- Azathioprine (Imuran)
- Mycophenolate mofetil (Cellcept)
- Cyclosporine (Neoral, Sandimmune, Gengraf)
- Methotrexate (Rheumatrex)
- Leflunomide (Arava)
- Cyclophosphamide (Cytoxan)
- Chlorambucil (Leukeran)
- Nitrogen mustard (Mustargen)
What are immunosuppressive medications?
Immunosuppressives are medications that help suppress the immune system. Many were originally used in patients who received organ transplants to help prevent their bodies from rejecting the transplanted organ. However, these drugs are now also used for the treatment of certain autoimmune diseases, such as lupus and rheumatoid arthritis. In people with lupus, the immune system mistakenly attacks the body’s own tissues. Most immunosuppressives work to downregulate (suppress) this attack by interfering with the synthesis of DNA, the material in your cells that contains the blueprints for all of your genetic information. In doing this, these medications prevent the cells of your immune system from dividing. When cells cannot divide correctly, they will eventually die. The immunosuppressives prescribed most commonly for the treatment of lupus are azathioprine (Imuran), mycophenolate (Cellcept), and cyclosporine (Neoral, Sandimmune, Gengraf).
Immunosuppressive medications are used to control more serious lupus activity that affects major organs, including the kidney, brain, cardiovascular system, and lungs. Before prescribing an immunosuppressive medication, your doctor may perform a biopsy of the kidney or affected organ system to evaluate the most effective course of treatment. Sometimes immunosuppressive medications are given in addition to or instead of steroid therapy to lower the dose of steroids needed and thus spare some of the undesirable side effects of steroid therapy. For this reason, these drugs are sometimes called “steroid-sparing” medications or “adjuvant” (helping) drugs. Steroid-sparing drugs usually have a two-fold benefit, since they often reduce or eliminate the need for steroids while also improving lupus symptoms.
Because immunosuppressive drugs put down the immune system, people taking them are at an increased risk for infection. Try to stay away from people who have colds or other illnesses, and make sure to wash your hands regularly and maintain good personal hygiene. If you are also taking steroid medications, you may not realize that you are ill because the steroid may suppress your fever symptoms. Contact your doctor immediately at the first sign of any infection or illness.
In addition, immunosuppressive medications are known to increase the risk of cancer development later in life. However, lupus itself is also known to increase the risk of cancer, so by controlling your lupus now and preventing it from doing further damage to your body, immunosuppressive therapy may actually decrease your risk of developing cancer. Either way, it is very important to control your lupus activity now to prevent other potentially life-threatening complications.
Types of Immunosuppressive Medications
Imuran is an anti-inflammatory immunosuppressive that can decrease joint damage and disability in people with lupus, rheumatoid arthritis, and other conditions. In addition, Imuran has proven to clearly improve lupus affecting the liver and kidneys. Imuran is “steroid-sparing,” which means that it may allow for a reduction of the amount of steroid being taken. Since the side effects of steroids generally increase with the dosage, this medication generally promotes a reduction in steroid side effects as well.
People with lupus have overactive immune systems. Imuran works by preventing some of the cells involved in this immune response (specifically, white blood cells [WBCs], or leukocytes) from spreading. Imuran is a “slow onset” drug, which means it may take 6-12 weeks for you to notice its effects. It usually comes in pill form and has fewer side effects than many other immunosuppressive medications. The most common and serious side effects involve the stomach and blood cells. Nausea and vomiting can occur, sometimes with stomach pain and diarrhea. Taking the medication with food may help to reduce these symptoms. Imuran can also decrease the number of certain cells in your blood. For this reason, blood tests should be done regularly to determine your white blood cell, platelet, and red blood cell count.
Less common side effects include liver test abnormalities, hepatitis (inflammation of the liver), pancreatitis (inflammation of the pancreas, a gland behind the stomach, that can cause abdominal pain), or an allergic reaction that can seem like the flu. During treatment, your doctor may perform tests for breakdown products (metabolites) of Imuran that can help monitor how your body is reacting to the drug.
Even though Imuran is effective in treating serious lupus symptoms, long term use of this medication does increase the risk of developing cancer. Your doctor can speak with you about this risk and any other concerns you may have. She/he will work with you to minimize the side effects of your medications while also maximizing the benefits.
