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 ResourcesNeedymeds.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®) |
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®) |
Action Block constriction of blood vessels |
Most Common Side Effects Diarrhea, dizziness, cough, muscle pain |
||
Others prazosin (Minipress®) pentoxifylline (Trental®) |
Action Relax blood vessels Unclear |
Most Common Side Effects Low blood pressure Nausea, dizziness |
||
|
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®) |
Action Inhibit stomach acid secretion |
Most Common Side Effects Mental confusion (cimetidine only), diarrhea, headache, dizziness |
||
Proton Pump Inhibitors omeprazole (Prilosec®) |
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®) |
Action Stimulate intestinal muscle
contractions, may improve heartburn |
Most Common Side Effects Abdominal cramping, diarrhea,
dizziness, headache, drowsiness |
||
Gastrointestinal Symptoms, continued Relieve Constipation |
||||
Bulking Agents calcium polycarbophil (FiberCon®,
Fiberall®) |
Action Soften stool |
Most Common Side Effects Abdominal bloating, flatulence |
||
Softening Agents docusate calcium (Surfak®,
Sulfolax®) |
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: |
Action Decrease bacterial overgrowth |
Most Common Side Effects GI upset, diarrhea, nausea, and vomiting, prolonged use may be complicated by superinfection |
||
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) flurbiprofen (Ansaid®) |
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®) |
Action Relieve severe pain |
Most Common Side Effects Addiction possible, constipation,
dizziness, drowsiness, nausea, vomiting |
||
Immunosuppressants (none proven in controlled
trials; cyclophosphamide (Cytoxan®) |
Action
|
Most Common Side Effects
|
||
| 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®)
|
Action 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 |
Most Common Side Effects |
||
Phosphodiesterase Type 5 (PDE5) Inhibitor sildenafil citrate (Revatio®) |
Action
|
Most Common Side Effects
|
||
| Renal Crisis/New Onset Hypertension | ||||
ACE Inhibitors captopril (Capoten®) |
Action Block constriction of blood vessels |
Most Common Side Effects Skin rash, dry mouth, taste disturbances, fluid retention, drowsiness, lightheadedness, diarrhea, cough |
||
Warning About Corticosteroids and Renal CrisisCorticosteroids, 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; 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®) |
Action Improves dry mouth symptoms in patients with Sjögren’s |
Most Common Side Effects Dizziness, headache, flushing,
urinary frequency, nausea, sweating, hypertension,
tachycardia |
||
Over-the-Counter Products Dry Mouth: Salivart® 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®) |
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®) |
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®) 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; hydroxychloroquine sulfate (Plaquenil®) methotrexate (Rheumatrex®, Trexall®)
|
Action
Suppress inflammation Unclear
|
Most Common Side Effects
Liver inflammation, nausea, mouth sores, skin rash
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 |
Action |
Most
Common Side Effects |
||
Antihistamines (Prescription) diphenhydramine (Benadryl®) Colchicine |
Action Block histamine response, thereby decreasing itching Reduce inflammation associated with calcinosis |
Most Common Side Effects Drowsiness, dry mouth Diarrhea |
||
