Medications for Scleroderma

Disease-modifying Antirheumatic Drugs (DMARDs)

Common names include:

• D-penicillamine]]> (Cuprimine, Depen)
• ]]>Hydroxychloroquine]]> (Plaquenil)
• ]]>Methotrexate]]> (Rheumtrex)
• ]]>Cyclophosphamide]]> (Cytoxan)
• ]]>Cyclosporine]]>

These drugs are given in an effort to slow or halt the progression of scleroderma. While research has yet to prove that these drugs can actual modify scleroderma’s course, they are often given anyway. They are all immunosuppressive agents. Because scleroderma is believed to be caused (at least in part) by an overactive immune system, it is hoped that calming the immune system’s activity will slow scleroderma’s progress.

D-penicillamine is thought to decrease collagen production, and therefore is given to reduce or slow skin hardening. Methotrexate may help decrease joint swelling, pain, and inflammation. Cyclophosphamide may reduce inflammation in the lungs.

Possible side effects include:

• Nausea
• Diarrhea
• Liver inflammation
• Bladder inflammation
• Kidney damage
• Nerve damage
• ]]>High blood pressure]]>

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Common names include:

• Naproxen]]> (Naprosyn, Anaprox, Aleve)
• ]]>Ketoprofen]]> (Orudis)
• ]]>Ibuprofen]]> (Motrin, Advil, Nuprin)
• ]]>Indomethacin]]> (Indocin)
• ]]>Sulindac]]> (Clinoril)
• ]]>Meclofenamate]]> (Meclomen)
• ]]>Ketorolac]]> (Toradol)
• ]]>Piroxicam]]> (Feldene)
• ]]>Diclofenac]]> sodium (Voltaren, Cataflam)

Although some NSAIDs are available as over-the-counter medications, you may be given a prescription in order to obtain a higher dosage. NSAIDs help reduce inflammation, swelling, and joint pain.

Possible side effects include:

• Stomach upset
• Stomach ulcers
• Kidney damage
• Liver inflammation
• Confusion

Corticosteroids

Common names include:

• Prednisone]]> (Deltasone, Cortan)
• ]]>Methylprednisolone]]> (Medrol)

Corticosteroids are very potent anti-inflammatory agents and are given to reduce swelling, inflammation, and joint pain.

Possible side effects for short-term use (about three weeks or less) include:

• Difficulty sleeping
• Increased appetite
• Mood swings
• Increases in blood pressure
• Increased blood sugar (especially in people with diabetes)

Possible side effects for long-term use (about three weeks or longer) include:

• Weakening of the immune system and an increased risk of developing infections
• ]]>Osteoporosis]]> (thinning, weak bones)
• ]]>Cataracts]]> , ]]>glaucoma]]>
• Indigestion
• Swelling in the hand, face, and legs
• Easy bruising
• ]]>Gastritis]]>

Calcium-channel Blockers

Common names include:

• Nifedipine]]> (Procardia, Adalat)
• ]]>Diltiazem]]> (Cardizem, Dilacor XR)
• ]]>Verapamil]]> (Calan, Isoptin)
• ]]>Nicardipine]]> (Cardene)
• Bepridil (Vascor)
• ]]>Isradipine]]> (DynaCirc)
• ]]>Amlodipine]]> (Norvasc)
• ]]>Nisoldipine]]> (Sular)
• ]]>Nimodipine]]> (Nimotop)

Calcium-channel blockers can reduce the symptoms of ]]>Raynaud’s phenomenon]]> by relaxing blood vessels. This allows better blood circulation through the fingers, toes, and tip of nose. When exposed to cold, you’ll have less trouble with skin blanching and less numbness and tingling. Use of calcium-channel blockers can reduce the chance of developing sores or ulcers on your fingertips.

Calcium-channel blockers may also be given to treat high blood pressure.

