Download Medication Guide for Scleroderma Scleroderma Medications Guide

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Medication Guide for Scleroderma
Although there isn’t a cure for scleroderma there are effective treatment options that help
alleviate symptoms and slow down disease progression. Current prescription and over-thecounter medication are designed to treat scleroderma by targeting: 1) inflammation, 2)
autoimmunity, 3) vascular disease, and 4) tissue fibrosis. As a medical doctor or health care
professional caring for persons with scleroderma, it is important to ensure patients understand
the nature of the medications they may be prescribed and how they work to help control disease
symptoms from progressing. Patient knowledge is powerful, as it reduces fear and increases
compliance, resulting in a higher percentage of successful treatment.
The following list of medication, commonly prescribed by doctors to treat patients with
scleroderma, has been compiled, in thanks, by the Scleroderma Foundation. The list is
provided for informational purposes only, and is not to be taken as an endorsement of any drug
by the Scleroderma Society of Ontario 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. It is important to consider, that not every medication is
appropriate for every patient. As a medical doctor familiar with your patient's medical history,
health status and disease progression, you will be able to determine the most appropriate
treatment options.
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®)
Angiotensin II Receptor
Antagonists
losartan (Cozaar®)
valsartan (Diovan®)
Action
Relax blood
vessels
Most Common Side Effects
Low blood pressure, constipation,
nausea, may worsen swallowing
difficulty, light-headedness, headache,
leg edema, palpitations, irregular
heartbeats
Action
Most Common Side Effects
Block constriction Diarrhea, dizziness, cough, muscle
of blood vessels pain
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136 Kenilworth Avenue North, Hamilton, Ontario, L8H 4R8
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Others
prazosin (Minipress®)
doxazosin (Cardura®)
Action
Relax blood
vessels
Most Common Side Effects
Low blood pressure
pentoxifylline (Trental®)
Unclear
Nausea, dizziness
Gastrointestinal Symptoms
Gastroesophageal Reflux Disease (GERD)
Antacids
Action
Most Common Side Effects
Gaviscon, Maalox, Mylanta, Rolaids, Neutralize
Diarrhea, constipation
Tums
stomach acidity
H-2 Blockers
Action
Most Common Side Effects
cimetidine (Tagamet®)
Inhibit stomach
Mental confusion (cimetidine only),
ranitidine (Zantac®)
acid secretion
diarrhea, headache, dizziness
famotidine (Pepcid®)
nizatidine (Axid®)
Proton Pump Inhibitors
Action
Most Common Side Effects
omeprazole (Prilosec®)
Inhibit stomach
Diarrhea, headache, dizziness
lansoprazole (Prevacid®)
acid secretion
esomeprazole (Nexium®)
rabeprazole (Aciphex®)
pantoprazole (Protonix®)
Others
Action
Most Common Side Effects
sucralfate (Carafate®)
Coat esophagus & Constipation
stomach; forms
protective barrier
Gastrointestinal Symptoms
Improve Swallowing
GI Stimulants
Action
Most Common Side Effects
bethanecol (Urecholine®)
Stimulate intestinal Abdominal cramping, diarrhea,
metoclopramide(Reglan®)
muscle
dizziness, headache, drowsiness
contractions, may (Reglan only)
improve heartburn
erythromycin
Gastric irritation, nausea
Can be helpful in
octreotide acetate (Sandostatin®), an very severe cases Low heart rate, cardiac arrhythmias,
injectable medication
for improving the nausea, diarrhea, pain at injection
motion of the
site, expense
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136 Kenilworth Avenue North, Hamilton, Ontario, L8H 4R8
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bowel
Gastrointestinal Symptoms
Relieve Constipation
Bulking Agents
calcium polycarbophil (FiberCon®,
Fiberall®)
psyllium (Metamucil®)
Softening Agents
docusate calcium (Surfak®,
Sulfolax®)
docusate sodium (Colace®)
Others
lactulose (Cephulac®, Cholac®)
polyethylene glycol (MiraLax®)
Action
Soften stool
Most Common Side Effects
Abdominal bloating, flatulence
Action
Soften stool
Most Common Side Effects
Mild abdominal cramping
Action
Make bowels
move
