An Overview of Common Lupus Medications

Lupus Warriors use many types of medications to treat lupus and its symptoms. Each lupus medication in your treatment plan serves a purpose, and comes with its own risks and
rewards. What exactly you will need depends on your symptoms and on your body.

Different symptoms require different treatment approaches.

Rheumatologists may prescribe immunosuppressant drugs if lupus is severely damaging internal organs. For pain, aspirin or other NSAIDs may be on the list. Each person with lupus is prescribed a unique cocktail of medications.

Talk to the doctors on your lupus treatment team about which medications are best for your symptoms and body. While there is no cure for lupus, drugs can help reduce symptoms and decrease your risks of a flare.

You can read more about building your treatment team here. So what medications might you encounter
on your journey with lupus?

NOTE: Speak with your lupus treatment team before starting or stopping medications. Also, share your full medication list with them to minimize interaction effects and fully understand side effects.

Anti-Inflammatory Medications

The symptoms of lupus are caused by inflammation in the body, and medications that bring this inflammation under control can do a lot of good. Not only can anti-inflammatories reduce the intensity of lupus’ symptoms, but they can:

• relieve pain
• prevent organ damage
• help resist flares
• stave off infection

NSAIDs

Non-steroidal anti-inflammatories include aspirin, ibuprofen, and Celecoxib (Celebrex). Though they primarily deal with pain, they also can reduce swelling and stiffness and bring down fevers. Aspirin also has blood- thinning and anti-coagulant properties, so it may be prescribed at low doses to lower stroke and heart attack risk.

Side effects can include gastrointestinal bleeding and an increased risk of bleeding strokes. But, as an over-the counter pain and inflammation reliever, NSAIDs may be very useful for many people with lupus.

Corticosteroids

Oral corticosteroids are a common medication for people with lupus. They are made up of a lab-derived chemical that mimics the chemicals that regulate important processes in the brain and body. They can:

• control symptoms quickly
• reduce the symptoms of flares

Because of this, they are considered essential and life-saving. But, they are known for their long list of side effects, including lifetime toxicity. Steroid tapering is used to minimize exposure at any given time.

Other steroid side effects include:

• weight gain
• insulin production (especially relevant for Lupus Warriors with diabetes)
• depression and mood swings
• osteoporosis
• bruising
• increased vulnerability to disease
  • Because they down-regulate the immune system, they also leave the body vulnerable to disease

You can read more about steroids and lupus here.

Prednisone

Prednisone is a powerful corticosteroid treatment that is known both for bringing down severe symptoms, ending major flares, and for intense side effects tied to fat metabolism. Side effects include moon-face, dorsocervical fat pad (buffalo hump), and abdominal bloating. These side effects can be a harsh blow to a person’s self- image, self-esteem, and mental health.

It also is known to cause weight gain, appetite changes, muscle shakiness, insomnia, and to interrupt menstruation. Like many lupus medications, it also leaves people with lupus open to infection. These side effects disappear with decreasing or weaning off the dose, and go away when the medication is stopped.

Low-Dose Naltrexone

Naltrexone is best known for helping to treat drug and alcohol addiction. But, in low doses, it can reduce pain and inflammation. Because it has effects on the opioid system, and because the opioid system influences many processes throughout the body, low-dose naltrexone’s effect may come from this. In higher dosages, it can help wean people with lupus off of opioids by preventing cravings.

You can read more about low-dose naltrexone here.

Topical Treatments for Lupus

A topical treatment is a medication that is applied to the skin. These treatments are especially good at targeting skin-related symptoms of cutaneous lupus. You can read more about cutaneous lupus here, and how topical medications are used to treat lupus here.

Because they are applied to the outside of the body, topical treatments generally have less severe side effects.

Topical treatments  can be absorbed into the skin and may have benefits for joint or muscle pain as well. This depends on the medication and the dose, and on the formulation of the medication. Many medications applied to the skin are mixed with moisturizers to help carry them to the skin and to moisturize the area. The moisturization of the skin can also help the healing process.

Topical Corticosteroids

Topical corticosteroids are similar to oral corticosteroids; they reduce inflammation in the body. However, they usually deliver a much lower dose of corticosteroids than the oral medication. Examples of topical corticosteroids include fluocinonide cream and hydrocortisone cream.

When applied to the skin, they only affect the skin and, to a limited extent, the joints in the body (as a small amount is absorbed deeper into the body). Topical corticosteroids calm the skin reactions of cutaneous lupus. Preventing new skin damage and lesions from forming and allowing the skin to heal.

Topical corticosteroids have proven effective at limiting the symptoms of cutaneous lupus. Larger doses may lead to side effects like:

• muscle and skin atrophying or thinning
• spidery or visible veins
• dermatitis or shedding of skin at the area

In general, however, topical corticosteroids are considered safe and effective.

Calcineurin Inhibitors

Calcineurin area type of topical immunosuppressant medication.

How do they work? Calcinuerin is an enzyme that activates T cells, the cells responsible for the immune system response. (You can read more about T cells here.) By inhibiting this enzyme, Calcineurin inhibitors prevent inflammation. It can be taken orally, injected, or applied to the skin, depending on what it is being used to treat.

A few examples of topical calcineurin inhibitors include tacrolimus and pimecrolimus. Research suggests that topical calcineurin inhibitors are particularly good for managing symptoms on the face.

Immunosuppressive Drugs and Lupus

Because lupus is an autoimmune disease, where the body’s own immune system attacks its own cells, suppressing the immune system with medications can help minimize the damage. Immunosuppressive medications can bring down lupus symptoms and break flares. However, they leave the body vulnerable to infections and some cancers. People on immunosuppressive drugs have to be very careful about what they eat, their hand-washing frequency, the health of the people around them, and any injuries they may sustain.

