Lupus Medications - What Are My Options?

Medications Used to Treat Lupus

Taking pills.
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Medications are an important aspect of the management of many patients with systemic lupus erythematosus. An array of drug options are now available, which have increased the potential for effective treatment and excellent patient outcomes.

The goals for treating a patient with lupus include:

  • reducing inflammation caused by the disease
  • suppressing immune system abnormalities that are responsible for tissue inflammation
  • preventing flares and treating them when they do occur
  • minimizing complications

Lupus patients should work with their doctors to develop their own treatment plan. Once a person has been diagnosed with lupus, a drug treatment plan will be developed by their doctor based on a person’s:

  • age
  • health
  • symptoms
  • lifestyle

It is important that patients thoroughly understand:

  • the reason for taking a drug
  • its action
  • dose
  • administration times
  • side effects

Pharmacists also can be a good resource for patients in helping them understand their medication treatment plan. If a patient experiences a problem believed to be related to a drug, the patient should notify her or his doctor immediately. It can be dangerous to suddenly stop taking some medications, and patients should not stop or change treatments without first talking to their doctor.

The array of medications and the complexity of treatment plans can be overwhelming and confusing.

Most patients do well on lupus medications and experience few side effects. Those who do experience side effects or adverse events should not become discouraged, since alternative drugs are often available.

Lupus treatment should include as few medications for as short a time as possible. Some patients never require medications, and others take them only as needed or for short intervals, but many require constant therapy with variable doses.

Despite their usefulness, no drugs are without risks. Medications frequently used to control lupus symptoms are:

Other medications may be necessary to control specific manifestations or to treat other conditions commonly seen with the disease. These include:

  • diuretics
  • antihypertensives
  • anticonvulsants
  • antibiotics

Medications used to treat lupus should be reevaluated regularly and revised as necessary to ensure treatment is as effective as possible.


Nonsteroidal anti-inflammatory drugs (NSAIDs) comprise a large and chemically diverse group of drugs that possess analgesic, anti-inflammatory, and antipyretic properties. Pain and inflammation are common problems in patients with lupus, and NSAIDs are usually the drugs of choice for patients with mild lupus with little or no organ involvement. Patients with serious organ involvement may require more potent anti-inflammatory and immunosuppressive drugs.

There are many NSAIDs on the market, and new ones are constantly becoming available. Some NSAIDs can be purchased as over-the-counter drugs, whereas larger doses are available only by prescription.

The therapeutic effects of NSAIDs stem from their ability to inhibit the release of prostaglandins and leukotrienes, which are responsible for producing inflammation and pain. NSAIDs are very useful in treating:

  • joint pain
  • inflammation and swelling
  • muscle pain
  • rib cage pain (pleuritic chest pain)

An NSAID may be the only drug needed to treat a mild flare; more active disease may require additional medications.

Although all NSAIDs appear to work in the same way, not every one has the same effect on every person. In addition, patients may do well on one NSAID for a period of time, then, for some unknown reason, derive no benefit from it. Switching to a different NSAID may produce the desired effects. Patients should use only one NSAID at any given time.


Antimalarials were first developed during World War II because quinine, the standard treatment for malaria, was in short supply. Investigators found antimalarials could also be used to treat the joint pain that occurs with rheumatoid arthritis. Subsequent use has shown that these drugs are effective in controlling:

  • lupus arthritis
  • skin rashes
  • mouth ulcers
  • fatigue
  • fever

Antimalarials are not used to manage more serious, systemic forms of lupus that affect the organs. It may be weeks or months before the patient notices that these drugs are controlling disease symptoms.

Antimalarials include:

Although chloroquine is still used, due to better safety, hydroxychloroquine is usually preferred. The anti-inflammatory action of these drugs is not well understood. In some patients who take antimalarials, the total daily dose of corticosteroids can be reduced. Antimalarials also affect platelets to reduce the risk of blood clots and lower plasma lipid levels.

