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by Carson-DeWitt R

Medications for Scleroderma

The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medications as advised by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.
There are no medications available to cure or halt the progression of scleroderma. Scleroderma is treated on a symptom-by-symptom basis.

Over-the-counter Medications

Prescription Medications

Disease-modifying Antirheumatic Drugs (DMARDs)
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.
Possible side effects include:
  • Nausea
  • Diarrhea
  • Liver inflammation
  • Bladder inflammation
  • Kidney damage
  • Nerve damage
  • High blood pressure
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
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
Corticosteroids are strong anti-inflammatory agents. They are given to reduce swelling, inflammation, and joint pain.
Possible side effects for short-term use (about 3 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 3 weeks or longer) include:
  • Weakening of the immune system and an increased risk of developing infections
  • Thinning, weak bones— osteoporosis
  • Cataracts , glaucoma
  • Indigestion
  • Swelling in the hand, face, and legs
  • Easy bruising
  • Gastritis
Calcium-channel Blockers
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 the tip the 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
  • Lightheadedness
  • Headache
  • Swelling
Vasodilators
These medications are used for Raynauds phenomenon that is not responding to other forms of treatment. They are also used to heal digital ulcerations and 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
Blood pressure medications are given to lower high blood pressure.
Possible side effects include:
  • Flushing of the skin
  • Cough
  • Headaches
  • Nausea
  • Jaw pain
  • Fainting
Prostanoids
Prostanoids are given to improve circulation of blood.
Possible side effects include:
  • Low blood pressure
  • Dry mouth
  • Cough
  • Lightheadedness
  • Diarrhea or constipation
Antibiotics
Antibiotics may be given to help treat the diarrhea of scleroderma, which is often caused by an overgrowth of bacteria in the small intestine.
Possible side effects include:
  • Nausea
  • Vomiting
  • Antibiotic allergic reaction
  • Increased sun sensitivity
H-2 Blockers
H-2 blockers help decrease acid production in the stomach. They may be given to help with heartburn and indigestion.
Possible side effects include:
  • Lighheadedness
  • Confusion
  • Headache
  • Diarrhea
Proton Pump Inhibitors
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:
  • Lightheadedness
  • Headache
  • Diarrhea
Gastrointestinal Stimulants
These medications are given to improve difficulty swallowing.
Possible side effects include:
  • Heart rhythm problems
  • Diarrhea
  • Stomach upset, cramping
  • Headache
  • Lightheadedness
  • Sleepiness

Over-the-Counter Medications

Antacids
Antacids work to neutralize acidity in the stomach. They’re given to improve symptoms of heartburn and indigestion
Possible side effects include:
  • Diarrhea
  • Constipation

Special Considerations

Whenever you are taking a prescription medication, take the following precautions:
  • Take your medicines as directed. Do not change the amount or the schedule.
  • Do not stop taking them without talking to your doctor.
  • Do not share them.
  • Ask what results and side effects to expect. Report them to your doctor.
  • Some drugs can be dangerous when mixed. Talk to a doctor or pharmacist if you are taking more than one drug. This includes over-the-counter medicines and herb or dietary supplements.
  • Plan ahead for refills so you don’t run out.

References

Durand F, Staumont D, Bonnevalle A, Hachulla E, Hatron PY, Thomas P. Ultraviolet A1 phototherapy for treatment of acrosclerosis in systemic sclerosis: controlled study with half-side comparison analysis. Photodermatol Photoimmunol Photomed. 2007;23(6):215-221.

Iloprost. Pulmonary Hypertension Association website. Available at: http://www.phassociation.org/Patients/Treatment/Iloprost. Accessed May 20, 2014.

Kreuter A, Hyun J, Stücker M, Sommer A, Altmeyer P, Gambichler T. A randomized controlled study of low-dose UVA1, medium-dose UVA1, and narrowband UVB phototherapy in the treatment of localized scleroderma. J Am Acad Dermatol. 2006;54(3):440-447.

Scleroderma. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health%5FInfo/Scleroderma/default.asp. Updated August 2012. Accessed May 20, 2014.

Systemic sclerosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 4, 2014. Accessed May 20, 2014.

Thompson AE, Shea B, Welch V, Fenlon D, Pope JE. Calcium-channel blockers for Raynaud's phenomenon in systemic sclerosis. Arthritis Rheum. 2001;44(8):1841-1847.

What is scleroderma? Scleroderma Foundation website. Available at: http://www.scleroderma.org/site/PageNavigator/patients%5Fwhatis.html. Accessed May 20, 2014.

Zachariae H, Halkier-Sorensen L, Bjerring P, Heickendorff L. Treatment of ischaemic digital ulcers and prevention of gangrene with intravenous iloprost in systemic sclerosis. Acta Dermato-Venereologica. 1996;76:236-238.

3/1/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Maalox Total Relief and Maalox liquid products: medication use errors. US Food and Drug Administration website. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm200672.htm. Updated February 18, 2010. Accessed March 20, 2014.

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