Ricker Polsdorfer, MD
Main Page | Risk Factors | Symptoms | Diagnosis | Treatment | Screening | Reducing Your Risk | Talking to Your Doctor | Living With Lupus | Resource Guide
Many medications are used for treatment of lupus, 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 lupus 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 lupus and will most likely be part of your treatment program at some point.
Less dangerous medications are the mainstay of controlling the symptoms of lupus as long as they are effective. Foremost on the list are the nonsteroidal anti-inflammatory drugs (NSAIDs). They, too, 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 lupus is the cytotoxic agents, the same ones used in
to treat cancer. These drugs, combined with glucocorticoids, reduce the incidence of kidney failure, the most lethal complication of lupus.
Many people with lupus 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.
(Cortisone-like Drugs, Steroids)
Nonsteroidal Anti-inflammatory Drugs
Experimental Therapies—B-Cell Depleting Medications
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)—Lower Doses
Common names include:
For lupus, cortisone-like drugs are given in short, sometimes tapering, bursts lasting a week or two. This is done to avoid the adverse effects of prolonged treatment. These doses are often quite effective in reducing inflammation, but should not be used when the inflammation is fighting off an infection. Beyond a week or two the adverse side effects increase rapidly.
There are many complications associated with glucocorticoids. Even repetitive doses separated by significant intervals of time may eventually cause damage. Before taking a dose of a cortisone-like drug, be sure to ask your doctor if you have any reasons for avoiding it. Additionally, you may need to take calcium, vitamin D, osteoporosis and blood pressure medication, and to monitor your blood sugar levels while taking corticosteroids.
Possible side effects of glucocorticoids include:
NSAIDS are widely used in the treatment of lupus, 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:
Since patients with lupus are at increased risk for heart attacks and strokes, you should discuss your risk factors (high blood pressure, high cholesterol, post-menopausal status, diabetes) with your doctor before starting an NSAID. He or she may prescribe an aspirin, or refer you for a heart evaluation. Also, take special care with NSAIDs and aspirin if you have had peptic disease (stomach or
). If appropriate, consider taking additional medication for gastric protection.
Originally used to treat malaria, these drugs modify the inflammatory response in ways that benefit lupus patients. They are not used for serious, organ-threatening disease, but rather for more moderate symptoms.
Possible side effects of antimalarials include:
None of these drugs is FDA-approved for lupus. However, when used carefully for severe episodes, they have proven effective. Treatment is stopped as soon as a satisfactory response is achieved or an undesirable side effect occurs.
Cyclophosphamide is the most effective and the most toxic. Azathioprine is second in effectiveness and less toxic. Mycophenolate mofetil is even less toxic, but may be less effective in treating organ-based inflammation.
Possible side effects of cytotoxic agents include:
Aspirin is really the first of the NSAIDs and acts in exactly the same way as the rest of them. There are minor differences among the available agents in terms of dosing intervals, frequency of certain side effects, and other characteristics.
Possible side effects of NSAIDs at low doses include:
Take special care with NSAIDs and aspirin if you have had peptic disease (stomach or
duodenal ulcers or
is a hormone produced by the adrenal glands. There is conflicting evidence as to how effective this supplement is in reducing symptoms of lupus.
Some possible side effects include:
Talk to your doctor before taking DHEA. This supplement can affect other conditions that you have or interfere with your medicines.
There are major advances being made in lupus research. Whole new branches of medicine called molecular biology and genetic engineering are focusing on the mechanisms of immunity and inflammation. For this reason, you may want to consider participating in a clinical trial of new treatments. The government-sponsored website,
maintains a listing of the trials that need volunteers.
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.
Whenever you are taking a prescription medication, take the following precautions:
Contact your doctor if:
Dehydroepiandrosterone (DHEA). EBSCO Natural and Alternative Treatments website. Available at:
. Updated September 2009. Accessed December 4, 2009.
Drug Facts and Comparisons.
56th ed. Facts & Comparisons; 2001.
Harrison's Principles of Internal Medicine
. 14th ed. McGraw-Hill; 1998.
National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at:
12/4/2009 DynaMed's Systematic Literature Surveillance
DynaMed's Systematic Literature Surveillance
: 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.
2009 Oct 22. [Epub ahead of print]