Cenerimod

Cenerimod is a new medication under development that blocks the release of lymphocytes, a type of white blood cell, into the blood stream. Lymphocytes are the cells that act as the body’s soldiers, attacking invaders and, in the case of lupus, healthy cells. It is currently in a Phase 3 trial and you can read more about Cenerimod here.

Methotrexate

Originally designed as an oral chemotherapy drug, methotrexate interferes with rapidly growing cells – even to the point of killing them. This shrinks tumors but it also inhibits the activity of the immune system. This allows methotrexate to reduce inflammation. It has since proven very effective at treating systemic lupus in many organ systems, including the skin.

Azathioprine

Azthioprine (Imuran) is used to prevent the immune system from rejecting transplants, but it also has use in treating lupus and rheumatoid arthritis. It can take up to 12 weeks (3 months) to see an effect.

Azthioprine works by interfering with DNA synthesis – rapidly dividing cells such as the ones in the immune system cannot make more DNA as effectively and are unable to replicate. This makes them less effective at fighting infection, but also stops them from damaging the body as in autoimmune disease.

You can read more about azathioprine here.

Cyclophosphamide

Cyclophosphamide is an injected drug. It is used to treat cancer but, in lower doses cyclophosphamide can be used to turn down the activity of the immune system. Specifically, it affects the T cells that target cells for destruction and the suppressor cells that help regulate the immune response. It is a powerful  treatment for lupus and has shown to improve symptoms dramatically.

However, side effects include sun-sensitivity, lung infections, liver damage, and mouth sores, and the drug cannot be taken with alcohol.

Biologics for Lupus

Biologics are medications that take the form of antibodies (parts of the immune system itself) designed to target specific antigens (proteins on the surface of cells) and flag problematic cells.

They can be used to attack and kill autoimmune cells and cancer cells, but can also be designed to specifically latch onto and block receptors. Because they are so specific, biologics have the potential to have fewer side effects than other drugs.

Type-1 Interferon blockers

Type-1 interferons are involved with regulating inflammation. These proteins fail to function properly for about 60-80% of people with lupus. They prevent cytokine production in the body, stopping the inflammation response from happening, while not suppressing it. This means that the damage from lupus is reduced, but the body is not left unprotected.

Anifrolumab is an example of this type of medication. You can read more about them here.

Benlysta

When it was approved in 2011, Benlysta was the first medication approved for the treatment of lupus in over 50 years. It can be administered via infusion or injection. And, it may soon be orally available.

It is a monoclonal antibody that blocks B-cell activity in the body – one of the major autoimmune attackers.

Antimalarial Medications for Lupus

Although developed originally to combat malaria, a mosquito-borne disease, anti-malarial medications have been proven to help combat lupus flares and prevent complications. In particular, they can help ease the joint pain associated with lupus. Antimalarials generally have milder side effects than other lupus medications.

Hydroxychloroquinine

Hydroxychloroquinine, also known as Plaquenil, is an antimalarial that can be used to treat both internal and skin-related symptoms of lupus. It also reduces the risk of atrial fibrillation (heart disease) by as much as 67%, according to one study.

One known troubling side effect of plaquenil is damage to the eye. However, this is a rare symptom, occurring only in 1/5000 people after it is used for several years.

Side Effects of Lupus Medications

Different medications have different side effects. But, there are some common themes.

Corticosteroids and other similar medications can lead to fluid retention and swelling. Immune-system suppressing medications (including antimalarials and chemotherapy drugs) make lupus patients more vulnerable to infection. Orally-taken medications, especially NSAIDs, can lead to intestinal irritation, ulcers, and allergic reactions.

You and your treatment team will make sure that your side effects are at acceptable levels, and for the most part the benefits of lupus medications outweigh their side effects.

Other Medications

Other medications treat the comorbidities of lupus – diseases that occur along with and may be exacerbated by lupus. These include serious symptoms such as increased risks of blood clotting and heart disease, seizures, and illness, and less life-threatening symptoms such as fatigue and urinary problems.

These medications include statins, diuretics, anticoagulants, hypertension medications, antibiotics, and stimulants. Be sure to disclose these medications if you are taking them to your lupus treatment team as they may interact with lupus medications.

Alongside these are the very important painkiller medications.

Opioid Painkillers and Lupus

Painkillers (also known as analgesics) can be vital for people with lupus. Getting rid of the pain can be exactly what someone needs to live their life and get through their day. For many forms of lupus-related pain, NSAIDs may be enough. Anti-inflammatory drugs also have a painkilling effect. However, opioids and combination opioid and anti-inflammatory drugs may be prescribed if the pain is not responding.

Opioids are a diverse group of medications that include codeine, tramadol, morphine, dilaudid, and oxycodone. All of these medications interact with the opioid receptors in the nervous system, which influences inflammation, digestion, pain perception, and pleasure. Natural opioids called endorphins are produced through exercise. And as a response to injuries or something that the body perceives as an injury, such as acupuncture.

Prescribed opioids are much more potent and can help with severe pain. But, they are also highly addictive and can create dependence. If you are prescribed opioids for your pain, be sure to take the medications as prescribed.

Need support for opioid dependence? Health and Human Services provides state-specific resources here.

Getting Your Medications

Most medications can be picked up at your local pharmacy or (for the infusion-delivered drugs) received at the hospital. Out-of-pocket costs can be prohibitively high and can cause stress. Financial stress, like any other type of stress, can negatively affect physical and mental health, and can even lead to worsening symptoms and flares.

Insurance plans can help pay for medications and visits to the doctor, but aside from that requesting generic versions of medications rather than brand name drugs can cut down on costs. Many medical practices also receive samples of medications that they can offer inexpensively, and some pharmaceutical companies have payment plans.

You can learn more about how to help ease the costs of lupus medications here.