Lupus and its Most Common Drug List

Introduction

A healthy and normal immune system works by identifying foreign objects, called antigens, when they enter our body and destroys them by producing special proteins called antibodies. This mechanism is quite coordinated and immune response is only triggered when a foreign object gains entry in the body. But it is not always the case and sometimes the immune system becomes hyperactive and starts attacking its own cells, giving rise to autoimmune diseases. Lupus is one such disease in which the immune system starts attacking the body cells of the person. There is excessive production of antibodies in the body which get deposited in different places in the body causing inflammation.

Despite extensive research, scientists have not understood the exact reason why people develop lupus. Scientists believe that there are a number of factors that trigger the flaring up of symptoms like genes, hormones and environmental factors. Women of child bearing age are the most commonly affected from lupus. As per the Lupus Foundation of America, there are nearly 1.5 to 2 million Americans are suffering from the disease.

Symptoms of Lupus

The most important feature of lupus is that no two cases of lupus are exactly same. The signs and symptoms of lupus can appear slowly or suddenly, can be severe or mild and temporary or permanent. Most of the lupus patients have a milder form of the disease characterized by episodes of flares when the symptoms become severe for small duration of time and then disappear or improve.
Some of the most commonly observed signs and symptoms of lupus are:

• Fever
• Fatigue
• Joint pain, swelling and stiffness
• Butterfly shaped rash on the face covering the cheeks and the bridge of nose
• Rashes on other parts of body
• Photo-sensitivity
• Raynaud’s phenomenon in which the fingers and toes become white or blue on being exposed to cold or stressful situation
• Shortness of breath
• Dry eyes
• Chest pain
• Headache
• Confusion
• Memory loss

Treatment of Lupus

There is no permanent cure for lupus. The treatment plan is aimed at managing the symptoms of lupus. Some of the commonly prescribed medicines that are used for managing the symptoms of lupus are described below:

1. Anti-Inflammatory drugs

These are the drugs that bring down the symptoms of lupus by decreasing inflammation and pain. These are the most commonly used drugs that are used for managing the symptoms of lupus like fever, pleurisy and arthritis. These symptoms disappear after a few days of starting the treatment. For many people with lupus, anti-inflammatory drugs might be the only treatment option available.

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly available anti-inflammatory drugs that are used for managing the symptoms of lupus. They inhibit the synthesis and release of a chemical called prostaglandin which is responsible for causing inflammation and pain. Cyclooxygenase (COX) is an enzyme that is necessary for the synthesis of prostaglandins. NSAIDs work by blocking the action of COX enzymes, thereby blocking the release of prostaglandins. By doing so, the inflammation and pain subsides.

Available as: Oral preparations

I. Aspirin
US-FDA Status: Approved
Availability: Over-the-counter
Generic name: aspirin
Brand name: Excedrin
Side-effects: Hives, itching, rash, upset stomach, coughing up blood, black,red or tarry stools, blood in urine
Indicated in pregnancy: Absolutely contraindicated in third trimester as it may affect the fetal cardiovascular system
Alcohol content: Absent

II. Acetaminophen
US-FDA Status: Approved
Availability: Over-the-counter
Generic name: acetaminophen
Brand name: Tylenol
Side-effects: Bloody or cloudy urine, black or tarry stools, hives, skin rash, sore fatigue
Indicated in pregnancy: Only if absolutely necessary
Alcohol content: Absent

III. Ibuprofen
US-FDA Status: Approved
Availability: Over-the-counter
Generic name: ibuprofen
Brand name: Motrin IB
Side-effects: Bloating, belching, acidity, cloudy urine, diarrhea, heartburn, decreased amount of urine
Indicated in pregnancy: Absolutely contraindicated in third trimester as it may affect the fetal cardiovascular system
Alcohol content: Absent

2. Corticosteroids

Corticosteroids are the drugs that are similar in structure and action to the hormones that are secreted by the adrenal gland, called cortisone. They help in regulating immune system and blood pressure. It is one of the most potent anti-inflammatory drugs that can be given for controlling inflammation. Corticosteroids that are used for managing the symptoms of autoimmune diseases is different from those used for body-building. These drugs work by suppressing inflammation and altering the activity of white blood cells. They decrease swelling, tenderness, warmth and pain associated with lupus.