In addition to having regular blood tests (CBCs), you should notify your doctor if you experience any of the following symptoms while taking Imuran: fever, a new rash, easy bruising or bleeding, or signs of infection. Be sure to speak with your doctor before taking getting any vaccines or having surgery. In addition, consult your doctor if you are pregnant, may become pregnant, or are breastfeeding, since Imuran can be harmful to your child.
Certain medications may interfere with Imuran, so be sure to notify your doctor of any other drugs you are taking. Medications that can interfere with Imuran include the gout medication allopurinol (Aloprim, Zyloprim), warfarin (Coumadin), some blood pressure medications including some ACE inhibitors (Accupril or Vasotec), olsalazine (Dipentum), mesalamine (Asacol, Pentasa), and sulfasalazine* (Azulfidine).
Mycophenolate mofetil (Cellcept)
Cellcept is an immunosuppressant used especially for lupus patients with signs of kidney disease. It works by targeting an enzyme in the body—a protein responsible for certain chemical reactions—that is important in the formation of DNA in your cells. In doing so, Cellcept impairs your immune system function as well. Usually Cellcept is given twice a day for a total dose of about 2000-3000 milligrams (mg) per day, but this dosage may be reduced. Like Imuran, Cellcept is steroid-sparing, so it may allow you and your doctor to reduce your dosage of steroid medications and thus also reduce their side effects.
Cellcept may cause some side effects. The most common effects include stomachache, nausea, vomiting, and/or diarrhea. Headache, dizziness, sleeplessness, and tremors (involuntary muscle movements) may also occur. Skin rashes can arise but are less common. Since lupus can also cause skin rashes, it may be difficult to determine whether a rash is from your medication or your lupus. You should speak with your doctor upon detecting any new rashes or symptoms.
Cellcept may also cause a reduction in the number of certain cells in your blood. A reduction in your white blood cell count could increase your chance of infection. As with other immunosuppressive medications, it is important that you try to avoid infection and notify your doctor at the first sign of illness. In addition, a reduction in red blood cells caused by Cellcept may lead to anemia, which could make you tired or lead to easy bruising. Cellcept can also reduce the number of platelets in your blood, which may also cause easy bruising or gastrointestinal bleeding (bleeding anywhere along the pathway that food travels in the body). Obtaining periodic blood tests while taking Cellcept can help you and your doctor to detect and correct these problems. Blood tests should be performed frequently during the first several months of taking this medication and less often as more time passes.
People over 65 and those that have experienced ulcers or other gastrointestinal disorders should speak to their doctors before taking Cellcept. People in these groups may experience an increased risk of side effects. In addition, there may be an increased risk of developing cancer such as lymphoma and skin cancer when taking immunosuppressives such as Cellcept. You should discuss this with your doctor before beginning this medication. It is important to realize, however, that Cellcept may be the best way to control the kidney disease associated with lupus, and that lupus too can cause cancer. Thus, prescribing Cellcept for your kidney involvement is not meant to introduce new risk factors, but rather to treat the seriousness of your condition at this moment in time.
In addition, be sure to wear sunscreen when going outside and avoid prolonged sun exposure—even if you are not taking immunosuppressive medications—since sunlight can also aggravate your lupus symptoms.
If you are pregnant, may become pregnant, or are breast-feeding, your doctor will strongly recommend that you stop taking Cellcept due to the risk of birth defects. In addition, even though it is not known whether Cellcept decreases the effectiveness of oral contraceptives, it may be able to reduce their concentration in the blood, so other forms of birth control are advised. Antacids can also interfere with your body’s absorption of Cellcept. If you need to take an antacid, do so at least one hour before or at least two hours after taking Cellcept. As with other immunosuppressive medications, you should speak to your doctor before getting any vaccines or having any sort of surgery.
Certain drugs may interact or interfere with the effectiveness of Cellcept. These medications include: cholestercholestyramine (Questran), acyclovir (Zovirax), gancyclovir (Cytovene), azathioprine (Imuran), antacids containing magnesium or aluminum hydroxide (such as Maalox, Rolaids, or Mylanta), oral contraceptives, trimethoprim/sulfamethoxazole (Bactrim),* theophylline (Theo-Dur), phenytoin (Dilantin), probenecid (Benemid), or aspirin and other salicylates.
Be sure to notify your doctor immediately if you experience easy bruising or bleeding, persistent or bloody diarrhea, trouble breathing, fever, or any sign of infection.
