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How to Use This Medication: Take with food or immediately after a meal to prevent stomach upset. Take this medication as prescribed. Follow the dosing schedule carefully. Be sure to ask your doctor if you have any questions. If you are taking this medication only once a day, it should be taken in the morning before 9 a.m. The liquid suspension form must be shaken well before using. If you have been taking this medication for a long time, do not suddenly stop taking it without your doctor's approval. Your dose may need to be gradually reduced. You may experience extreme fatigue, weakness, stomach upset or dizziness when the medication is suddenly stopped. WARNING! Stopping this medication suddenly can cause "Adrendal Shock" which can be a very seriouos condition! Long-term steroid use causes the adreanal glands to stop functioning and the body becomes completely dependant upon the medication. When tapered slowly, the adreanal gland begins to function once again.
Side Effects: May cause dizziness, nausea, indigestion, increased appetite, weight gain, weakness or sleep disturbances. These effects should disappear as your body adjusts to the medication. If they persist or become bothersome, inform your doctor. Notify your doctor if you experience vomiting of blood, black or tarry stools, puffing of the face, swelling of the ankles or feet, unusual weight gain, prolonged sore throat or fever, muscle weakness, breathing difficulties or mood changes while taking this medication.
** Steroid-dependent patients may develop bloating, ulcers, acid reflux, fungal infections of the mouth, throat, and stomach, elevated cholesterol and triglycerides which can result in diabetes. Muscle weakness and "avascular necrosis" (or "dead bone") can develop, requiring joint-replacement surgery. Mood swings, irritability, water retention, high blood pressure, menstrual irregularities, cataracts and glaucoma can also develop.
However, no one develops all of these complications and many patients who are steroid-dependent develop none of them. Talk to your doctor about the risks of steroid-therapy as opposed to the condition which is being treated. Many physicians tend to misuse steroids simply because they are unaware of the options. With organ-threatening disease, steroids *must* be prescribed or permanent damage will occur to the organ. Where organs are not involved, there are now many other treatment options available for lupus patients and Plaquenil is the most effective substitute for steroids.
Precautions: * No enviroment is ideal for a patient taking steroids because of the increased risk of infection and prolonged healing time, and should avoid contact with colds or other infections as much as possible.
*Do not have a vaccination, other immunization, or any skin test while you are taking this drug unless your doctor specifically tells you that you may.
* WARNING! It is especially important you do not come in contact with anyone who has an active herepes virus, such as chicken pox or shingles; or anyone who has been immunizied within the previous 48 hours.
* Before you take this drug, tell your doctor if you are pregnant, think that you may be pregnant or wish to become pregnant. If you become pregnant, contact your doctor. Because this drug appears in breast milk contact your doctor before breast-feeding. This medication can cause growth suppression in infants.
* Before you take this drug, tell your doctor your entire medical history, particularly if you have liver, kidney, intestinal, or heart disease; an underactive thyroid gland; high blood pressure; myasthenia gravis; osteoporosis (brittle bones); herpes eye infection; or a history of tuberculosis (TB), seizures, ulcers, or blood clots. If you have a history of ulcers or take large doses of aspirin or other arthritis medication, limit your consumption of alcoholic beverages while taking this medication. It may make your stomach and intestines more susceptible to the irritating effects of alcohol, aspirin, and certain arthritis medications, increasing your risk of ulcers. Report any injuries or signs of infection (fever, sore throat, pain during urination, and muscle aches) that occur during treatment and within 12 months after treatment with this drug. Your dose may need to be adjusted or you may need to start taking the drug again.
* If you have Diabetes, this drug may increase your blood sugar level. Test your urine for sugar (glucose) frequently and contact your doctor if sugar is present; your dose of diabetes medication and your diet may need to be changed.
* If you have Asthma, and your sputum (the matter you cough up) thickens or changes color from clear white to yellow, green, or gray, contact your doctor; these changes may be signs of an infection.
* This drug may cause an allergic reaction in patients with a history of sensitivity to "Glucocorticoids."
Interactions: Before you take this drug, tell your doctor what prescription and nonprescription medications you are taking, especially aspirin, arthritis medication, anticoagulants ("blood thinners"), diuretics ("water pills"), rifampin, phenobarbital, estrogen (e.g. birth-control pills), phenytoin, ketoconazole, neostigmine, pyridostigmine, ambenonium, and drugs for diabetes.
