Medications Used to Treat Lupus
Types of Antimalarials
The drugs most often prescribed are hydroxychloroquine sulfate (Plaquenil) and chloroquine (Aralen).
Mechanism of Action and Use
The anti-inflammatory action of these drugs is not well understood. In some patients who take antimalarials, the total daily dose of corticosteroids can be reduced. Antimalarials also affect platelets to reduce the risk of blood clots and lower plasma lipid levels.
Central Nervous System: Headache, nervousness, irritability, dizziness, and muscle weakness.
Gastrointestinal: Nausea, vomiting, diarrhea, abdominal cramps, and loss of appetite.
Ophthalmologic: Visual disturbances and retinal changes manifested by blurring of vision and difficulty in focusing. A very serious potential side effect of antimalarial drugs is damage to the retina. Because of the relatively low doses used to treat SLE, the risk of retinal damage is small. However, patients should have a thorough eye examination before starting this treatment and every 6 months thereafter.
Dermatologic: Dryness, pruritus, alopecia, skin and mucosal pigmentation, skin eruptions, and exfoliative dermatitis.
Hematologic: Blood dyscrasia and hemolysis in patients with glucose 6-phosphate dehydrogenase (G6PD) deficiency.
Antimalarials are considered to have a small risk of harming a fetus and should be discontinued in lupus patients who are attempting to become pregnant.
Considerations for Health Professionals
History: Known allergies to the prescribed drugs, psoriasis, retinal disease, hepatic disease, alcoholism, pregnancy, and lactation.
Laboratory data: CBC, liver function tests, and G6PD deficiency.
Physical: All body systems to determine baseline data and alterations in function, skin color and lesions, mucous membranes, hair, reflexes, muscle strength, auditory and ophthalmological screening, liver palpation, and abdominal examination.
Therapeutic response and side effects.
Before or after meals at the same time each day to maintain drug levels.
Corticosteroids are hormones secreted by the cortex of the adrenal gland. SLE patients with symptoms that do not improve or who are not expected to respond to NSAIDs or antimalarials may be given a corticosteroid. Although corticosteroids have potentially serious side effects, they are highly effective in reducing inflammation, relieving muscle and joint pain and fatigue, and suppressing the immune system. They are also useful in controlling major organ involvement associated with SLE. These drugs are given in much higher doses than the body produces and act as potent therapeutic agents. The decision to use corticosteroids is highly individualized and is dependent upon the patient's condition.
Once the symptoms of lupus have responded to treatment, the dose is usually tapered until the lowest possible dose that controls disease activity is achieved. Patients must be monitored carefully during this time for flares or recurrence of joint and muscle pain, fever, and fatigue that can result when the dosage is lowered. Some patients may require corticosteroids only during active stages of the disease; those with severe disease or more serious organ involvement may need long-term treatment.