Most Common Side Effects
Abdominal cramping, flatulence
Nausea, abdominal bloating,
cramping, flatulence
Gastrointestinal Symptoms
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
Action
Most Common Side Effects
Examples include:
Decrease bacterial GI upset, diarrhea, nausea, and
tetracycline
overgrowth
vomiting, prolonged use may be
ampicillin
complicated by superinfection
metronidazole (Flagyl®)
vancomycin, ciprofloxacin (Cipro®)
amoxicillin/clavulanate (Augmentin®)
clarithromycin (Biaxin®)
azithromycin (Zithromax®)
Joint & Tendon Pain
Non-Steroidal Anti-Inflammatory
Action
Most Common Side Effects
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136 Kenilworth Avenue North, Hamilton, Ontario, L8H 4R8
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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®)
COX-2 Inhibitors
celecoxib (Celebrex®)
Suppress
inflammation
GI upset, stomach ulcers, impaired
kidney function, liver inflammation,
confusion
Action
Suppress
inflammation
Action
Relieve pain
Most Common Side Effects
Headache, edema, rash
Analgesics
acetaminophen (Tylenol®)
tramadol (Ultram®)
Narcotics
Action
acetaminophen/propoxyphene
Relieve severe
(Darvocet-N®)
pain
acetaminophen/hydrocone (Vicodin®)
acetaminophen/oxycodone
(Percocet®)
oxycodone hydrochloride
(OxyContin®, OxyIR®)
Most Common Side Effects
Risk of liver & kidney damage
Esophagus irritation & sedation
Most Common Side Effects
Addiction possible, constipation,
dizziness, drowsiness, nausea,
vomiting
Sedation, low blood pressure, nausea,
vomiting
Pulmonary Fibrosis/Alveolitis
Immunosuppressants
Action
Most Common Side Effects
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136 Kenilworth Avenue North, Hamilton, Ontario, L8H 4R8
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(none proven in controlled trials;
the following have been used)
cyclophosphamide (Cytoxan®)
azathioprine (Imuran®)
cyclosporine (Neoral®,
Sandimmune®)
mycophenolate mofetil (Cellcept®)
Suppress immune Bone marrow damage, hair loss,
response
nausea, diarrhea, bladder
inflammation, increased cancer risk,
increased infection
Suppress immune
response
Nausea, pancreatitis, increased
infection, increased cancer risk,
Impair
anemia
lymphocytes
Tremor, headache, hypertension,
nausea, vomiting, kidney & liver injury,
Impair
infections
lymphocytes
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 Action
Most Common Side Effects
ambrisentan (Letairis®)
Act on blood
Edema, and birth defects
vessels
bosentan (Tracleer®)
Potential liver injury, headache,
Act on blood
flushing, edema, anemia, male
vessels
infertility, birth defects
Prostaglandin Derivatives
Action
Most Common Side Effects
epoprostenol (Flolan®)
Act on blood
Headache, flushing, jaw pain,
vessels
diarrhea, foot/bone pain, potential
serious infection associated with
central line catheter in the chest wall
Flushing, increased cough, low blood
Act on blood
pressure, headaches, nausea, spasm
iloprost (Ventavis®) inhalation
vessels
of jaw muscles, fainting
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136 Kenilworth Avenue North, Hamilton, Ontario, L8H 4R8
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solution
Act on blood
vessels
trepostinil (Remodulin®)
Calcium Channel Blockers
Action
Can be helpful to a small proportion of See Raynaud's
patients; see Raynaud’s section
section
Phosphodiesterase Type 5 (PDE5) Action
Inhibitor
sildenafil citrate (Revatio®)
Act on blood
vessels
tadalafil (Adcirca®)
Act on blood
vessels
Renal Crisis/New Onset Hypertension
ACE Inhibitors
Action
captopril (Capoten®)
Block constriction
enalapril (Vasotec®)
of blood vessels
lisinipril (Prinivil®, Zestril®)
quinapril (Accupril®)
ramipril (Altace®)
fosinopril (Monopril®)
benazopril (Lotensin®)
moexipril (Univasc®)
trandolapril (Mavik®)
Headache, flushing, pain at infusion
site
Most Common Side Effects
See Raynaud's section
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
Most Common Side Effects
Skin rash, dry mouth, taste
disturbances, fluid retention,
drowsiness, light-headedness,
diarrhea, cough
If taking corticosteroids, monitor your blood pressure frequently, and report
changes to your healthcare provider immediately.