Corticosteroids (Steroids)

Corticosteroids are hormones secreted by the cortex of the adrenal gland. The term "steroids" is often misunderstood. Confusion results when corticosteroids are mistaken for anabolic steroids.

Lupus patients with symptoms that do not improve or who are not expected to respond to NSAIDs or antimalarials may be given a corticosteroid.

Although corticosteroids have potentially serious side effects, they are highly effective in reducing inflammation, relieving muscle and joint pain and fatigue, and suppressing the immune system. They are also useful in controlling major organ involvement associated with lupus.

These drugs are given in much higher doses than the body produces and act as potent therapeutic agents. The decision to use corticosteroids is highly individualized and is dependent upon the patient’s condition.

Once the symptoms of lupus have responded to treatment, the dose is usually tapered until the lowest possible dose that controls disease activity is achieved. Patients must be monitored carefully during this time for flares or recurrence of joint and muscle pain, fever, and fatigue that can result when the dosage is lowered. Some patients may require corticosteroids only during active stages of the disease; those with severe disease or more serious organ involvement may need long-term treatment.

Treatment with corticosteroids must not be stopped suddenly. Administration of corticosteroids causes the body’s own production of adrenal hormones to slow down or stop, and adrenal insufficiency, or even adrenal crisis (a potentially life-threatening state) may result if the drug is stopped suddenly.

Tapering the dose allows the body’s adrenal glands to recover and resume production of the natural hormones. The longer a patient has been on corticosteroids, the more difficult it is to lower the dose or discontinue use of the drug.

Corticosteroids used to treat lupus include:

  • Prednisone (Orason, Meticorten, Deltasone, Cortan, Sterapred)
  • Hydrocortisone (Cortef, Hydrocortone)
  • Methlyprednisolone (Medrol)
  • Dexamethasone (Decadron)

Prednisone, which is a synthetic steriod, is the corticosteroid most often used to treat lupus.

Corticosteroids are available as:

  • topical creams or ointments (for skin rashes)
  • oral tablets
  • liquid solutions
  • steriod shots (intramuscular or intravenous injections)

Corticosteroids are highly effective in reducing inflammation and suppressing the immune response. These drugs may be used to control exacerbation of symptoms and are used to control severe forms of the disease. Corticosteroids are usually administered orally. During periods of serious illness, they may be administered intravenously; once the patient has been stabilized, oral administration should be resumed.

Immunosuppressives / DMARDs (Disease-Modifying Anti-Rheumatic Drugs)

Immunosuppressives and other disease-modifying anti-rheumatic drugs (DMARDs) are used in treating serious, systemic cases of lupus in which major organs such as the kidneys are affected or in which there is severe muscle inflammation or intractable arthritis.

Because of their steroid-sparing effect, immunosuppressives may also be used to reduce or sometimes eliminate the need for corticosteroids, thereby sparing the patient from undesirable side effects of corticosteroid therapy.

Immunosuppressives and DMARDs can have serious side effects. Patients need to understand, however, that side effects are dose dependent and are generally reversible by reducing the dose or stopping the medication.

There are many serious risks associated with the use of immunosuppressives and DMARDs, These include:

  • immunosuppression
  • increased susceptibility to infection
  • bone marrow suppression
  • development of malignancies

A variety of immunosuppressive drugs and other disease-modifying anti-rheumatic drugs are available to treat lupus. All of these apply to a group of drugs essentially used as a second line of defense against lupus and other forms of arthritis. Although they have different mechanisms of action, each type functions to decrease or prevent an immune response.

Immunosuppressives and DMARDs used to treat lupus now include:

  • Azathioprine (Imuran)
  • Cyclophosphamide (Cytoxan)
  • Mycophenolate (CellCept)
  • Methotrexate (Rheumatrex)
  • Cyclosporine (Sundimmune, Neoral)

In choosing any particular medication or drug therapy to combat lupus, you and your physician must carefully weigh the benefits and the risks of the treatment plan.


NIAMS, Lupus: A Patient Care Guide for Nurses and Other Health Professionals

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