If you have been diagnosed with Lupus then your Doctor may have recommended some medications for you. This blog post covers a few of the most commonly prescribed medications for Lupus treatment. It will tell you the pro’s and con’s of taking them and what nutritional supplements you can safely include to support your body along the way.
Let’s start with the first drug your specialist is likely to recommend:
Plaquenil. I guarantee that most if not ALL of you have been advised to take Plaquenil when you were first diagnosed. There are many Rheumatologists who believe that everyone with Lupus should be on this medication for life. Plaquenil as you may know is an anti malarial drug called hydroxychloroquine. Originally this drug came from the bark of a chichona tree but of course it is synthetically manufactured today.
A few facts about Plaquenil:
- It takes a long time to work, at the quickest the effects of this drug can be achieved in one month but for some people it can take up to 12 months to get the full effects.
- It is commonly used to treat rashes, joint pain and to reduce the risk of getting severe organ involvement. This is according to the medical profession BUT in line with the research papers I have read Plaquenil is most effective for preventing kidney damage in people with Lupus NOT damage to ALL internal organs. I would also like to add that there are NO papers which compare people taking Plaquenil with people on an anti inflammatory diet! I personally believe sticking to an anti inflammatory diet reduces the risk of organ damage from Lupus because the damage is caused by inflammation. Therefore if you are reducing inflammation then your organs are going to be preserved.
- Plaquenil does not work if you already HAVE kidney damage it has only been shown to REDUCE the risk of getting it.
- Eye problems (retinopathy) are the most serious side effect. In reality eye problems are RARE. They are estimated to happen in 1-3% or people who are on this drug for more than 7 years (ref. The Lupus Encyclopaedia). This is on a dose of 400mg per day.
- If you weight less than 135 pounds then you should not take more than 300mg per day. Decreasing your dose decreases your risk of eye problems.
- Routine eye examinations are important if you take Plaquenil. You need to make sure your Ophthalmologist is doing a ‘hydroxychloroquine evaluation’
- Many Optometrists’ are not able to do the correct evaluation so ALWAYS check.
- If you experience blurred vision, light sensitivity or see halo’s around lights get your eye’s checked.
- This drug is metabolised via the kidneys and liver.
- Side effects include stomach upset and nausea, this is the most common. Pigment changes in the skin, rash, insomnia, nervousness, weight loss anaemia and a low white blood cell count are also possible.
- Taking this drug with food and including the probiotic strain saccromyces bollardi can help with gastrointestinal side effects.
Prednisone, Prednisolone and methylprednisolone. Let’s discuss these 3 drugs together as they are all steroids, firstly their differences.
Prednisone- most common type of steroid prescribed.
Prednisolone- normally prescribed when prednisone isn’t well tolerated.
Methylprednisolone- can also be prescribed when prednisone isn’t well tolerated. This can be a pill form or IV, IV form is normally used for pulse dosing. Pulse dosing would be high doses (1gram) intravenously for around 3 days.
From here on I will describe them collectively as steroids. Here are the facts:
- Before steroids were introduced only 15% of people with Lupus would survive past 2 years. ( ref The Lupus Encyclopaedia)
- Cortisone was originally produced from cows.
- The effects of steroids are IMMEDIATE. This makes them lifesaving in acute situations. This is where I believe their place with Lupus patients is.
- Sometimes doctors will prescribe steroids with plaquenil together. The steroids will help with symptoms until the Plaquenil starts working (remember it takes months to kick in). If this is the case be sure to ask your doctor when you will start feeling better if it’s time to start tapering off of the steroids. If you don’t ask they won’t suggest it!
- Steroids can be used topically on skin rashes and injected into muscles or joints.
- The body naturally produces steroids.
- Its main action is to reduce inflammation.
- It is important to take steroids on waking in the morning. This is because cortisol (our own naturally produced steroid) rises after we wake up so you are going with the natural cycle.
- This drug can cause adrenal insufficiency; the main symptom is extreme fatigue. You are at risk of this if you take them for longer than one month. For this very reason it is important that when you are coming off of steroids you SLOWLY taper your dose down and don’t go cold turkey.
- Steroids can cause (this list is not complete) high blood pressure, type 2 diabetes, weight gain, fluid retention including ankle puffiness and moon face, thin skin, stretch marks, increased hunger, osteoporosis (thinning of the bones), muscle weakness, spasms and pain, joint pain on tapering down the dose, bruising, acne, high cholesterol, irregular menstrual cycles, decreased fertility, strokes, hardening of the arteries, depression, anxiety, anger, tremors, insomnia, cataracts, nausea, peptic ulcer, heartburn, diverticulitis and increased risk of infection. Psychotic episode (high dose only).
- It is my belief that steroids are most beneficial when taken in acute situations such as a flare. When taken long term any of the above side effects can become evident. I do NOT believe that long-term steroid use is helpful, because the side effects far out way the benefits. There are alternatives.
