Your Medications: A Guide to Better
Understanding
In previous articles in "Scleroderma Voice,"
we have encouraged you to become better educated about
your disease, and to keep an accurate accounting of
your current medication list, allergies, surgeries,
and annual diagnostic screenings.
Knowledge is Power!
Becoming better informed and more organized will help
you be a more effective partner in your healthcare.
Knowledge is power, and we certainly want you to be
as empowered as possible.
To that end, we are providing yet another way to help
you engage in an open and healthy dialogue with your
physicians. Because persons with scleroderma may see
several physicians for a variety of health issues, the
list of medications that one takes can be confusing
to say the least. It is our goal to take as much of
the mystery out of your medication list as possible,
and to raise your medication IQ.
Understand What You Are Taking and Why
During an appointment with your physician, a new medication
may be prescribed for you. Due to all the other issues
that may be discussed during that short and hectic period
of time, you may leave the doctor’s office wondering
exactly what this new medication is supposed to do for
you. Based on my conversations with patients, this scenario
is more common than you may imagine.
After returning to the quiet of your home, you can
start to absorb the information from your recent office
visit, and review your doctor’s instructions.
You may ask yourself: Which one of my symptoms was
this prescription intended to treat? How soon will I
see an improvement? What side effects should I look
for?
To help address these questions you may have, we have
decided to offer the following guide as a tool. We sincerely
hope it will help to clarify some of the issues.
Disclaimer
This list is provided for informational purposes only,
and is not to be taken as an endorsement of any drug
by the Scleroderma Foundation or its Medical Advisory
Board.
Many of these drugs are prescribed by doctors, but
have not been proven useful and should be used only
with caution and supervision.
Please keep in mind, not every medication is appropriate
for every patient.
A review of your present medication list—including
over-the-counter and herbal preparations —taking
into account your symptoms and unique medical history,
will be necessary to help you and your physician make
informed decisions about changes to your medication
regime.
This Medications Guide Will Be Updated As Needed,
Here On Our Website
The Scleroderma Foundation plans to publish an updated
version of this guide each year in our magazine, Scleroderma
Voice.
Also, we will maintain this medications guide on this
page of our website. The online guide will be updated
on an ongoing basis as required.
The Scleroderma Foundation
will inform you about any new developments regarding
drug breakthroughs on our website and in our publications
as we become aware of them.
Can't
Afford Your Prescriptions? Look into Patient Assistance
Programs (PAPs)
If you can’t afford to buy your prescription
medications, most drug makers offer a limited
supply of free prescription medication to eligible
patients through Pharmaceutical Manufacturers
Patient Assistance Programs (PAPs).
For more information, ask your doctor or your
pharmacist, or look in the PhRMA (Pharmaceutical
Research and Manufacturers of America) directory.
To get the directory, call 800-762-4636 or visit
www.phrma.org.
Web Resources
Needymeds.com
– A resource for finding Patient Assistance
Programs and other assistance with the cost of
healthcare.
You can also search online at www.helpingpatients.org,
a new website created by PhRMA and 48 of its member
companies, designed to help providers and patients
find Patient Assistance Programs.
The searchable database at www.rxassist.org
helps you find PAPs by company, brand name, generic
name and drug class. It includes eligibility and
application instructions.
At www.benefitscheckup.org,
thanks to the National Council on the Aging (202-479-1200),
persons 55 and over can get a personalized report
of programs that can help save money on prescription
drugs. |
Scleroderma
Medications Guide
| Raynaud's
Phenomenon |
| Calcium
Channel Blockers
nifedipine (Procardia®,