Possible side effects include:

• Low blood pressure
• Constipation
• Nausea
• Dizziness
• Headache
• Swelling due to fluid retention
• Difficulty swallowing

Vasodilators

Common names include:

• Epoprostenol]]> (Iloprost)
• ]]>Sildenafil]]> (Bosentan)

These medications are used to treat refractory Raynauds Phenomenon and to heal digital ulcerations. They are also used to treat pulmonary hypertension associated with scleroderma.

Possible side effects include:

• Life threatening pulmonary artery pressure changes
• Liver damage
• Blood pressure changes

Blood Pressure Medications

Common names include:

• Captopril]]> (Capoten)
• ]]>Enalapril]]> (Vasotec)
• ]]>Lisinopril]]> (Prinivil, Zestril)
• ]]>Quinapril]]> (Accupril)
• ]]>Nifedipine]]> (Procardia, Adalat)
• ]]>Diltiazem]]> (Cardizem, Dilacor XR)
• ]]>Verapamil]]> (Calan, Isoptin)
• ]]>Nicardipine]]> (Cardene)
• Bepridil (Vascor)
• ]]>Isradipine]]> (DynaCirc)
• ]]>Amlodipine]]> (Norvasc)
• ]]>Nisoldipine]]> (Sular)
• ]]>Nimodipine]]> (Nimotop)
• ]]>Clonidine]]> (Catapres)
• ]]>Prazosin]]> (Minipress)

Blood pressure medications are given to lower high blood pressure.

Possible side effects include:

• Low blood pressure
• Skin rash
• Dry mouth
• Cough
• Dizziness
• Diarrhea or constipation

Antibiotics

Common names include:

• Tetracycline]]>
• ]]>Ampicillin]]>
• ]]>Metronidazole]]> (Flagyl)
• ]]>Clarithromycin]]> (Biaxin)
• ]]>Azithromycin]]> (Zithromax)
• ]]>Vancomycin]]>

Antibiotics may be given to help treat the diarrhea of scleroderma, which is often caused by an overgrowth of bacteria in the small intestine.

Special precautions for antibiotics include the following:

• Take tetracycline with food to avoid stomach upset.
• Wait two hours between taking antacids or milk and taking a dose of tetracycline.
• Take ampicillin on an empty stomach.
• Avoid alcohol while using metronidazole.

Possible side effects include:

• Nausea
• Vomiting
• Antibiotic allergic reaction
• Increased sun sensitivity
• Children given tetracycline may develop permanent tooth discoloration

H-2 Blockers

Common names include:

• Cimetidine]]> (Tagamet)
• ]]>Ranitidine]]> (Zantac)
• ]]>Famotidine]]> (Pepcid)
• ]]>Nizatidine]]> (Axid)

H-2 blockers help decrease acid production in the stomach. They may be given to help with ]]>heartburn]]> , indigestion, and difficulty swallowing.

Possible side effects include:

• Dizziness
• Confusion (cimetidine, especially in the elderly)
• Headache
• Diarrhea

Proton Pump Inhibitors

Common names include:

• Omeprazole]]> (Prilosec)
• ]]>Lansoprazole]]> (Prevacid)

Proton pump inhibitors decrease acid production in the stomach. They may be given to help with heartburn, indigestion, and difficulty swallowing.

Possible side effects include:

• Dizziness
• Headache
• Diarrhea

Gastrointestinal Stimulants

Common names include:

• Bethanechol]]> (Urecholine)
• ]]>Metoclopramide]]> (Reglan)

These medications are given to improve difficulty swallowing.

Possible side effects include:

• Heart rhythm problems (cisapride)
• Diarrhea
• Stomach upset, cramping
• Headache
• Dizziness
• Sleepiness (metoclopramide)

Antacids

Common brand names include: Gaviscon, Di-Gel, Mylanta, Maalox, Tums

Antacids work to neutralize acidity in the stomach. They’re given to improve symptoms of heartburn and indigestion

Possible side effects include:

• Diarrhea
• Constipation