Drug Tips: *Persons taking this medication for long-term therapy should wear or carry identification stating that they are taking a corticosteroid. Get information HERE
Do not allow anyone else to take this medication.
* The use of antacids, diuretics, and mild sedatives are often helpful to counteract steroid side-effects of heartburn and bloating, water retention, and sleeplessness.
* Patients should keep a low-sodium, low-fat, and low-carbohydrate diet, and limit calorie intake. They should also take at least 1000 mg. of calcium per day to prevent bone-loss, and remain as active as possible to minimize muscle atrophy and osteoporosis.
Missed Dose: If you miss a dose, and are taking 1 dose every other day, take the missed dose as soon as remembered if you remember the same morning, then resume your usual schedule. If you do not remember the missed dose until later, skip the missed dose and resume your regular dosing schedule the following day. If you take 1 dose daily, take the missed dose as soon as remembered then resume your regular dosing schedule. If you do not remember until the next day, skip the missed dose. Do not "double-up" the dose. If you take 2 or more doses daily, take the missed dose as soon as remembered unless it is near time for the next dose. In that case, take the missed and next dose together.
How to Use This Medication: Imuran (Azathioprine) tablets should be taken with food or milk to prevent stomach upset. Take this medication exactly as prescribed. Do not stop taking the medication without your doctor's approval.
Side Effects: This medication may cause stomach upset, diarrhea, nausea, or vomiting during the first few days as your body adjusts to the medication. If these symptoms persist or become severe, inform your doctor. Notify your doctor if you experience any of the following while taking this medication: stomach cramps, pale stools, darkened urine, mouth sores, easy or unusual bleeding or bruising, hair loss, tingling of the hands or feet, changes in vision, joint pain, skin rash, fever, sore throat, or weakness. This medication can increase your risk of developing an infection. Notify your doctor at the first sign of a possible infection (fever, sore throat, weakness).
Precautions: Before you take Imuran (Azathioprine), tell your doctor if you are pregnant (or may become pregnant) or if you have liver or kidney disease.
Interactions: Before you take this drug, tell your doctor what prescription and nonprescription drugs you are taking, especially allopurinol (Zyloprim).
Drug Tips: Lab tests will be done frequently while taking this medication to ensure it is working properly and to watch for potential side effects. Do not allow anyone else to take this medication.
Missed Dose: If dose is once a day: skip missed dose, do not double the next dose. If more than one dose daily: take as soon as remembered, unless it is time for the next dose. If so, take both doses together and resume your usual schedule. Call your doctor if you miss more than one dose.
How to Use This Medication: This is a potent medication. Take it exactly as prescribed.Unless your doctor instructs you otherwise, drink plenty of fluids while taking this medication. This helps your kidneys to remove the drug from your body and avoid some of the side effects. Call your doctor if you experience vomiting.
Side Effects: Nausea, vomiting, loss of appetite, acne, skin rash, increased sun sensitivity or itch are common side effects.Taking the medication on an empty stomach with a full glass of water may help relieve vomiting. Changes in diet such as eating several small meals or limited activity may help lessen some of these effects.In some cases, drug therapy may be necessary to prevent or relieve nausea and vomiting. Temporary hair loss is another common side effect when used intraveniously, but less often occurs with oral doese. In any case, normal hair growth should return after treatment has ended. Contact your doctor, without delay, if you experience any of the following symptoms: Fever, chills, painful or difficult urination, blurred vision, headache, weakness or drowsiness, easy bruising or bleeding, black or tarry stools, blood in urine or stools, bloody vomit, stomach pain, diarrhea, joint pain, swollen feet or lower legs, sores in the mouth or on the lips, yellow eyes or skin,dark urine, cough, shortness of breath, lower back or side pain.
Precautions: This medication can increase your sensitivity to sunlight. Do not use a sunlamp and avoid sun exposure until you know how you react. Use an effective sunscreen. This medication is not recommended for use in pregnant or nursing women. If you become pregnant while taking this drug, contact your doctor. Do not drink alcoholic beverages while taking this medication.