Adalat®)
amlodopine (Norvasc®)
isradipine (Dynacirc®)
diltiazem (Cardizem®, Dilacor XR®)
nicardipine (Cardene®)
nisoldipine (Sular®)
felodipine (Plendil®) |
Action
Relax blood vessels |
Most
Common Side Effects
Low blood pressure, constipation,
nausea, may worsen swallowing difficulty, lightheadedness,
headache, leg edema, palpitations, irregular heartbeats |
| Angiotensin
II Receptor Antagonists
losartan (Cozaar®)
valsartan (Diovan®) |
Action
Block constriction of blood
vessels |
Most
Common Side Effects
Diarrhea, dizziness, cough,
muscle pain |
| Others
prazosin (Minipress®)
doxazosin (Cardura®)
pentoxifylline (Trental®) |
Action
Relax blood vessels
Unclear |
Most
Common Side Effects
Low blood pressure
Nausea, dizziness |
| Gastrointestinal
Symptoms
Gastroesophageal
Reflux Disease (GERD) |
| Antacids
Gaviscon, Maalox, Mylanta,
Rolaids, Tums |
Action
Neutralize stomach acidity |
Most
Common Side Effects
Diarrhea, constipation |
| H-2
Blockers
cimetidine (Tagamet®)
ranitidine (Zantac®)
famotidine (Pepcid®)
nizatidine (Axid®) |
Action
Inhibit stomach acid secretion |
Most
Common Side Effects
Mental confusion (cimetidine
only), diarrhea, headache, dizziness |
| Proton
Pump Inhibitors
omeprazole (Prilosec®)
lansoprazole (Prevacid®)
esomeprazole (Nexium®)
rabeprazole (Aciphex®)
pantoprazole (Protonix®) |
Action
Inhibit stomach acid secretion |
Most
Common Side Effects
Diarrhea, headache, dizziness |
| Others
sucralfate (Carafate®) |
Action
Coat esophagus & stomach;
forms protective barrier |
Most
Common Side Effects
Constipation |
| Gastrointestinal
Symptoms, continued
Improve
Swallowing |
| GI
Stimulants
bethanecol (Urecholine®)
metoclopramide(Reglan®)
erythromycin
octreotide acetate (Sandostatin®), an injectable
medication |
Action
Stimulate intestinal muscle
contractions, may improve heartburn
Can be helpful in very severe cases for improving
the motion of the bowel |
Most
Common Side Effects
Abdominal cramping, diarrhea,
dizziness, headache, drowsiness
(Reglan only)
Gastric irritation, nausea
Low heart rate, cardiac arrhythmias, nausea, diarrhea,
pain at injection site, expense |
| Gastrointestinal
Symptoms, continued
Relieve
Constipation |
| Bulking
Agents
calcium polycarbophil (FiberCon®,
Fiberall®)
psyllium (Metamucil®) |
Action
Soften stool |
Most
Common Side Effects
Abdominal bloating, flatulence |
| Softening
Agents
docusate calcium (Surfak®,
Sulfolax®)
docusate sodium (Colace®) |
Action
Soften stool |
Most
Common Side Effects
Mild abdominal cramping |
| Others
lactulose (Cephulac®,
Cholac®)
polyethylene glycol (MiraLax®) |
Action
Make bowels move |
Most
Common Side Effects
Abdominal cramping, flatulence
Nausea, abdominal bloating,
cramping, flatulence |
| Gastrointestinal
Symptoms, continued
Small
Intestine Dysfunction: Bacterial Overgrowth/Diarrhea
Broad
Spectrum Antibiotic use is the mainstay of treatment
for this complication. There are many potential
approaches to this therapy. Example: Antibiotics
are given in 2–3 week courses followed by
a 1–2 week drug holiday. Generally a few
cycles of this treatment can allow for quiet periods
of a few months to a few years. However, some
persons may require almost continuous antibiotics.
Alternating
antibiotics and increasing the antibiotic-free
period will decrease the development of resistant
strains of bacteria.
Note:
Prolonged use of Broad Spectrum Antibiotics may
be complicated by superinfection. |
| Broad
Spectrum Antibiotics
Examples include:
tetracycline
ampicillin
metronidazole (Flagyl®)
vancomycin, ciprofloxacin (Cipro®)
amoxicillin/clavulanate (Augmentin®)
clarithromycin (Biaxin®)
azithromycin (Zithromax®) |
Action
Decrease bacterial overgrowth |
Most
Common Side Effects
GI upset, diarrhea, nausea,
and vomiting, prolonged
use may be complicated by superinfection |
| Joint
& Tendon Pain |
| Non-Steroidal
Anti-Inflammatory Drugs (NSAIDs)
flurbiprofen (Ansaid®)
fenoprofen (Nalfon®)
nabumeton (Relafen®)
diclofenac (Voltaren®, Cataflam®)
diclofenac & misoprostol (Arthrotec®)
diclofenac sodium (Voltaren®)
etodolac (Lodine®)
ibuprofen (Motrin®, Advil®, Nuprin®)
indomethacin (Indocin®)
ketoprofen (Orudis®)
ketorolac (Toradol®)
meloxicam (Mobic®)
naproxen (Naprosyn®, Anaprox®,
Aleve®)
oxaprozin (Daypro®)
piroxicam (Feldene®)