Recently, the FDA issued an alert regarding a possible relationship between Cellcept and a serious neurological disease called multifocal leukoencephalopathy (PML). A similar warning was issued regarding the drug rituximab (Rituxan) in late 2006. PML is an extremely rare but fatal disease, but it is important to understand that Cellcept and rituximab are not unique in their linkage to PML. PML is associated with conditions of severe immune deficiency, such as AIDS, cancer, lupus, and the immunosuppression that can be involved in the treatment of those conditions. Although immunosuppressive medications are effective in the treatment of lupus, your doctor can discuss with you the risk of this possible relationship and the use of the immunosuppressive medications involved in your advised treatment.
Cyclosporine (Neoral, Sandimmune, Gengraf)
Cyclosporine is a more potent immunosuppressive medication that works by blocking the function of cells in your immune system called T-lymphocytes, or “T-cells.” Like other immunosuppressives, it was originally used to prevent the immune systems of patients with transplanted kidneys from rejecting the transplanted organs. It is now also prescribed for people who suffer from inflammation of the kidney caused by lupus, otherwise known as lupus nephritis. However, cyclosporine can be toxic to the kidneys, so use of this medication is usually reserved for cases in which a person’s lupus does not respond to other immunosuppressive medications like Cellcept. Cyclosporine is also prescribed for people with severe psoriasis, a skin condition that can also cause pain and swelling of the joints, and it can be helpful in reducing some of the pain, swelling, and stiffness associated with lupus arthritis.
The starting dose of cyclosporine depends on your body weight (usually 2.5 milligrams [mg] per kilogram [kg] per day). The dose is then increased depending on how well the medication works for you and how well your body tolerates the drug. Cyclosporine comes in 25 and 100 mg tablets, and patients usually end up taking 75 or 100 mg per day. You may notice some reduction in pain and swelling after about a week of taking the medication, but its full effects are usually not felt for about 3 months.
Cyclosporine can cause some side effects. About 25% of people taking cyclosporine develop high blood pressure (hypertension). In addition, because cyclosporine can be tough on the kidneys, it can cause a substance called uric acid to build up in the blood (a state known as hyperuricemia). Sometimes this buildup of uric acid can cause gout, a condition that causes intense swelling in one of the joints, often the the big toe. If you already have gout, your condition may worsen while taking cyclosporine. Fortunately, many of these side effects go away as treatment with cyclosporine is reduced or stopped, so your doctor can work with you to adjust your dosage if you begin to experience these problems.
Other common side effects include headaches, stomach pain (including dyspepsia, a gnawing or burning pain in the pit of your stomach accompanied by bloating), vomiting, diarrhea, and swelling in your hands or feet. Less common side effects include tremors (unintentional muscle movements), increased hair growth, muscle cramps, and numbness or tingling in your hands and feet (a condition known as neuropathy). Some people may also experience swelling of the gums while taking cyclosporine. Be sure to brush and floss regularly; this routine may alleviate some of this swelling.
Cyclosporine may increase your risk of developing certain types of cancer, including skin cancer. For this reason, you should coordinate regular skin exams with your doctor. In addition, try to stay out of the sun and make sure to wear sunscreen when you do go outside.
Do not eat grapefruit or drink grapefruit juice while taking cyclosporine. Grapefruit increases the amount of cyclosporine that is absorbed by your body.
Like other immunosuppressive medications, cyclosporine increases your risk of infection, so make sure to wash your hands and stay away from people who may be sick. Notify your doctor at the first sign of any illness. In addition, tell your doctor if you plan to have any vaccines or surgeries, since both can pose risks for people taking immunosuppressive medications.
Cyclosporine can cause serious complications during pregnancy such premature labor and high blood pressure and fluid retention in your baby, so you should not take cyclosporine if you are pregnant or may become pregnant. Also, do not take cyclosporine while breast-feeding, since it can be passed to your baby through breast milk.
