anticoagulants. These drugs help keep the blood from clotting too much.

Prescription Medicines

Glucocorticoids

  • Prednisone
  • Prednisolone

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)—higher doses

  • Ibuprofen
  • Naproxen
  • Sulindac
  • Diclofenac
  • Piroxicam
  • Ketoprofen
  • Diflunisal
  • Nabumetone
  • Etodolac
  • Oxaprozin
  • Indomethacin
  • Celecoxib

Antimalarial Drugs

  • Hydroxychloroquine sulfate
  • Chloroquine

Immune modulators

  • Methotrexate
  • Cyclophosphamide
  • Azathioprine
  • Mycophenolate mofetil

Targeted B-cell therapy

  • Belimumab
  • Rituximab

Anticoagulants and Antithrombotics

  • Low dose aspirin
  • Heparin
  • Warfarin

Experimental Therapies

Over the Counter Medicines

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)—lower doses

  • Aspirin
  • Ibuprofen
  • Naproxen

Prescription Medicines

 

Glucocorticoids

Common names are:

  • Prednisone
  • Prednisolone

These drugs are used if you have severe problems. They are given in short bursts that last one to two weeks. They lower over time. This is done so you don't have reactions. These doses are can help ease swelling. But they should not be used when the swelling is fighting off an infection. The longer you take them, the greater your risk of problems from them.

There are many health problems linked to these drugs. Before taking a dose, ask your doctor if you have any reasons not to take it. You may also need to take calcium, vitamin D, osteoporosis and blood pressure drugs while taking them. You will also need to watch your blood sugar levels.

Problems are:

 

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)—higher doses

Common names are:

  • Ibuprofen
  • Naproxen
  • Sulindac
  • Diclofenac
  • Piroxicam
  • Ketoprofen
  • Diflunisal
  • Nabumetone
  • Etodolac
  • Oxaprozin
  • Indomethacin
  • Celecoxib

NSAIDs are used to treat mainly muscle and bone problems. They are likely safer for long term use than other drugs. But they can cause bad problems. Stay in touch with your doctor if you are on one of these drugs. You may not be able to take them if you have digestive issues.

Problems at high doses are:

  • Stomach problems, including ulcers and bleeding
  • Worsening of health problems like high blood pressure, heart failure, or kidney disease
  • Kidney damage
  • Liver inflammation
  • Lightheadedness
  • Severe allergic reaction, such as hives, problems breathing, or swelling around the eyes
  • Greater risk of bleeding—tell your doctors or dentists that you are taking an NSAID before you have any procedures

NSAIDs may raise your risk of serious heart problems, like heart attack and stroke. Patients with heart disease or those who have risks for heart disease will need to be careful.

Take special care with NSAIDs and aspirin if you have had peptic ulcer disease ( gastric or duodenal ulcers, or gastritis).

 

Antimalarial Drugs

Common names are:

  • Hydroxychloroquine sulfate
  • Chloroquine

These drugs change the way the body reacts to swelling. They are used for mild problems.

Problems are:

  • Headache
  • Mood changes
  • Lightheadedness
  • Weakness
  • Nausea
  • Vomiting
  • Diarrhea
  • Belly cramps
  • Lack of hunger
  • Vision problems
  • Rashes
  • Blood damage
  • Muscle weakness
 

Immune Modulators (Immunosuppressives)

Common names are:

  • Methotrexate
  • Cyclophosphamide
  • Azathioprine
  • Mycophenolate mofetil

Immune modulators lower the immune system and inflammation. These may be used when someone can't handle high doses of steroids. They may also help people who aren't helped by steroids. These drugs make it harder for the body to fight infection. You will need to watch cuts, scrapes, or any small wounds for signs of infection. You may also be at a higher risk for bacterial or viral infections.

Problems are:

  • Bone marrow damage
  • Increased frequency of cancer
  • Hair loss
  • Ovary damage
  • Liver damage (azathioprine)
  • Bladder damage (cyclophosphamide)
 

Targeted B-cell Therapy

Common names are:

  • Belimumab
  • Rituximab

Targeted B-cell therapy is for people who are getting other standard therapies. The drug, given by IV, may lower the number of abnormal B-cells thought to harm tissue. The reduced action of infection-fighting lymphocytes raises your risk of bacterial or viral infections.

