Medical Health Encyclopedia

NO-NSAIDS. Experimental drugs are being developed that combine nitric oxide with NSAIDs (NO-NSAIDs). Nitric oxide increases blood flow in the mucous lining and secretions of mucus and bicarbonate.

Antimalarial Drugs

Antimalarial drugs may be prescribed for discoid lupus or for mild lupus when skin problems and joint pains are the predominant symptoms:

• The most common antimalarial drug used for SLE is hydroxychloroquine (Plaquenil). This drug is effective as maintenance therapy to reduce flares in patients with mild or inactive disease. Hydroxychloroquine may help protect against blood clots in people with antiphospholipid syndrome, high cholesterol levels, and bone loss.
• Other antimalarial drugs include chloroquine (Aralen) or quinacrine (Atabrine).

High doses may be prescribed initially in order to accumulate high levels of the drug in the blood stream. It is not known why antimalarials work. Some researchers believe they inhibit the immune response and others think they interfere specifically with inflammation.

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Side Effects. Side effects of antimalarials may include:

• Skin rash.
• Change in skin color (yellow in the case of quinacrine)
• Gastrointestinal problems
• Headache.
• Hair loss
• Muscle aches
• Eye damage

The most serious is damage to the retina, although this is very uncommon when low doses are used. Eye damage after taking hydroxychloroquine is reversible when caught in time and treated, but it is not reversible if it develops after taking chloroquine. An eye exam is advisable every 6 months or so.

Antimalarials may also be used in combination with other anti-SLE drugs, including immunosuppressants and corticosteroids. It should be noted that smoking significantly reduces the effectiveness of antimalarial drugs.

Thalidomide

Thalidomide inhibits a number of potent cytokines and reduces the formation of new blood vessels that allow the disease to progress. In low doses it has been found to be safe and effective for severe cutaneous lupus in many patients. It does not appear to have any benefits for systemic complications of lupus.

A major side effect of thalidomide is peripheral neuropathy, which can cause numbness, tingling, or other altered sensation in the nerves of limbs (feet, legs, hands, fingers). The drug should be taken for the shortest time possible. The drug is also notorious for producing very serious birth defects in children. Women who are in their reproductive years must be sure they are not pregnant before taking thalidomide and they must use very reliable birth control while taking it.