suldinac (Clinoril®) |
Action
Suppress inflammation |
Most
Common Side Effects
GI upset, stomach ulcers,
impaired kidney function, liver inflammation,
confusion
|
| COX-2
Inhibitors
celecoxib (Celebrex®) |
Action
Suppress inflammation |
Most
Common Side Effects
Headache, edema, rash |
| Analgesics
acetaminophen (Tylenol®)
tramadol (Ultram®) |
Action
Relieve pain |
Most
Common Side Effects
Risk of liver & kidney
damage
Esophagus irritation &
sedation |
| Narcotics
acetaminophen/propoxyphene
(Darvocet-N®)
acetaminophen/hydrocone (Vicodin®)
acetaminophen/oxycodone (Percocet®)
oxycodone hydrochloride (OxyContin®, OxyIR®) |
Action
Relieve severe pain |
Most
Common Side Effects
Addiction possible, constipation,
dizziness, drowsiness, nausea, vomiting
Sedation, low blood pressure, nausea, vomiting |
| Pulmonary
Fibrosis/Alveolitis |
| Immunosuppressants
(none proven in controlled
trials;
the following have been used)
cyclophosphamide (Cytoxan®)
azathioprine (Imuran®)
cyclosporine (Neoral®, Sandimmune®)
mycophenolate mofetil (Cellcept®) |
Action
Suppress immune response
Suppress immune response
Impair lymphocytes
Impair lymphocytes
|
Most
Common Side Effects
Bone marrow damage, hair loss, nausea, diarrhea,
bladder inflammation, increased cancer risk, increased
infection
Nausea, pancreatitis, increased infection, increased
cancer risk, anemia
Tremor, headache, hypertension, nausea, vomiting,
kidney & liver injury, infections
Tremor, headache, hypertension, chest pain, GI
hemorrhage, nausea, vomiting, anemia, fever, infection,
sepsis, leg edema
|
| Pulmonary
Arterial
Hypertension Patients
diagnosed with pulmonary arterial hypertension
should be referred to a pulmonary hypertension
center for experienced evaluation and management
of this serious scleroderma complication. |
|
Endothelin
Receptor Antagonists
ambrisentan (Letairis®)
bosentan (Tracleer®) |
Action
Act on blood vessels
Act on blood vessels |
Most
Common Side Effects
Potential risk of liver
injury, edema, and birth defects
Potential liver injury,
headache, flushing, edema, anemia, male infertility,
birth defects |
| Prostaglandin
Derivatives
epoprostenol (Flolan®)
iloprost (Ventavis®) inhalation solution
trepostinil (Remodulin®)
|
Action
Act on blood vessels
Act on blood vessels
Act on blood vessels
|
Most
Common Side Effects
Headache, flushing, jaw
pain, diarrhea, foot/bone pain, potential serious
infection associated with central line catheter
in the chest wall
Flushing, increased cough, low blood pressure,
headaches, nausea, spasm of jaw muscles, fainting
Headache, flushing, pain
at infusion site |
| Calcium
Channel Blockers
Can be helpful to a small
proportion of patients; see Raynaud’s
section |
Action
See Raynaud's
section |
Most
Common Side Effects
See Raynaud's
section |
Phosphodiesterase
Type 5 (PDE5) Inhibitor
sildenafil citrate (Revatio®)
tadalafil (Adcirca®)
|
Action
Act on blood vessels
Act on blood vessels
|
Most
Common Side Effects
headache, dyspepsia, flushing, nosebleeds,
insomnia
headache, stomach upset,
back pain, muscle pain, nasal stuffiness, flushing, pain
in arms or legs, dizziness, or vision change
|
| Renal
Crisis/New Onset
Hypertension |
| ACE
Inhibitors
captopril (Capoten®)
enalapril (Vasotec®)
lisinipril (Prinivil®, Zestril®)
quinapril (Accupril®)
ramipril (Altace®)
fosinopril (Monopril®)
benazopril (Lotensin®)
moexipril (Univasc®)
trandolapril (Mavik®) |
Action
Block constriction of blood
vessels |
Most
Common Side Effects
Skin rash, dry mouth, taste
disturbances, fluid retention, drowsiness, lightheadedness,
diarrhea, cough |
 |
| If
taking corticosteroids, monitor your blood
pressure frequently, and report changes
to your healthcare provider immediately. |
Warning
About Corticosteroids and Renal Crisis
Corticosteroids, such as
prednisone and medrol, have been used to treat
several complications of systemic scleroderma,
such as pulmonary fibrosis, pruritis (itchy skin),
and joint pain.
Recent findings indicate
that corticosteroids can be implicated in precipitating
renal crisis.
Therefore, the medical
community has concluded corticosteroids should
be used cautiously, in a carefully screened patient
population.
For example: to manage
patients who also have myositis (muscle inflammation).
