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.
Enter information into the online form at www.medicare.gov/Prescription/Home.asp
(or call toll-free 877-267-2323) and find programs offering discounted
or free medication; assistance with other health care costs; and
Medicare health plans that include prescription coverage.
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
bosentan (Tracleer®) |
Action
Act on blood vessels |
Most
Common Side Effects
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®)
|
Action
Act on blood vessels
|
Most
Common Side Effects
headache, dyspepsia, flushing, nosebleeds, insomnia
|
| 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 |
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, kidney & liver damage,
mouth sores, skin rash, nausea, diarrhea, anemia
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
Headache, flushing, pain at infusion site
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, kidney damage, mouth
sores, skin rash, nausea, diarrhea, anemia
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 |
|