Plaquenil v. Prednisone
I was reading, and I noticed that some people are on Plaquenil and some on Prednisone... And that most people aren't on both... I'm just curious what the difference is and what one treats as opposed to the other? And, is there a reason why people typically aren't on both?
I, for one, am on Plaquenil and cannot take steroids because of my type 1 diabetes. I have an allergy to NSAIDs. Steroids raise your blood sugars horribly if you have diabetes.
They had to start me off slowly on the Plaq because my stomach is paralyzed and, with the flare, I was throwing up pretty much everything or it would sit on my stomach for days and days. I have to rely on gravity to move food (and pills!) through my stomach.
I have had VERY few problems with this drug and they upped to the full dose today so now I can look forward to feeling better.
Some people probably react better to drug A than to drug B. Some may need a combination of drugs. It's a very individual thing.
prednisone vs plaquenil
I am taking plaquenil 200 mg per day, and prednisone as well, i flare up pretty bad 5 months ago, so they put me on plaquenil, prednisone and cytoxin.
i went from 60 mg of prednisone to 5 mg.
the docs generally put you on both after a bad flare up.
i am suppose to go off prednisone in a month. (i am so tired of beeing a chubby hairy thing!!!!LOL)
In my case, I am on Plaq 400 mg a day. I'm not on prednisone BUT I get corticosteroid shots every six months or so in my hips (both sides) which does the same thing the Prednisone would do without the side effects ;) (that's what my dr said anyway). I can always tell when I've gotten a shot tho cause the pain gets much worse for a day or two, then that and the inflammation recede. They don't go away but they do get much better.
I've been in the midst of a bad flare for a month or so now so my dosages keep going up. I am on 400 mg of Plaquenil a day, 30 mg of prednisone a day, 500 mg of sulfasalazine a day, and 20 mg of mexotrexate a week (my rheumy wants to up this dosage with an injectible version). I'm so sick of taking pills I could scream. :shock:
I think the prednisone has more visible side effects, but it takes less time to get inflammation down than plaquenil. They usually try to keep you off it if your getting results with other meds and your flares are under control, but I seem to go back on it within a month of them taking me off it. Seems to be the only thing that can effectively control the inflammation in my joints and around my heart.
Thanks guys for your replies!!
Ironically, I was just asking out of curiousity... Then yesterday (exactly one week later, if you notice) my nephrologist said that she wanted to try and get me on Plaquenil... I must be FREAKIN' PSYCHIC!! LOL!!
So, I'm still not really sure what Plaquenil is for...??? She mentioned this medication after I said something to her about my increasing joint and muscle pain... Is this a PAIN pill? If so, is it going to make me drowsy? What ARE the side effects, and how do they differ from Prednisone's?
Full of questions as usual!!
I'm on both
AND Methotrexate. I don't like the side effects of Prednisone so I'm weaning off of it.
The primary differences are:
1. Plaquenil is an antimalrial (a Hydroxychloroquine )
2. Prednisone is a corticosteroid (anti-inflammatory drug)
Their uses are for two completely different reasons in the treatment of lupus.
Anti-malarials are particularly effective in treating skin and joint symptoms that may occur in SLE. They have been demonstrated to improve:
muscle and joint pain - inflammation of the lining of the heart (pericarditis) -
inflammation of the lining of the lung (pleuritis) - other symptoms of lupus such as fatigue and fever. Anti-malarials are also useful in subacute cutaneous lupus, and in overlap syndromes which have acute symptoms of lupus and other autoimmune disorders.
Anti-malarials appear to interfere with immune cellular function. The antimalarials are weak bases and can alter the pH inside the cell, thus interfering with intracellular enzyme activity that depends on a more acidic micro environment. When this occurs, there is an anti-inflammatory effect. Many chemicals that participate in the inflammatory cascade are altered, and blood is thinned due to alterations in platelet aggregation.
It is also known that anti-malarials protect against the damaging effects of ultraviolet light and can improve skin lesions.
In addition, anti-malarials combine with certain chemicals or groups of proteins that play a role in the immune response. Anti-malarials have an effect on immune mediators, such as cytokines: They decrease auto-antibody production, inhibit the proliferative response of lymphocytes that are activated, and may have a direct effect on DNA. In these ways anti-malarials have the potential to put the disease into remission.
The side effects of plaquenil are not common, when they do occur, they are generally headache, dizziness, loss of appetite, upset stomach, diarrhea, stomach pain, vomiting, and skin rash.
Plaquenil has been known to cause retinal damage. Your doctor will have you see an opthomologists 2-3 times a year to make sure this does not occur. It generally takes several weeks to see the benefits of plaquenil, but when it starts, it usually is very successful.
Many of the symptoms of lupus result from inflammation in various tissues of the body. Cortisone, a steroid manufactured naturally by the body's adrenal glands, has been found to have a distinct anti-inflammatory effect. Cortisone medications made synthetically are among the most effective anti-inflammatory drugs known. Although these drugs can cause undesirable side effects, their use can substantially reduce the symptoms associated with inflammation, such as: swelling, warmth, tenderness, and pain.
Steroids produced by the outer part (cortex) of the adrenal gland are called corticosteroids . Corticosteroids are different from the “anabolic steroids” that weightlifters and other athletes sometimes take illegally to increase strength. Prednisone is the synthetic corticosteroid preparation most often used in the treatment of lupus. Prednisone is an extremely effective drug and may be necessary to control active lupus. Those individuals with organ-threatening disease (i.e., heart, lung, brain, kidney, liver) usually need steroids in order to prevent loss of function in the organ. Corticosteroid treatment usually relieves most symptoms promptly. When pleurisy (inflammation around the lung) or pericarditis
( inflammation around the heart) occur, small or moderate doses of steroids are helpful. Steroids can often be avoided completely in mild cases of lupus (i.e., those involving only the joints and skin).
Side effects include increased appetite, indigestion, nervousness or restlessness, swollen face. At a high dose, Prednisone may cause fluid retention and high blood pressure. If this happens, you may need a low-salt diet and a potassium supplement. With prolonged Prednisone treatment, eye problems may develop (e.g. a viral or fungal eye infection, cataracts, or glaucoma). If you take it over the long term, the buildup of adrenal hormones in your body may cause a condition called Cushing's syndrome, marked by weight gain, a "moon-faced" appearance, thin, fragile skin, muscle weakness, brittle bones, and purplish stripe marks on the skin. Women are more vulnerable to this problem than men.
I hope that I've answered your question. 8)
Peace and Blessings
I've been on both at the same time..many many times....