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Medications Used to Treat Lupus

Immunosuppressives continued...

Immunosuppressives 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.

Types of Immunosuppressives

A variety of immunosuppressive drugs is available to treat lupus. Although they have different mechanisms of action, each type functions to decrease or prevent an immune response. The immunosuppressives most frequently used with SLE patients are azathioprine (Imuran), cyclophosphamide (Cytoxan), methotrexate (Rheumatrex), and cyclosporine (Sundimmune, Neoral).

Mechanism of Action and Use

Drugs like azathioprine, methotrexate, and cyclosporine are referred to as antimetabolite agents. These drugs block metabolic steps within immune cells and then interfere with immune function. Cytotoxic drugs like cyclophosphamide work by targeting and damaging autoantibody-producing cells, thereby suppressing the hyperactive immune response and reducing disease activity.

Risks

There are many serious risks associated with the use of immunosuppressives. They include immunosuppression (resulting in increased susceptibility to infection), bone marrow suppression (resulting in decreased numbers of RBCs, WBCs, and platelets), and development of malignancies.

Side/Adverse Effects

Dermatologic: Alopecia (cyclophosphamide only).

Gastrointestinal: Nausea, vomiting, stomatitis, esophagitis, and hepatotoxicity.

Genitourinary: Hemorrhagic cystitis, hematuria, amenorrhea,* impotence,* and gonadal suppression (cyclophosphamide only).*

*Temporary or reversible once drug therapy is discontinued
*Recovery of function after drug is discontinued is unpredictable

Hematologic: Thrombocytopenia, leukopenia, pancytopenia, anemia, and myelo-suppression.

Respiratory: Pulmonary fibrosis.*

Other: Increased risk of serious infections or malignancies.

Pregnancy and Lactation

Use of immunosuppressives presents definite risks to the fetus. Female patients should use contraceptive measures during treatment and for 12 weeks after ending azathioprine therapy. Azathioprine may pass into breast milk, and women using this drug should consult with their doctors before breastfeeding.

*With high doses

Considerations for Health Professionals

Assessment

History: Allergy to immunosuppressive drugs, infections, impaired hepatic or renal function, pregnancy, lactation, corticosteroid therapy, immunosuppression, and bone marrow suppression.

Laboratory data: CBC, differential, platelet count, renal function studies, liver function tests, pulmonary function tests, chest x-ray, and electrocardiogram (ECG).

Physical: All body systems to determine baseline data and alterations in function, temperature, pulse, respirations, weight, skin color, lesions, hair, and mucous membranes.

Evaluation

Therapeutic response and adverse effects.

Administration

Orally or intravenously.

Precaution: Drug administration protocols can vary. The nurse must work closely with the prescribing physician to safely administer the drug and to monitor the patient to minimize adverse effects and achieve expected outcomes.

Brand names included in this article are provided as examples only; their inclusion does not mean that these products are endorsed by NIH or any other Government agency. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.

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WebMD Public Information from the U.S. National Institutes of Health

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