Problems are:

  • 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 Medicines

 

Nonsteroidal anti-inflammatory drugs (NSAIDs)—lower doses

Common names are:

  • Aspirin
  • Ibuprofen
  • Naproxen

There are minor differences, such as dosing intervals and problems.

Problems from NSAIDs at low doses are:

  • Stomach problems, including ulcers and bleeding
  • Worsening of health problems, such as high blood pressure, heart failure, or kidney disease
  • Kidney damage
  • Liver inflammation
  • Lightheadedness
  • Severe allergic reaction, such as hives, problems breathing, or swelling around the eyes
  • Increased risk of bleeding—tell your doctors that you are taking an NSAID before you have any medical or dental procedures

NSAIDs may raise your risk of serious heart problems, like heart attack and stroke. This risk is important for patients with heart disease or those who are have risk factors for heart disease.

Take special care with NSAIDs and aspirin if you have had peptic ulcer disease ( gastric or duodenal ulcers, or gastritis).

 

Anticoagulants and Anti-Thrombotics

Common names are:

  • Aspirin (anti-thrombotic)
  • Heparin
  • Warfarin

Anticoagulants work by interfering with the clotting process. They are used in people with antiphospholipid antibody syndrome. This is an autoimmune disease that makes the blood clot easier. Blood clots can cause serious problems that can change the way blood flows all over the body. It also raises the risk of heart attack and ischemic stroke. Anticoagulant use needs to be watched to find the right balance. Too much can cause bleeding.

Problems are:

  • Lower than normal number of platelets, which can raise blood clotting time
  • Allergic reaction
  • Hemorrhagic stroke
  • Hair loss (warfarin)
  • Bleeding in the eye (warfarin)
  • Gastrointestinal bleeding or ulcers (aspirin)
  • Ringing in the ear— tinnitus (aspirin)

  Clinical Trials of New Drugs

There is progress being made in SLE research. New branches of medicine are focusing on how immunity and inflammation work. You may want to think about joining a clinical trial of new treatments. The website, Clinical Trials, keeps a list of ones that need volunteers.

The trials are tightly controlled experiments by researchers in the field. Each one is approved by groups of health professionals for their safety and benefit. Each participant is told about the risks and expected to cooperate with the program. Some use drugs that are on the market for other health problems. Others are new ones that have been through at least two phases of testing—in the lab and on healthy people. Most trials give free care.

If you think you want to be part of one, talk to your doctor about whether it is right for you.

Special Considerations

If you are taking medications, follow these general guidelines:

  • Take your medication as advised. Do not change the amount or schedule.
  • Ask what side effects could happen. Report them to your doctor.
  • Talk to your doctor before you stop taking any prescription medicine.
  • Do not share your prescription medicine.
  • Medicines can be dangerous when mixed. Talk to your doctor or pharmacist if you are taking more than one, including over-the-counter products and supplements.
  • Plan ahead for refills.

When to Contact Your Doctor

Call your doctor if:

  • Your medicine is not doing what it was intended to do
  • A side effect happens
  • You have new stomach symptoms
REFERENCES:

Aspirin. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T233300/Aspirin. Updated August 9, 2018. Accessed September 5, 2018.

Heparin. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T233284/Heparin. Updated August 9, 2018. Accessed September 5, 2018.

Lupus. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health_Info/Lupus/default.asp. Updated June 30, 2016. Accessed August 31, 2018.

Systemic lupus erythematosus (SLE). EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T115873/Systemic-lupus-erythematosus-SLE. Updated July 20, 2018. Accessed August 31, 2018.

Systemic lupus erythematosus (SLE). Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/musculoskeletal_and_connective_tissue_disorders/autoimmune_rheumatic_disorders/systemic_lupus_erythematosus_sle.html. Updated February 2018. Accessed August 31, 2018.

Warfarin. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T233133/Warfarin. Updated August 9, 2018. Accessed September 5, 2018.

Medications used to treat lupus. Lupus Foundation of America website. Available at: http://www.lupus.org/answers/entry/medications-to-treat-lupus. Accessed September 5, 2018.

12/4/2009 DynaMed Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T115873/Systemic-lupus-erythematosus-SLE. Hartkamp A, Geenen R, Godaert GL, Bijl M, Bijlsma JW, Derksen RH. 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.

Last reviewed May 2018 by EBSCO Medical Review Board Daniel A. Ostrovsky, MD  Last Updated: 9/5/2018