Cyclosporine interacts with certain drugs, so be sure to notify your doctor of any medications you may be taking, including prescription and over-the-counter drugs, supplements, and vitamins. Drugs that may interfere or interact with cyclosporine include:
- Heart and blood pressure medications: diltiazem (Cardizem, Tiazac), nicardipine (Cardene), verapamil (Calan, Covera-HS, Isoptin, Verelan), “potassium sparing diuretics” amiloride (Midamor), spironolactone (Aldactone) and triamterene (Dyrenium)
- Cholesterol lowering medications: lovastatin (Mevacor) and simvastatin (Zocor)
- Antibiotics and antifungals: clarithromycin (Biaxin), erythromycin, naficillin, fluconazole (Diflucan), intraconazole (Sporanox), ketoconazole (Nizoral), and rifampin (Rifadin, Rimactane)
- Anti-seizure (anti-epileptic) medications: carbamazepine (Tegretol), phenobarbital (Solfoton), and phenytoin (Dilantin)
- Antidepressants: nefazadone (Serzone) and the selective serotonin reuptake inhibitors (SSRIs) such as paroxitine (Paxil), fluoxetine (Prozac), and sertraline (Zoloft)
- Human immunodeficiency virus (HIV) protease inhibitors: indinivir (Crixivan), saquinavir (Fortovase, Invirase), ritonavir (Norvir), and nelfinavir (Viracept)
- Others: allopurinol (Lopurin, Zyloprim), bromocryptine (Parlodel), androgens (male hormones), estrogens (female hormones), danazol (Danocrine), metoclopramide (Reglan), methylprednisolone, octreotide, ticlopidine (Ticlid), cimetidine (Tagamet), methoxsalen (Oxsoralen), coal tar (Balnetar, Zetar), trioxsalen (Trisoralen)
Be sure to tell your doctor if you are taking any of these medications.
Disease-Modifying Antirheumatic Drugs (DMARDs)
Disease-modifying antirheumatic drugs, better known as “DMARDs,” are immunosuppressive medications that are used to treat the pain and swelling of the arthritis that can accompany lupus. DMARDs not only reduce this pain and swelling, but they may also be able to decrease long term damage to your joints.
Methotrexate is one of the most commonly used drugs for the treatment of rheumatoid arthritis, and it is used in lupus patients to alleviate the joint pain and swelling of polyarthritis (arthritis involving multiple joints). It is only mildly effective for more severe lupus symptoms involving the kidneys and other organs and should be used carefully in people with these conditions. Historically, methotrexate has been used to treat cancer and psoriasis, a skin condition that can also affect the joints. However, in the late 1980s, the medication was approved by the FDA for the treatment of arthritis and has been used commonly for this ever since. Methotrexate works by interfering with the production of folic acid, which is a building block for growing cells in your body. As a result, methotrexate hinders the growth of certain cells, including those of the immune system. This medication is also steroid-sparing, meaning it can be used in conjunction with steroids to lower the dose of steroid therapy and thus also lower the associated side effects.
The medication is usually taken as a tablet in doses of 7.5 to 25 milligrams (mg) per week, but it can also be given as an injection. People taking methotrexate usually feel improvements in 3-6 weeks, but it can take up to 3 months to feel the full benefit of the drug. Be sure to take this medication as directed. If you miss a dose, you can usually take the medication up to 4 or 5 days after. However, if you miss this window, contact your doctor regarding how you should proceed.
Most people taking methotrexate do not experience side effects and many of the more minor side effects will decrease with time. However, the likelihood of these side effects does increase as your dosage goes up. Many of the side effects of methotrexate involve the fact that the medication works by interfering with the production of folic acid in your body. Therefore, your doctor will most likely recommend that you take folate supplements, which will prevent many of these side effects, including mouth sores (stomatitis). Other side effects may include nausea, vomiting, and an increased risk for abnormal liver function tests. Because of the danger to your liver, you should not drink alcohol while taking methotrexate; drinking while on this medication can cause irreversible damage to your liver. In addition, it is important that people taking methotrexate have normal liver function tests. Be sure to tell your doctor if you have a history of liver disease. In addition, lung problems, such as a continuing cough or shortness of breath, can occur while taking this medication but are more common in people with preexisting lung conditions. Talk to you doctor if you experience these symptoms.
Some patients experience gradual hair loss (alopecia), but hair usually grows back once you stop taking methotrexate. In addition, methotrexate can increase your sensitivity to sunlight. Since many lupus patients already experience sun sensitivity, try to limit sun exposure and be sure to wear sunscreen when going outdoors.
It is important to remember that sometimes the side effects of this medication can go unnoticed; sometimes people may have abnormal blood tests while feeling no side effects at all, so it is important to have blood tests (complete blood counts, or “CBCs”) performed every 2-3 months while taking methotrexate.
If you are pregnant, may become pregnant, or are breastfeeding, you should not take this medication because it can cause serious birth defects and complications during pregnancy. Women taking this medication should use an effective method of birth control. Speak to your doctor about any pregnancy plans or concerns.