Interactions: Do not take any medicines for pain or inflammation like aspirin or ibuprofen (Motrin-like drugs) without first asking your doctor. Inform your doctor if you are being treated for gout with probenecid (Benemid) as your dose may need to be adjusted.
Drug Tips: This medication can lower your body's ability to fight an infection. Notify your doctor if you develop any signs of an infection such as fever, sore throat, rash or chills. Avoid touching your eyes or inside your nose without first washing your hands. You should always flush the toilet twice after each use to ensure that no traces of waste remain. Use caution with sharp objects like safety razors or nail cutters and avoid activities such as contact sports in order to lower the chance of getting cut, bruised or injured. Do not have immunizations/vaccinations without consent of your doctor.
Avoid contact with people who have recently received oral polio vaccine.
Regular doctor visits are important. Frequent blood tests will be done to monitor therapy. Contraceptive (birth control) measures are recommended for use in men and women while taking this medication.
Missed Dose: Contact your doctor if you miss a dose. Do not "double-up" the dose.
How to Use This Medication: Take this medication with food to prevent stomach upset. Take this medication exactly as prescribed. While taking this medication, your doctor may schedule lab tests to check your eye sight, hearing and blood.
Side Effects: Nausea, vomiting, stomach upset, cramps, loss of appetite, diarrhea, tiredness, weakness or headache may occur the first several days as your body adjusts to the medication. If these effects continue or become bothersome,inform your doctor. Notify your doctor if you develop any changes seeing such as blurred vision, trouble seeing at night or problems focusing clearly. Also report if you experience ringing in the ears or have difficulty hearing while taking this medication.
Precautions: This drug should be used only if clearly needed during pregnancy. Since small amounts of this medication are found in breast milk; consult your doctor before breast-feeding. Tell your doctor if you have pre-existing liver disease, blood disorders, or psoriasis. This drug may cause an allergic reaction in patients with a history of sensitivity to: 4-Aminoquinolones.
Interactions: Tell your doctor of any over-the-counter or prescription medication you may take.
Drug Tips: Children are very sensitive to the effects of this medication. It is important to keep this and all medications out of the reach of children.
Missed Dose: If dosing schedule is 1 per 7 days, take missed dose as soon as possible and resume regular schedule. If dosing is 1 per day, take missed dose that day.If not remembered until the next day, skip missed dose, resume regular schedule and do not double the doses. If dosing is 1 or more per day, take missed dose if within 1 hour. If not remembered until later, skip missed dose, resume regular schedule and do not double dose.
Uses: This medication is taken with other medications to help control seizure disorders. Seizures occur in about 15% of lupus patients, but anticonvulsant medications are also very effective in the treatment of other nervous system symptoms caused by SLE, such as various types of neuritis and nerve pain.
How to Use This Medication: Take this medication by mouth exactly as prescribed. During the first few days your doctor may gradually increase your dose to allow your body to adjust to the medication. To minimize side effects, take the very first dose at bedtime. For best effects, take this medication at evenly spaced times throughout the day and night. This will ensure a constant level of drug in your body. Do not take this more often or increase your dose without consulting your doctor. Your condition will not improve any faster but the risk of serious side effects may be increased. Do not stop taking this drug suddenly since seizures may reoccur. Your dose should be gradually reduced over time.
Side Effects: Headache, fatigue, drowsiness, dizziness, blurred vision, tremor, stomach upset and anxiety may occur the first several days as your body adjusts to the medication. If any of these effects continue or become bothersome, inform your doctor. Notify your doctor if you develop a rapid, pounding or irregular heartbeat, skin rash, runny nose, flu-like symptoms, itching, difficulty moving, clumsiness or seizures while taking this medication. This medication may cause drowsiness or dizziness. Use caution operating machinery or engaging in activities requiring alertness.
Precautions: This medication should be used only if clearly needed during pregnancy. Discuss the risks and benefits with your doctor. It is not known if this medication appears in breast milk. Consult your doctor before breast-feeding. Tell your doctor if you have any pre-existing kidney disease or if you have any allergies.
