Medications Used to Treat Lupus
Treatment with corticosteroids must not be stopped suddenly if they have been taken for more than 4 weeks. Administration of corticosteroids causes the body's own production of adrenal hormones to slow down or stop, and adrenal insufficiency will result if the drug is stopped suddenly. Tapering the dose allows the body's adrenal glands to recover and resume production of the natural hormones. The longer a patient has been on corticosteroids, the more difficult it is to lower the dose or discontinue use of the drug.
Types of Corticosteroids
Prednisone (Orason, Meticorten, Deltasone, Cortan, Sterapred), a synthetic corticosteriod, is most often used to treat lupus. Others include hydrocortisone (Cortef, Hydrocortone), methlyprednisolone (Medrol), and dexamethasone (Decadron). Corticosteroids are available as a topical cream or ointment for skin rashes, as tablets, and as an injectable for intramuscular or intravenous administration.
Mechanism of Action and Use
The frequently prescribed corticosteroids are highly effective in reducing inflammation and suppressing the immune response. These drugs may be used to control exacerbation of symptoms and are used to control severe forms of the disease. The drug is usually administered orally. During periods of serious illness, it may be administered intravenously; once the patient has been stabilized, oral administration should be resumed.
Central Nervous System: Convulsions, headache, vertigo, mood swings, and psychosis.
Cardiovascular: Congestive heart failure (CHF) and hypertension.*
Endocrine: Cushing's syndrome, menstrual irregularities, and hyperglycemia.
Gastrointestinal: GI irritation, peptic ulcer, and weight gain.
Dermatologic: Thin skin, petechiae, ecchymoses, facial erythema, poor wound healing, hirsutism,* and urticaria.
Musculoskeletal: Muscle weakness, loss of muscle mass, and osteoporosis.*
Ophthalmologic: Increased intraocular pressure, glaucoma, exophthalmos, and cataracts.*
Other: Immunosuppression and increased susceptibility to infection.
Pregnancy and Lactation
Corticosteroids cross the placenta, but can be used cautiously during pregnancy. They also appear in breast milk; patients taking large doses should not breastfeed.
Considerations for Health Professionals
History: Hypersensitivity to corticosteroids, tuberculosis, infection, diabetes, glaucoma, seizure disorders, peptic ulcer, CHF, hypertension, and liver or kidney disease.
Laboratory data: Electrolytes, serum glucose, WBC, cortisol level.
Physical: All body systems to determine baseline data and alterations in function, weekly weight gain of >5 pounds, GI upset, decreased urinary output, increased edema, infection, temperature, pulse irregularities, increased blood pressure, and mental status changes (e.g., aggression or depression).
Therapeutic response, including decreased inflammation and adverse effects.
With food or milk (to decrease GI symptoms).
Immunosuppressive agents are generally used to reduce rejection of transplanted organs. They are also used in serious, systemic cases of lupus in which major organs such as the kidneys are affected or in which there is severe muscle inflammation or intractable arthritis. Because of their steroid-sparing effect, immunosuppressives may also be used to reduce or sometimes eliminate the need for corticosteroids, thereby sparing the patient from undesirable side effects of corticosteroid therapy.