Medicines

Cytotoxic , or Immunosuppressive Drugs

These drugs are used are used to suppress the immune system in people with lupus. The most commonly used drugs of this type are azathioprine (Imuran), cyclophosphamide (Cytoxan), and methotrexate (Rheumatrex), and cyclosporine (Sandimmune, Neoral) . These drugs are generally reserved for people with more serious manifestations of lupus such as — lupus kidney disease ( nephritis ), or or acute neurologic complications disease— in who have failed m treatment with corticosteroids . has failed.

When Should My Doctor Prescribe Immunosuppressive Drugs?

• These drugs are generally reserved for people with more serious manifestations of lupus, such as lupus nephritis or neurologic disease, in whom treatment with corticosteroids has failed.
• It is very important that immunosuppressive cytotoxic drugs only be given by physicians who are experienced with the use of these medications. The possible toxicities of these cytotoxic drugs are considerable and individuals treated with these drugs must be very carefully monitored. Some of these The drugs have a n major effect on cells produced by the bone marrow, including white blood cells, red blood cells, and platelets. Thus, people treated with immunosuppressive cytotoxic drugs must have regular complete blood counts (CBCs) to make certain that levels of these cells do not become too low. In addition, immunosupressive cytotoxic drugs reduce a person's ability to fight off infections. Those receiving cytotoxic immunosupressive drugs are more likely to contract viral infections such as shingles (herpes zoster), and other more serious infections may also develop.

Immunosuppressive Side Effects

The possible toxicities of cytotoxic drugs are considerable and individuals treated with these drugs must be very carefully monitored.

• The drugs have a major effect on cells produced by the bone marrow, including:
  • white blood cells
  • red blood cells
  • platelets.
• Thus, people treated with cytotoxic drugs must have regular complete blood counts (CBCs) to make certain that levels of these cells do not become too low.
• In addition, cytotoxic drugs reduce a person's ability to fight off infections.
• Those receiving cytotoxic drugs are more likely to contract viral infections such as shingles (herpes zoster)
• Other more serious infections may also develop.

Specific Toxicities

There are distinct toxicities that are unique to each cytotoxic immunosupressive drug. Cyclophosphamide, for instance, may cause hair loss, bladder complications, and sterility. Azathioprine may cause an allergic-type of hepatitis and pancreatitis. Methotrexate may cause liver damage, including cirrhosis, as well as a serious lung toxicity. Cyclosporine commonly produces hypertension and may lead to kidney damage. All cytotoxic immunosupressive drugs are thought to increase a person's risk for developing cancer.