Medications for Scleroderma
En Español (Spanish Version)

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 recommended 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.

Prescription Medications
Disease-modifying antirheumatic drugs (DMARDs)

  • D-penicillamine (Cuprimine, Depen)
  • Hydroxychloroquine sulfate (Plaquenil)
  • Methotrexate (Rheumatrex)
  • Cyclophosphamide (Cytoxan)
  • Cyclosporin
  • Imitanib Mesylate (Gleevec)
  • Dasatanib
Nonsteroidal anti-inflammatory drugs (NSAIDs)

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

  • Prednisone (Deltasone, Cortan)
  • Methylprednisolone (Medrol)
Calcium-channel blockers

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

  • Epoprostenol (Iloprost)
  • Sildenafil (Bosentan)
Blood pressure medications

  • 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)
Antibiotics

  • Tetracycline
  • Ampicillin
  • Metronidazole (Flagyl)
  • Clarithromycin (Biaxin)
  • Azithromycin (Zithromax)
  • Vancomycin
H-2 Blockers

  • Cimetidine (Tagamet)
  • Ranitidine (Zantac)
  • Famotidine (Pepcid)
  • Nizatidine (Axid)
Proton pump inhibitors

  • Omeprazole (Prilosec)
  • Lansoprazole (Prevacid)
Gastrointestinal stimulants

  • Bethanecol (Urecholine)
  • Metoclopramide (Reglan)
Over-the-counter Medications
Antacids

  • Gaviscon
  • Di-Gel
  • Mylanta
  • Maalox Advanced Regular Strength
  • Tums
Prescription Medications
Disease-modifying Antirheumatic Drugs (DMARDs)
Common names include:

  • D-penicillamine (Cuprimine, Depen)
  • Hydroxychloroquine (Plaquenil)
  • Methotrexate (Rheumtrex)
  • Cyclophosphamide (Cytoxan)
  • Cyclosporine
  • Imitanib Mesylate (Gleevec)
  • Dasatanib
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 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
Common names include:

  • Epoprostenol (Iloprost)
  • Bosentan (Tracleer)
These medications are used for Raynauds phenomenon that is not responding toother forms of treatment, 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
  • Dry mouth
  • Cough
  • Lightheadedness
  • 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.

Possible side effects include:

  • Nausea
  • Vomiting
  • Antibiotic allergic reaction
  • Increased sun sensitivity
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 and indigestion.

Possible side effects include:

  • Lighheadedness
  • 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:

  • Lightheadedness
  • 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
  • Lightheadedness
  • Sleepiness (metoclopramide)
Over-the-Counter Medications
Antacids
Common brand names include: Gaviscon, Di-Gel, Mylanta, Maalox Advanced Regular Strength, 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
Special Considerations
Whenever you are taking a prescription medication, take the following precautions:

  • Take them as directed—not more, not less, not at a different time.
  • Do not stop taking them without consulting your doctor.
  • Don’t share them with anyone else.
  • Know what effects and side effects to expect, and report them to your doctor.
  • If you are taking more than one drug, even if it is over-the-counter, be sure to check with a doctor or pharmacist about drug interactions.
  • 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.

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_Info/Scleroderma/default.asp . Updated August 2012. Accessed August 21, 2013.

Systemic sclerosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed.ebscohost.com/about/about-us . Updated August 5, 2013. Accessed August 21, 2013.

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_whatis.html . Accessed August 21, 2013.

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 https://dynamed.ebscohost.com/about/about-us : 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 2, 2010.

Last Reviewed August 2013



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