Interactions: Tell your doctor of any over-the-counter or prescription medication you may take especially other medication for seizures, and antacids. Because antacids may interfere with the absorption of the medication into the body, it is best to take this medication at least two hours after taking an antacid. Do not take them at the same time. Limit intake of alcohol while taking this medication.
Drug Tips: Laboratory tests may be done periodically while taking this medication to monitor the effects. See your doctor regularly.
Missed Dose: Try to take each dose at the scheduled time. If you miss a dose, take it as soon as remembered; do not take it if it is near the time for the next dose, instead, skip the missed dose and resume your usual dosing schedule. Do not "double-up" the dose to catch up.
Uses: This medication is a nonsteroidal anti-inflammatory drug which relieves pain and reduces inflammation (swelling). It is used to relieve swelling and stiffness associated with arthritis.
How to Use This Medication: Take this medication as directed. Do not increase your dose or take it more often without your doctor's approval. Take this medication with food,milk or antacids to prevent stomach upset.
Side Effects: Stomach upset is the most common side effect. Nausea, vomiting, bloating, gas, increased sun sensitivity and loss of appetite might also occur. If these effects become severe, notify your doctor. Inform your doctor if you develop persistent stomach pain, black or bloody stools, skin rash, itching, breathing difficulties, edema (swelling of the feet or hands), ringing in the ears or vision changes while taking this medication. This medication may cause dizziness, drowsiness or blurred vision. Avoid activities requiring alertness if this occurs.
Precautions: Alcohol may aggravate stomach irritation. This medication should be used during pregnancy only if clearly needed. Because this medication appears in breast milk, consult your doctor before breast-feeding. Be sure your doctor knows your complete medical profile especially if you have a history of ulcers. Do not take aspirin without consulting your doctor. Check the ingredients of any nonprescription medication you may be taking since many cough and cold formulas contain aspirin. This medication may cause you to be more sensitive to sunlight. Avoid prolonged sun exposure. Wear protective clothing and use a sunscreen when outdoors. This drug may cause an allergic reaction in patients with a history of sensitivity to the following: Salicylates; NSAID; Pyrazoles.
Interactions: Inform your doctor about all the drugs you use especially if you take "blood thinners" warfarin (Coumadin), other arthritis medication, water pills or lithium as your dose may need to be adjusted.
Drug Tips: In arthritis, it may take up to two weeks before the full effects of this medicine are noted. For best results,this medication must be taken regularly and used together with a proper exercise program as directed by your doctor.
Missed Dose: If you miss a dose, take it as soon as remembered; do not take if it is almost time for the next dose, instead, skip the missed dose and resume your usual dosing schedule. Do not "double-up" the dose to catch up.
How to Use This Medication: May be taken with food if stomach upset occurs. Take this medication as directed. Do not increase your dose or take it more often than prescribed. If you experience a hung-over type feeling the following morning after taking this medication, you should talk to your doctor about reducing your dosage or possibly prescribing a less-potent muscle relaxant.
Side Effects: May cause stomach upset, heartburn, constipation, headache, dizziness or drowsiness or dry mouth the first few days as your body adjusts to the medication. If these symptoms persist or become severe, notify your doctor. Inform your doctor if you develop muscle stiffness, skin rash, itching, rapid heart rate, swelling of the face or difficulty urinating while taking this medication. When rising quickly from a sitting or lying position, dizziness or lightheadedness may occur. Change positions slowly and use caution on stairs. Avoid activities requiring alertness if dizziness or drowsiness occurs.
Precautions: Before taking this drug, tell your doctor if you have glaucoma, an overactive thyroid gland, heart disease, or difficulty urinating. Inform you doctor if you are pregnant or breast-feeding before taking this drug. Alcohol adds to the dizziness and drowsiness caused by Flexeril (cyclobenzaprine). Limit alcohol intake. This drug may cause an allergic reaction in patients with a history of sensitivity to the following: Carbamazepine; Tricyclic Anti-depressants.
Interactions: Tell your doctor what prescription and nonprescription medications you are taking, especially cimetidine and antidepressants. Do not take sedatives, tranquilizers, sleeping pills, or medication for allergies, asthma, coughs, or colds while taking this drug without consulting your doctor. Do not allow anyone else to take this medication.