As with other drugs that may suppress your immune system, talk to your doctor about any vaccines or surgeries you may have. In addition, be sure to notify him/her of any other medications, both prescription and over-the-counter, that you may be taking. Methotrexate can interact with certain drugs, including the antibiotic trimethoprim (Bactrim)* and NSAIDs such as ibuprofen (Advil, Motrin) and celecoxib (Celebrex). Do remember, though, that sometimes methotrexate may be used in combination with certain NSAIDs to treat lupus. Your doctor will work with you to determine which treatments will work best to treat your lupus symptoms with the fewest side effects.
Leflunomide is another DMARD used to treat the swelling, pain, and stiffness that many lupus patients feel due to arthritis. It can either be prescribed alone or in combination with other treatments, such as methotrexate; often leflunomide is prescribed for patients who do not respond well to methotrexate. Leflunomide works by blocking the formation of DNA in the cells of your body, including those of the immune system. In hindering the formation of DNA, leflunomide stops the body from producing the overactive immune cells that are responsible for the swelling, stiffness, and pain in your joints.
Leflunomide is usually taken in tablets of 10 or 20 milligrams (mg) once a day. 6-12 weeks may pass before you feel the full benefits of this medication, although your joint pain and stiffness will probably start to improve after just a few weeks. It takes some time for the medication to build up in your body, so some doctors may prescribe something called a “loading dose” when you first begin to take leflunomide. A loading dose is a large dose—about 100 mg—usually given once a week for three weeks in addition to your regular dose. Alternatively, some doctors may give this loading dose over the first three days. This technique, however, usually increases the chance that the person will develop side effects, including diarrhea. The good news is that the diarrhea usually goes away once the loading dose is stopped.
Leflunomide does have several side effects. The most common side effect is diarrhea, which affects about 1 in 5 people, but this symptom usually goes away with time. In addition, your doctor can talk with you about taking an anti-diarrheal medication to curb some of this discomfort. If the diarrhea persists, she/he may lower your dosage.
Other side effects include nausea, indigestion, rash, or hair loss (alopecia), but these effects are less common. In addition, about 1 in 10 patients taking leflunomide have abnormal liver function tests or decreased blood cell counts, so individuals taking this medication should have liver enzyme and blood count tests done regularly every 3-4 months. Because of this risk to your liver, you should not drink alcohol while taking leflunomide, and you should tell your doctor if you have had liver problems in the past.
Women who are pregnant, may become pregnant, or are breastfeeding should speak with their doctor before taking leflunomide, since this medication can cause serious birth defects and complications. In addition, women should use an effective method of birth control while taking leflunomide and continue to do so until two years after leflunomide is stopped, since the medication is known to remain in your body well after you actually stop taking it. Men who want to have children should also talk to their doctor about stopping the medication. Anyone who is on the medication and would like to have children should speak to their doctor about a medication called cholestyramine (Questran), which can help eliminate leflunomide from your body.
As with other drugs that suppress your immune system, speak with your doctor about any vaccinations or surgeries you plan to have and any other medications you may be taking, including prescription drugs, over-the-counter medications, vitamins, and supplements. Medications that can interact with leflunomide include cholestyramine (Questran), tolbutamide (Orinase), and rifampin (Rifadin, Rimactane), so be sure to tell your doctor if you are on these medications.
Nitrogen mustard (Mustargen)
Cytotoxic medications are a class of immunosuppressives that were originally developed (and are still used) to treat certain types of cancer. The cytotoxic drugs usually prescribed to treat lupus symptoms are classified as alkylating agents and are reserved for patients with more serious forms of lupus that involve organs such as the kidneys, central nervous system, lungs, and blood vessels. Cytotoxic medications work against the cells of your immune system that make antibodies (immunoglobulins). Usually, these molecules help the body to ward of infections and other invaders. However, with lupus, these antibodies actually work against your own body and are produced at a rapid rate. Cytoxic drugs fight the rapidly dividing cells of the immune system, but in doing so, they also work against other rapidly dividing cells in your body, including blood cells, hair cells, and sex cells. As a result, cytotoxic medications can have serious long term side effects. Even though cytotoxics have proven to improve the symptoms of kidney, nervous system, lung, and blood vessel disease in lupus patients, it is important for you and your doctor to evaluate the costs and benefits of cytotoxic therapy before beginning this treatment.
