Systemic Lupus Erythematosus Drug Summary

Apply thin coat 24 hourly or as often as needed

• No photoallergic or contact properties
• Opacity may be cosmetically undesirable

• Hematologic effects (bone marrow disorders, leukopenia, thrombocytopenia, anemia); GI effects (GI disturbance, nausea, pancreatitis, cholestasis, liver damage); Other effects (increased risk of secondary infection and neoplasia, hypersensitivity reaction)

• Monitor CBC with differential and platelet, LFTs, total bilirubin, CrCl, symptoms of infection
  • At least once weekly CBC on the first month; twice monthly on the second and third month, and monthly or more frequently if dosage alterations or other therapy changes are necessary
• Patient should promptly report any signs of infection, bruising or bleeding or other manifestations of bone marrow depression; most neutropenia associated with immunosuppressants occurs sporadically many months after starting therapy
• Contraindicated in patients with chickenpox/herpes zoster
• Use with caution in patients with renal or hepatic impairment

• Dermatologic effects (alopecia, skin and nails hyperpigmentation); GI effects (nausea/vomiting, mucositis); Other effects (inappropriate ADH secretion, carbohydrate metabolism disturbances, gonadal suppression, interstitial pulmonary fibrosis)
• Severe reactions: Anaphylactic reactions, bone marrow failure, severe immunosuppression, urotoxicity, cardiotoxicity, hyponatremia, hemorrhagic cystitis

• Patient should promptly report any signs of infection, bruising or bleeding or other manifestations of bone marrow depression; most neutropenia associated with immunosuppressants occurs sporadically many months after starting therapy
• Contraindicated in patients with impaired bone marrow function, bladder inflammation, urinary outflow obstruction and active infections
• Use with caution in patients with renal or hepatic impairment, DM, severe immunosuppression

• CV effects (hypertension, hypotension, peripheral edema, chest pain, tachycardia); CNS effects (pain, headache, insomnia, dizziness, anxiety); GI effects (abdominal pain, diarrhea, nausea/vomiting); Metabolic effects (hyperglycemia, hypercholesterolemia, hypomagnesemia, hypokalemia, hypocalcemia, hyperkalemia); Other effects (rash, fever, abnormal CBC)

• Use with caution in patients with severe renal impairment, active GI disorders, and in those with intrauterine devices (due to increased risk of infection)
• Risk of infection and activation of latent viral infection is increased; neutropenia (including severe neutropenia) may occur, requiring dose reduction or interruption of treatment

• Respiratory effects (nasopharyngitis, upper respiratory tract infections, bronchitis, cough); Other effects (infusion-related reactions, herpes zoster)
• Serious hypersensitivity reactions including angioedema and anaphylaxis have been reported

• Avoid initiating treatment during an active infection and avoid use of live or live-attenuated vaccines
• Before prescribing Anifrolumab, consider the individual benefit-risk in patients with known risk factors for malignancy
• Contraindicated in patients with a history of anaphylaxis with Anifrolumab-fnia

• CNS effect (migraine); GI effects (nausea, diarrhea); Psychological effects (suicide/suicidal ideation, depression); Dermatologic effects (rash, urticaria, pruritus, hypersensitivity reaction), Respiratory effects (upper respiratory tract infection, bronchitis); Other effects (fever, leukopenia, injection site reactions, urinary tract infection)

• Not recommended for use in patients with severe active CNS lupus, HIV, history of/currently with hepatitis B/C, hypogammaglobulinemia or IgA deficiency, history of major organ transplant, hematopoietic stem cell/marrow transplant, or renal transplant
• Patient's condition should be evaluated continuously
• Should not be administered as an IV bolus

• CNS effects (headache, tremor, paresthesia, hearing loss, visual disturbances, peripheral neuropathies, convulsions); CV effects (hypertension, cardiac arrest, heart failure, ventricular arrhythmias, palpitations, cardiomyopathies); GI effects (nausea, diarrhea, dyspepsia, constipation, GI hemorrhage and ulceration); Respiratory effects (dyspnea, parenchymal lung disorders, pleural effusions, cough, nasal congestion, pharyngitis, asthma); Dermatologic effects (acne, alopecia, skin rashes, pruritus); Musculoskeletal effects (muscle cramps, asthenia, arthralgia); Hematologic effects (pancytopenia, agranulocytosis, coagulation disorders); Other effects (renal impairment, hyperlipidemia, febrile disorders, edema, liver dysfunction)
• Potentially fatal: Polyoma virus infections, GI perforation

• Use with caution in patients with renal impairment and hepatic impairment, patient with risk factors for QT prolongation
• Monitor for infections, ECG, BP, FBS, hematological, neurological (including visual) and coagulation parameters, electrolytes, hepatic and renal function, whole blood Tacrolimus trough concentration (especially during diarrhea episodes)

• GI effects (diarrhea, abdominal pain, dyspepsia, mouth ulceration); Renal effects (decreased GFR, renal impairment, acute kidney injury); Other effects (hypertension, headache, anemia, cough, UTI, alopecia, fatigue, tremor, decreased appetite)

• Establish an accurate baseline estimated GFR (eGFR) and check BP prior to starting Voclosporin; modify dose based on eGFR
• Contraindicated in patients with known serious or severe hypersensitivity reaction to Voclosporin or any of its excipients, concomitantly using Ketoconazole, Itraconazole or Clarithromycin
• Use with caution in patients with risk factors for hyperkalemia or QT prolongation
• Monitor for neurologic abnormalities, drug interactions, renal function, serum potassium levels
• Consider discontinuing therapy if without therapeutic benefit by 24 weeks
• Avoid live vaccines