Medications used to treat lupus
Hydroxychloroquine and other antimalarials
Hydroxychloroquine (Plaquenil) is a type of antimalarial medicine. Antimalarials work by reducing autoantibodies (proteins in the blood that attack healthy cells and tissues). Doctors use antimalarials to treat malaria, but these medicines can also treat lupus by:
- Reducing pain and inflammation
- Preventing lupus flares and helping with lupus skin problems
- Lowering the dose (amount you need to take) of your other lupus medicines
Most people with lupus take hydroxychloroquine throughout their lives. It helps control lupus symptoms with very few side effects.
Hydroxychloroquine may also help prevent blood clots and organ damage from lupus. It usually takes 1 to 3 months to start working.
Types of antimalarials
Hydroxychloroquine (Plaquenil) is the most common antimalarial for lupus. If you can’t take hydroxychloroquine, your doctor may recommend chloroquine (Aralen®). These medicines can be taken as pills or liquids.
Side effects of antimalarials
Most people don’t notice any side effects, but antimalarials sometimes cause stomach pain and digestive problems, like nausea or diarrhea. These side effects usually go away once your body adjusts to the medicine.
In rare cases, taking a high dose of antimalarials or taking them for a long time may damage your eyes. If you’re taking antimalarials, ask your doctor about getting regular eye exams to make sure your eyes are healthy and to monitor for any changes.
Any medicine you take for lupus can have serious side effects. Before you start taking a new medicine, talk to your doctor about the risks and benefits, and ask what side effects to look out for.
Steroids can help reduce pain and inflammation. They work by decreasing the activity of overactive white blood cells. This prevents them from causing inflammation that leads to lupus symptoms.
You may hear other words for steroid medicines, like corticosteroids, glucocorticoids or cortisone. Steroids you take for lupus are different from the steroids that some athletes take to improve their performance — those are called anabolic steroids.
Types of steroids
Prednisone is the most common steroid that doctors use to treat lupus. If you have liver problems, your doctor may recommend different steroids called prednisolone or methylprednisolone (Medrol®).
There are a few different ways to take steroids:
- Most people take steroids as pills
- If you can’t take steroid pills or you’re having severe lupus symptoms, your doctor may give you steroid injections (also called pulse steroids)
- If you have skin problems, your doctor may recommend steroid skin cream or gel, which can treat lupus skin problems with fewer side effects than steroid pills or injections
Side effects of steroids
Steroids can cause a range of side effects, including swelling, weight gain, and problems sleeping. If you take steroids for a long time, they can also raise your risk of other health problems, like infections, osteoporosis (weak bones), and diabetes.
Non-steroidal anti-inflammatories (NSAIDs)
NSAIDs can also reduce pain and inflammation, but they’re not steroids. They work by reducing chemicals in the body that cause inflammation.
NSAIDs usually start working within a few days. They’re the most common treatment for typical lupus symptoms like fever and joint pain.
Types of NSAIDs
Common NSAIDs include:
- Ibuprofen (like Advil® or Motrin®)
- Naproxen (like Aleve® or Naprosyn®)
- Indomethacin (Indocin®)
- Nabumetone (Relafen®)
- Celecoxib (Celebrex®)
You can get some NSAIDs over the counter (without a prescription), but you need a prescription for others.
In addition to treating pain and inflammation, aspirin can also help prevent blood clots. Many people with lupus take a daily low-dose aspirin (also called baby aspirin) to lower their risk for blood clots.
Acetaminophen (Tylenol®) is an over-the-counter medicine that can help ease pain and lower fever, but it’s not an NSAID and it doesn’t treat inflammation or any other lupus symptoms. Always talk to your doctor before taking any over-the-counter medicines.
Side effects of NSAIDs
NSAIDs can cause problems with your digestive system, like stomach pain and ulcers. Taking NSAIDs with food can help prevent stomach pain. Your doctor may also recommend medicines to help with digestive side effects, like:
- Omeprazole (Prilosec®)
- Lansoprazole (Prevacid®)
- Over-the-counter antacids like TUMS®
Regular use of NSAIDs can also damage your kidneys. If you have kidney problems from lupus, talk with your doctor about ways to treat inflammation without using NSAIDs.
Some medicines used to treat lupus aren’t safe to take when you’re pregnant or breastfeeding. If you’re pregnant or trying to get pregnant, talk with your doctor about treatment options that are safe for you and your baby.
Immunosuppressives help stop your immune system from attacking your body’s healthy tissue. Your doctor may recommend immunosuppressives if you’re having serious lupus symptoms that affect your organs, like your brain, kidneys, heart, or lungs.
Types of immunosuppressives
The most common immunosuppressives for lupus include:
- Methotrexate (Rheumatrex®)
- Mycophenolate mofetil (Cellcept®)
- Azathioprine (Imuran®)
- Cyclophosphamide (Cytoxan®)
- Voclosporin (Lupkynis™)
Each of these immunosuppressive medicines works differently and treats different lupus symptoms. Lupkynis is only approved to treat lupus nephritis in adults. Your doctor will help you decide if your treatment plan should include immunosuppressive medicine.
Side effects of immunosuppressives
Immunosuppressives make it harder for your body to fight off infections. If you’re taking immunosuppressives, use these tips to protect yourself from infections:
- Wash your hands often
- Clean and protect any cuts or wounds
- Avoid people with colds or other illnesses you could catch
- Talk with your doctors about taking antibiotics before procedures — like surgery or dental work
- Tell a doctor right away if a cut becomes red, painful, or swollen — or if you have a fever over 100°F
- Prevent viral infections by staying up to date with vaccines
Different immunosuppressives can also cause different side effects, including damage to your organs. Some can also raise your risk of cancer. Talk with your doctors about the risks and benefits, and ask about ways to prevent or manage side effects.
Blood thinners (also called anticoagulants) can help prevent blood clots. If you’ve had blood clots or you have antiphospholipid antibodies, your doctor may recommend blood thinners to lower your risk of clots.
Types of blood thinners
Common blood thinners for lupus include:
- Heparin injections (Calciparine® or Liquaemin®)
- Warfarin pills (Coumadin®)
- Low-dose aspirin
Side effects of blood thinners
Blood thinners can cause bleeding that is difficult to control. Get medical help right away if you notice these symptoms:
- Bleeding more than usual from a cut
- Very heavy bleeding during your period
- Red or brown urine (pee)
- Blood in the toilet after a bowel movement or dark black color of bowel movements
- Vomiting or coughing up blood
- Feeling dizzy or weak
If you’re taking warfarin, you may need regular blood tests to make sure your blood doesn’t get too thin. Ask your doctor how often you need to get your blood tested.
Monoclonal antibodies (mAbs)
A monoclonal antibody is a type of protein made in a laboratory that is developed to find and attach to only one type of substance in the body. There are many kinds of monoclonal antibodies and they can be used to treat a number of diseases. There are two types of monoclonal antibodies approved to treat lupus. Benlysta is also approved to treat lupus nephritis in adults and children over 5.
Types of monoclonal antibodies
Side effects of monoclonal antibodies
Each type of monoclonal antibody can have different side effects. They can include:
- Nausea and diarrhea
- Trouble sleeping
- Pain in the arms and legs
- Migraine headaches
- Increased risk of infection
- Increased risk of shingles
Acthar® Gel (repository corticotropin) can help reduce inflammation. Experts aren’t sure how it works, but they think it may help your body make cortisol (an anti-inflammatory hormone). ActharGel is an injection that you get at the doctor’s office.
Side effects of Acthar Gel
Acthar Gel has similar side effects as steroid medicines. Before starting Acthar Gel, talk to your doctor about side effects.