Anyone taking corticosteroids
should monitor blood pressure frequently, and
report changes to the healthcare provider immediately. |
| Skin
Fibrosis |
| Immunosuppressants
(none proven in controlled
trials;
the following have been used)
cyclophosphamide (Cytoxan®)
cyclosporine (Neoral®),
Sandimmune®)
D-penicillamine (Cuprimine®,
Depen®)
methotrexate (Rheumatrex®,
Trexall®)
mycophenolate mofetil (Cellcept®) |
Action
Suppress immune response
Impair lymphocytes
May inhibit collagen cross-linking
Suppress immune response
Impair lymphocytes |
Most
Common Side Effects
Bone marrow damage, hair
loss, nausea, diarrhea, bladder inflammation,
increased cancer risk, increased infections
Tremor, headache, hypertension,
nausea, vomiting, kidney & liver injury, infections
Bone marrow damage (rare), kidney
damage, mouth sores, skin rash, nausea, diarrhea
Liver inflammation, nausea,
mouth sores, skin rash
Tremor, headache, hypertension,
chest pain, GI hemorrhage, nausea, vomiting, anemia,
fever, infection, sepsis, leg edema |
| Sjögren's
Syndrome |
| Prescription
Drugs
pilocarpine hydrochloride
(Salagen®)
cevimeline hydrochloride (Evoxac®) |
Action
Improves dry mouth symptoms
in patients with Sjögren’s |
Most
Common Side Effects
Dizziness, headache, flushing,
urinary frequency, nausea, sweating, hypertension,
tachycardia
Headache, rhinitis, diarrhea, nausea, sweating,
urinary frequency |
| Over-the-Counter
Products
Dry Mouth:
Salivart®
Biotene Oral Balance
Moisturizing Gel®
Biotene Dry Mouth Gum®
Biotene Dry Mouth Toothpaste®
Biotene Dry Mouth Mouthwash®
Optimoist®
Salix Lozenges®
Dry Eyes:
Artificial tears® |
Action
Saliva substitute, alleviate
dry mouth
Provide tear-like lubrication |
Most
Common Side Effects
No significant side effects
observed
Mild stinging, temporary
blurred vision |
| Reactive
Depression
|
| Selective
Serotonin Reuptake Inhibitors (SSRI's)
sertraline (Zoloft®)
paroxetine (Paxil®)
fluoxetine (Prozac®)
fluvoxamine (Luvox®) |
Action
Improve symptoms of depression
and peripheral pain; Prozac may also improve Raynaud's |
Most
Common Side Effects
Headache,insomnia, sleepiness,
nervousness, diarrhea, nausea, constipation (Paxil®
only) |
| Tricyclic
Antidepressants
amitriptyline (Elavil®)
nortriptyline (Pamelor®)
imipramine (Tofranil®)
clomipramine (Anafranil®) |
Action
Improve symptoms of depression,
may improve restorative sleep |
Most
Common Side Effects
Drowsiness, dry mouth,
blurred vision, orthostatic hypotension, weight
gain, constipation |
| Other
Treatments
bupropion (Wellbutrin®)
venlafaxine (Effexor®)
nefazodone (Serzone®)
trazadone (Desyrel®) |
Action
Improve symptoms of depression
Improve depression
May improve depression-related
insomnia |
Most
Common Side Effects
Headache, insomnia, dry
mouth, high blood pressure, nausea
Sedation, nausea, orthostatic
hypotension |
| Localized
Scleroderma |
| Medications
(none proven in controlled
trials;
the following have been used)
hydroxychloroquine sulfate
(Plaquenil®)
methotrexate (Rheumatrex®,
Trexall®)
prednisone (Deltasone®,
Cortan®)
phenytoin (Dilantin®)
potassium p-aminobenzoate
(POTABA®)
D-penicillamine (Cuprimine®,
Depen®)
PUVA (phototherapy)
|
Action
Unclear
Suppress immune response
Suppress inflammation
Unclear
Unclear
May inhibit collagen cross-linking
Decrease skin thickening
|
Most Common Side Effects
Seizures, leukopenia, thrombocytopenia
Liver inflammation, nausea,
mouth sores, skin rash
Fluid retention, GI irritation
Dizziness, confusion, nausea,
vomiting
Skin rash, nausea, diarrhea
Bone marrow damage (rare), kidney
damage, mouth sores, skin rash, nausea, diarrhea
Burning, itching, nausea,
skin aging |
| Skin
Itching (Pruritis)/Dryness To
relieve dry itchy skin, it is necessary to moisturize
often. Also, you must protect your skin from harsh
detergents, hot water, and the cold winter air,
all of which will rob moisture from your skin.
You may want to consider using a humidifier in
the home during the cold winter heating months
to replace much-needed moisture into the air.
Remember that not everyone will have the same
response to every product. You may have to try
a few products until you find one that will work
for you. |
| Over-the-Counter
Skin Lotions
KeriCream®
Lanalor®
Lubriderm®
Eucerin Moisturizing® creams and lotions
Nivea Moisturizing®
UltraDerm®
Alpha Keri Bath Oil®
Penederm alpha hydroxy cream®
Aveeno bath oil & moisturizer® |
Action
Moisturize skin |
Most
Common Side Effects
No significant side effects
observed |
| Antihistamines
(Prescription)
diphenhydramine (Benadryl®)
hydroxyzine (Atarax®)
Colchicine |
Action
Block histamine response,
thereby decreasing itching
Reduce inflammation associated
with calcinosis |
Most
Common Side Effects
Drowsiness, dry mouth
Diarrhea |
|