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136 Kenilworth Avenue North, Hamilton, Ontario, L8H 4R8
Toll Free: 1-888-776-7776
www.sclerodermaontario.ca
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
Most Common Side Effects
Suppress immune Bone marrow damage, hair loss,
response
nausea, diarrhea, bladder
inflammation, increased cancer risk,
Impair
increased infections
lymphocytes
Tremor, headache, hypertension,
nausea, vomiting, kidney & liver injury,
May inhibit
infections
collagen crossBone marrow damage (rare), kidney
linking
damage, mouth sores, skin rash,
Suppress immune nausea, diarrhea
response
Liver inflammation, nausea, mouth
Impair
sores, skin rash
lymphocytes
Tremor, headache, hypertension,
chest pain, GI hemorrhage, nausea,
vomiting, anemia, fever, infection,
sepsis, leg edema
Sjögren's Syndrome
Prescription Drugs
Action
pilocarpine hydrochloride (Salagen®) Improves dry
mouth symptoms
in patients with
Sjögren’s
Most Common Side Effects
Dizziness, headache, flushing, urinary
frequency, nausea, sweating,
hypertension, tachycardia
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136 Kenilworth Avenue North, Hamilton, Ontario, L8H 4R8
Toll Free: 1-888-776-7776
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cevimeline hydrochloride (Evoxac®)
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
Headache, rhinitis, diarrhea, nausea,
sweating, urinary frequency
Most Common Side Effects
Saliva substitute, No significant side effects observed
alleviate dry mouth
Provide tear-like
lubrication
Mild stinging, temporary blurred vision
Action
Most Common Side Effects
Reactive Depression
Selective Serotonin Reuptake
Inhibitors (SSRI's)
sertraline (Zoloft®)
paroxetine (Paxil®)
fluoxetine (Prozac®)
fluvoxamine (Luvox®)
Tricyclic Antidepressants
amitriptyline (Elavil®)
nortriptyline (Pamelor®)
imipramine (Tofranil®)
clomipramine (Anafranil®)
Other Treatments
bupropion (Wellbutrin®)
venlafaxine (Effexor®)
nefazodone (Serzone®)
Improve symptoms Headache,insomnia, sleepiness,
of depression and nervousness, diarrhea, nausea,
peripheral pain;
constipation (Paxil® only)
Prozac may also
improve
Raynaud's
Action
Most Common Side Effects
Improve symptoms Drowsiness, dry mouth, blurred vision,
of depression, may orthostatic hypotension, weight gain,
improve restorativeconstipation
sleep
Action
Most Common Side Effects
Improve symptoms Headache, insomnia, dry mouth, high
of depression
blood pressure, nausea
Improve
depression
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136 Kenilworth Avenue North, Hamilton, Ontario, L8H 4R8
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trazadone (Desyrel®)
May improve
depression-related
insomnia
Sedation, nausea, orthostatic
hypotension
Localized Scleroderma
Medications
(none proven in controlled trials;
the following have been used)
hydroxychloroquine sulfate
(Plaquenil®)
methotrexate (Rheumatrex®,
Trexall®)
Action
Most Common Side Effects
Unclear
prednisone (Deltasone®, Cortan®)
Seizures, leukopenia,
thrombocytopenia
Suppress immune Liver inflammation, nausea, mouth
response
sores, skin rash
Suppress
Fluid retention, GI irritation
inflammation
phenytoin (Dilantin®)
Unclear
potassium p-aminobenzoate
(POTABA®)
Unclear
D-penicillamine (Cuprimine®,
Depen®)
May inhibit
collagen crosslinking
Decrease skin
thickening
PUVA (phototherapy)
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
Action
Most Common Side Effects
KeriCream®
Moisturize skin
No significant side effects observed
Lanalor®
Lubriderm®
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136 Kenilworth Avenue North, Hamilton, Ontario, L8H 4R8
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Eucerin Moisturizing® creams and
lotions
Nivea Moisturizing®
UltraDerm®
Alpha Keri Bath Oil®
Penederm alpha hydroxy cream®
Aveeno bath oil & moisturizer®
Antihistamines (Prescription)
diphenhydramine (Benadryl®)
hydroxyzine (Atarax®)
Colchicine
Action
Most Common Side Effects
Block histamine
Drowsiness, dry mouth
response, thereby
decreasing itching
Reduce
inflammation
associated with
Diarrhea
calcinosis
To learn more about prescription and over-the-counter medication as well as new
medications, supplements and herbal remedies not listed in the table above, the U.S.
National Library of Medicine National Institutes of Health has developed the
"MedlinePlus" web-site, which can be found at:
ww.nlm.nih.gov/medlineplus/druginformation.html
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