Drug Tips: Do not use for longer than 3 weeks unless specifically instructed to do so. This medication provides temporary relief and must be used in addition to rest, physical therapy and other measures. With muscle spasms, pain, and weakness associated with SLE and FM, many patients find massage therapy and electro-accupuncture quite beneficial.
Missed Dose: Do not double dose if missed, but take it as soon as remembered. If it is almost time for the next dose, resume regular dosing schedule.
If you have lupus and your doctor has directed you to take an asprin a day, chances are it is to reduce your risk of developing blood clots due to the "Lupus Anticoagulant Syndrome". Lupus patients who have a history of blood clots may be placed on prescription anti-coagulant medication (blood thinners), but this is usually avoided when possible since the Lupus Anticoagulant Syndrome can also cause a patinet to experience excessive bleeding as well as clotting. One asprin a day (sometimes a mere baby asprin is recommended) is usually sufficient to prevent blood clots. If you have lupus and have never been tested, or do not know if you have been tested for the Anticoagulant Syndrome, I suggest that you do so. Many physicians remain unaware of this syndrome and therefore do not know to order the blood test.
If you are pregnant or considering becoming pregnant, it is extremely important that your physician know
(1) that you have lupus, and (2) whether or not you have the Anticoagulant Syndrome.
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Many lupus patients suffer bouts of depression and/or anxiety. These can be caused by the natural emtional response to having the physical limitations, complications, and permanence of any chronic illness, and can also be the result of actual physiological symptoms of Central Nervous System involvement of SLE. I personally suggest that you learn whether or not your anxiety and depression is an emotional response or if you do suffer from CNS involvement. Antidepressant medications are very useful in relieving CNS symptoms, but if your depression is strictly an emotional response, it would be wise for you to seek counseling or other types of support to help you learn to accept your disease and its restrictions, and be happy despite them. Using medications to relieve a psychological depression is much like placing a bandage over a dirty wound... it merely covers up the problem, but does not cure it, nor really help it. The wound will become infected in spite of the bandage, ultimately causing greater problems which will spread to other areas. Only your doctor can determine whether your anxiety and depression are the result of CNS involvement, and many physicians are too eager to prescribe antidepressant medications rather recommending a good counselor or support group.
But I'm Not Depressed!
If you have not had trouble with anxiety or depression and yet your physician has prescribed an anti-depressant, chances are it is due to either sleep disturbances or nerve pain. "Tricyclic" antidepressants are especially helpful in promoting deep and restful sleep, the lack of which is a major problem with lupus patients. Many people with SLE also have Fibromyalgia (FM) as one of their secondary conditions and steroids tend to increase the symptoms of FM. Therefore, many do not ever stay asleep long enough or sleep deeply enough to experience the full sleep cycle necessary for restful sleep. Sleeplessness and sleep disturbances greatly increase muscle pain and weakness and the over-all flu-like symptoms of lupus/fm. These antidepressant medications have also been found to be very effective in eliminating some types of nerve pain associated with SLE.
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You should also be aware that there are actually two classes of narcotic pain relievers: (1) Codeine (2) Hydrocodone. While some patients cannot tolerate one, they may be able to take the other without any side-effects. Should you experiece problems (most commonly, itching) with one type of codeine pain reliever, you should ask your doctor to prescribe one from the other class of drugs. Codeine pain relievers, such as percocet, loratab, darvocet, and tylenol3 are often prescribed to lupus patinets who experience a great deal of joint, muscle, and/or nerve pain. If you experience considerable pain, do not hesitate to explain this to your doctor and request pain medication. While it does not cure the problem, you must realize that there is no cure for SLE and the best we can hope for is to minimize our symptoms. However, keep in mind that these medications are addictive, so be sure to take them only as directed. Do not increase your dose without first consulting with your physician.
* FYI: Drugs ending in "cet" indicate that Acetaminophen (such as Tylenol) is used in the compound as opposed to Asprin.
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Most drugs that cause preexisting lupus to exacerbate do so by acting as sun-sensitizing agents or by promoting hypersensitivity or allergy-like reactions. Such drugs include:
This is not a complete listing. Therefore, if you notice an increase in your lupus symptoms after beginning a new medication, you should talk to your doctor about the possibility of complications from the medication.
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01/29/98.