Available as: Oral and Topical preparation

I. Prednisolone
US-FDA Status: Approved
Availability: Prescription only
Generic name: prednisone
Brand name: Prednisone
Side-effects: Aggression, agitation, dizziness, headache, irritability, mood changes, numbness in arms, weight gain and shortness of breath
Indicated in pregnancy: No, unless benefits outweigh risks
Alcohol content: Absent

II. Methylprednisolone
US-FDA Status: Approved
Availability: Prescription only
Brand name: Methylprednisolone
Side-effects: Aggression, agitation, dizziness, headache, irritability, mood changes, numbness in arms, weight gain and shortness of breath
Indicated in pregnancy: Absolutely contraindicated in third trimester as it may affect the fetal cardiovascular system
Alcohol content: Absent

3. Antimalarials

Antimalarial drugs in combination of steroids and other drugs is given to reduce the symptoms of lupus. By adding antimalarial drugs to the treatment program, it is possible to effectively reduce the dose of other medicines used for managing the symptoms of lupus. Antimalarials are commonly prescribed for treating skin rashes, joint pain and mouth ulcers. When taken in low doses, the drug is effective in treating lupus where blood clotting and inflammation is a matter of concern.

When prescribed to lupus patients, antimalarial drugs decrease the production of antibodies produced by the immune system against the body’s cells, protect against the damaging effects of sun and improves the condition of skin lesions. This helps in bringing down the symptoms to a great level.

Availability: Oral Preparation

I. Hydroxychloroquine
US-FDA Status: Approved
Availability: Prescription
Generic name: hydroxychloroquine sulfate
Brand name: Plaquenil
Side-effects: Blistering, dark urine, diarrhea, dizziness and cough
Indicated in pregnancy: No
Alcohol content: Absent

II. Chloroquine
US-FDA Status: Approved
Availability: Prescription
Generic name: chloroquine phosphate
Brand name: Chloroquine phosphate
Side-effects: Anxiety, bleeding gums, blurred vision, chest pain and cough
Indicated in pregnancy: Yes, with precaution
Alcohol content: Absent

4. Immunosuppressive drugs or Immunomodulators

When corticosteroids fail to bring down the symptoms of lupus or the person cannot be prescribed high dose corticosteroids, immunosuppressive drugs are given to control the over active immune system. They act on the white blood cells (more specifically T-lymphocytes) and alter their activity. This brings down inflammation and the patient is relieved of the symptoms of lupus.

I. Cyclophosphamide
US-FDA Status: Approved
Availability: Prescription
Generic name: Cyclophosphamide
Brand name: Cyclophosphamide
Side-effects: Cough, fever, painful urination, joint pain, dizziness and shortness of breath
Indicated in pregnancy: No
Alcohol content: Absent

II. Methotrexate
US-FDA Status: Approved
Availability: Prescription
Generic name: methotrexate sodium
Brand name: Folex tablet
Side-effects: Cough, fever, painful urination, joint pain, dizziness and shortness of breath
Indicated in pregnancy: No
Alcohol content: Absent

III. Azathioprine
US-FDA Status: Approved
Availability: Prescription
Generic name: azathioprine
Brand name: Azasan
Side-effects: Cough, fever, painful urination, joint pain, dizziness and shortness of breath
Indicated in pregnancy: No
Alcohol content: Absent

5. Anticoagulants

Blood clots can become life threatening for lupus patients and therefore, the clotting ability of blood is kept at minimal by taking anticoagulants. These drugs might become a lifelong therapy for people having lupus. They work by inhibiting the synthesis of various factors that are responsible for clotting of blood.

Availability: Oral preparation and Injection

I. Aspirin (low dose)
US-FDA Status: Approved
Availability: Over-the-counter
Generic name: acetaminophen
Brand name: Tylenol
Side-effects: Bloody or cloudy urine, black or tarry stools, hives, skin rash, sore fatigue
Indicated in pregnancy: Only if absolutely necessary
Alcohol content: Absent

II. Warfarin
US-FDA Status: Approved
Availability: Prescription
Generic name: warfarin sodium
Brand name: Coumadin
Side-effects: Bleeding gums, blurred vision, confusion, dizziness, headache, nosebleed and sweating
Indicated in pregnancy: No
Alcohol content: Absent

III. Heparin
US-FDA Status: Approved
Availability: Prescription
Generic name: heparin sodium
Brand name: Heparin sodium
Side-effects: Bleeding gums, blurred vision, confusion, dizziness, headache, nosebleed and sweating
Indicated in pregnancy: No
Alcohol content: Absent

6. Monoclonal Antibodies (mAbs)

These antibodies are produced synthetically in the lab for controlling the activity of white blood cells that cause inflammation in lupus patients. When the triggering factors of inflammation are suppressed, the symptoms come to a rest.

I. Belimumab
US-FDA Status: Approved
Availability: Prescription
Generic name: belimumab
Brand name: Benlysta
Side-effects: Bleeding, blistering, chills, cough, diarrhea, dizziness and fever
Indicated in pregnancy: No, unless benefits outweigh risks
Alcohol content: Absent

OTC Drug List

Although the disease is incurable, some anti-inflammatory drugs like NSAIDs are available over the counter. Here is the list of different OTC drugs that are available in different countries as per the norms and regulations of the governing bodies in that country: