From the National Magazine

An Overview on Lupus Medication

Breda Cronnolly, Senior Pharmacist for South Bucks NHS Trust, gave a very interesting and informative presentation to members of the Thames Valley group attending the December meeting at Reading. The talk outlined the main drugs that are used to manage lupus, including their advantages and disadvantages.

Aches and pains are the most common symptoms of lupus and painkillers need to be taken regularly. Paracetamol is the most common painkiller used and the dose is 1g four times daily. Some lupus sufferers may require stronger analgesia. Non-steroidal anti-inflammatories are often used e.g. Diclofenac, Ibuprofen, Naproxen, etc. These may cause stomach upset, however a stomach protectant can be prescribed, e.g. Ranitidine or Lansoprazole.

Many drugs that are used in lupus can also be used in other diseases. A common example is Hydroxychloroquine, which was initially launched as an antimalarial drug. It is no longer used as an antimalarial but it remains a useful option in the management of lupus. Annual eye tests should be carried out as Hydroxychloroquine can sometimes affect the eyes.

Mepacrine is an alternative agent that can be used; it is not prescribed as commonly as Hydroxychloroquine. It is traditionally a drug used for tropical infections. It is usually given on alternate days in a dose of 100mg. Rarely, it discolours the skin or nails.

Azathioprine is an immunosuppressive drug that can be offered with or without steroids for lupus. It is often used so that lower doses of steroids can be given. Blood tests should be carried out regularly so that the doctor can monitor your liver function and blood count while you are on this medicine.

Cyclophosphamide is a useful agent to use if the kidneys have been affected by lupus. It can be given daily or on alternate days depending on the severity of the disease. Full blood counts should always be carried out while you are taking cyclophosphamide.

Corticosteroids are commonly used with lupus, these are given if there is any lung or heart involvement. The dose depends on the severity of the lupus. Steroids unfortunately can have several side-effects including:-
weight gain
worsening existing diabetes
high blood pressure
increased chance of infection
osteoporosis

However, steroids will only be prescribed if the doctor feels that benefits outweigh the risks. Steroids are highly effective drugs in the management of lupus.

Mycophenolate is a new immunosuppressive agent and can be useful when other, more common, drugs have failed. It is sometimes combined with steroids. As with all new drugs data is limited, however it looks promising. It has fewer side-effects than azathioprine and cyclophosphamide but may cause stomach upset.

Some lupus patients have antibodies that affect clotting of the blood. These patients are usually given aspirin, however if there are recurrent clotting problems then warfarin may be prescribed.

Many lupus patients are young females who may wish to become pregnant while on their current medication. This will need to be discussed with your doctor who will adjust the medication accordingly. If you have any concerns about the medication you are taking while pregnant, you should discuss this with your doctor or your local pharmacist.

One of the gains from the recognition of APS Syndrome is that it is a significant cause of recurrent miscarriage. Thankfully, this is now treatable. The simple theory as to the cause is that the "sticky blood" is unable to reach the smallest blood vessels in the placenta.

Treatment in pregnancy: Pregnancy complicated by APS requires expert care and a multidisciplinary team approach. In our pregnancy clinic, patients with APS undergo assessment and counselling before they conceive. Close monitoring of pregnancy is essential.

Thank you, Breda, for this helpful information. A brief note was made at the end of the presentation about Patient Information Leaflets which are included in all packs of prescribed medication. These can often contain long lists of side effects which may frighten the patient. Breda advised that if anyone has any queries with their medication to contact their local pharmacist who should be able to provide accurate advice as to the likelihood of these side effects.

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