Cytoxan is a cytotoxic medication usually reserved for lupus patients with serious kidney problems who have not responded to other medications. The dosage of Cytoxan varies from person to person. It can be taken in tablet form, but more often it is given intravenously (IV) at the doctor’s office. The IV procedure usually take about 15 to 60 minutes, and a medication may be given before to reduce any nausea you may feel. Doctors usually give Cytoxan once a month for 6 months and then every 2 to 3 months for two years. It may take a few weeks or months for Cytoxan to improve your lupus symptoms.
The side effects of Cytoxan range from mild to severe and may be worse when the medication is taken in tablet form. Side effects include nausea and vomiting, which can sometimes be prevented with an anti-nausea medication such as ondansetron (Zofran). Hair loss (alopecia) can occur, but hair usually grows back when the medication is stopped. Skin rashes can also occur and be difficult to differentiate from lupus symptoms. Like other medications that suppress your immune system, Cytoxan can increase your risk of infections, especially shingles and certain “opportunistic infections,” infections that do not usually cause disease in healthy individuals. Therefore, it is important that you wash your hands regularly, maintain good personal hygiene, and notify your doctor at the first sign of any infection or fever. Also tell your doctor if you are to have any vaccines or surgeries, since your immune system will be suppressed by Cytoxan.
More serious side effects include a reduction in white blood cell count, which usually occurs about 8-12 days after starting treatment. Your doctor should perform blood tests at this time to determine whether your dosage should be altered. In addition, Cytoxan can cause infertility in both men and women when taken for long periods of time. However, an injection called leuprolide (Lupron) can be given to help protect your body against this sterility; you may want to discuss this issue with your doctor before starting the medication. In addition, women can stop having periods when on Cytoxan. However, you can still become pregnant, so it is recommended that you use a method of birth control, since taking this drug can cause serious harm to the fetus. Be sure to talk to your doctor before taking Cytoxan if you are pregnant, could become pregnant, or are breastfeeding.
Cytoxan can also cause certain bladder problems. In order to use this drug, your body must break it down into several byproducts, one of which can irritate your bladder and cause scarring or blood in your urine. This side effect is common, so you should drink plenty of fluids—at least 8 glasses of water—per day. If you are taking Cytoxan intravenously, you may be given mesna (Mesnex) to prevent these bladder issues.
Because Cytoxan targets normal cells within your body in addition to those of the immune system, it increases your risk of cancer. The more Cytoxan you take and the longer you take it, the greater your risk of developing cancer, even later in life. Leukemia and bladder cancer are the most common form of cancer developed in patients taking Cytoxan, so your doctor should perform urine tests regularly.
Cytoxan can interact with certain drugs, so be sure to tell your doctor about any medications you are taking, either prescription or over-the-counter. Also tell him/her about any dietary supplements (including herbal supplements) and/or vitamins that you may be taking. The following drugs can interact with Cytoxan: the gout medication allopurinol (Aloprim, Zyloprim), phenobarbital (Solfoton), warfarin (Coumadin), thiazide diuretics, such as hydrochlorothiazide, and some psychiatric medications. Be sure to notify your doctor if you are taking any of these medications.
Chlorambucil (Leukeran) and nitrogen mustard (Mustargen)
Chlorambucil (Leukeran) and nitrogen mustard (Mustargen) are cytotoxic medications similar to Cytoxan. They have been used in the past to treat lupus symptoms but are not used as commonly as Cytoxan at present. Leukeran is usually taken by mouth and is commonly used in Europe and developing countries. In the U.S., it is usually given to people who cannot tolerate Cytoxan or who have an allergy to the medication. The medication is usually tolerated better than Cytoxan tablets. However, it is more dangerous than IV Cytoxan because it must be taken for a longer period of time, which increases the risk of developing cancer. Therefore, if you take Leukeran tablets, you should do so only for a maximum of two years.
Nitrogen mustard was actually the first cytotoxic medication found to be effective in the treatment of lupus. However, it is seldom used today because it is trickier to administer and it must be given intravenously in the hospital. Your doctor will speak to you in more detail if this medication becomes involved in your treatment.
∗ People with lupus should not take Bactrim, sulfa antibiotics (e.g., Gantrisin, Septra), or sulfa diuretics (e.g., Aldactone), since these medications can cause lupus flares by increasing sun sensitivity and occasionally lowering blood counts. If you are prescribed one of these medications, talk to your doctor about possible alternatives.
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