- A dose of more than 7mg per day means you are at risk of developing osteoporosis and therefore you should be taking a bone supplement. This isn’t just a calcium tablet but one that includes other bone supporting nutrients such as boron, manganese, magnesium, copper, zinc, potassium and vitamin d.
- You should be on at least 1000IU’s of vitamin d per day.
- If you are taking this drug and you have the crazy hunger going on then make sure you eat foods which are LOW CARB and opt for vegetables and small amounts of protein. At least this way you are less prone to experience the weight gain.
- Smoking, caffeine and drinking alcohol make you more at risk of developing the side effects associated with this drug some of which are serious (diabetes, high blood pressure, hardening of the arteries)
- If you feel your Lupus is under control ALWAYS discuss with your doctor if it’s time to reduce your dose of this drug.
Finally I would like to add that there are MANY natural alternatives to taking Prednisone or Prednisolone long term. Long term use IS NOT a good idea. Some good natural alternatives include curcumin (turmeric), boswellia, fish oils (high dose), magnesium, ginger and vitamin c and of course an anti inflammatory diet. You should always check that any natural therapies you try will not interact with your meds and if you are going to stop taking your steroid I would always recommend taking one or two of these supplements to help support your body in the process.
Methotrexate. This drug is one you may already be on or possibly your specialist has recommended it to you. It’s an immune suppressing drug so it works by dampening down the activity of the immune system. Here are a few facts about methotrexate.
- It is normally recommended for people who have moderate to severe Lupus and is often recommended in conjunction with Plaquenil.
- It does not start working immediately. At best it will start working in a few weeks but 3 months is the generally time to get the full effect.
- It is not very well absorbed via the gastrointestinal tract at doses over 15mg per week. In this sort of case you may be offered this drug via an injection for optimal absorption.
- If you take this drug you should ALWAYS be on folinic acid or folic acid. There are 2 reasons, firstly this drug blocks absorption so you may get a folic acid deficiency. Secondly the side effects of this drug are reduced if you take folinic acid.
- Folinic acid and folic acid are different and my preference is folinic acid. This is because it’s the natural form found in food and it’s a much easier form for our body’s to absorb. In addition some people actually cannot metabolize folic acid so folinic acid is needed.
- Taking this medication with food decreases side effects but it also decreases absorption so you should take it without food if you can stomach it.
- 10% of people on this drug with get thinning of their hair.
- Milk and Caffeine decrease absorption of methotrexate.
- You should NOT have any live vaccines whilst on this drug.
- A common side effect is high liver enzymes on your blood tests and/or a low blood cell count.
- Other side effects can be nausea, diarrhea, mouth sores, headaches, sun sensitivity, anemia, liver inflammation (serious and very uncommon), infections.
- Aside from taking folinic acid, I would also recommend taking a multi strain probiotic to reduce any gastrointestinal side effects and an activated B complex.
Cyclophosphamide. This chemotherapy drug has been used to treat Lupus since 1963. Here are a few facts:
- Cyclophosphamide strongly suppresses the immune system.
- If Lupus becomes life threatening or your organs are at risk of major damage then this is one drug that may be offered to you.
- This is a medication given via IV. A pill form is available but with quite severe side effects.
- At most you may be offered this treatment for up to a 2 year period.
- One of the most serious side effects is infection, this is due to the white cell count dropping dramatically during treatment.
- Your risk of getting bladder cancer, cervical cancer or leukaemia doubles with the use of this drug. It can happen years after treatment.
- Cyclophosphamide can cause infertility.
- If you have an active infection DO NOT take this medication.
- Common side effects are nausea, hair loss, mouth sores and diarrhoea.
- Whilst having this treatment make sure you drink plenty of water, this reduces the risk of bladder cancer.
Cymbalta (duloxetine). This drug is used to treat fibromyalgia, a common overall condition with Lupus it is a serotonin norepinephrine reuptake inhibitor. More facts below:
- This drug works by stopping the body re absorbing serotonin and norepinephrine by the nerves or nerve pathways.
- These hormones serotonin and norepinephrine help decrease the amount of pain the brain is sensing.
- People with fibromyalgia have reduced levels of these 2 hormones.
- It’s best taken in the evening after food.
- If sleep problems are experienced then take it after breakfast instead.
- It generally takes around 1 to 2 months to start working.
- If you are on this medication you need to avoid St Johns Wort, Kava and Tryptophan because they work in the same way as this drug. Therefore you will have an increased effect.
- Alcohol will do the same thing, increase the effect.
- Not recommended if you have severe kidney disease.
- Not recommended if you have Bipolar.
- Common side effects can be nausea, dry mouth, constipation or diarrhoea, headaches, tremors, drowsiness or insomnia.
- Not so common side effects can be high blood sugar, high cholesterol and high blood pressure. Again I think there are some wonderful herbal medicines to try which could be an alternative to this drug namely St John’s Wort, Passionflower and Ziziphus.
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