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DRUGS & SUPPLEMENTS
General Information
This is the National Library of Medicine searchable drug and supplement data bases. It can be helpful to know more about the medication you are taking if you are having problems tolerating a drug. This is a common problem for Sjogren's patients. Sometimes drug reactions are caused by inactive ingredients.
How to find both active and inactive drug ingredients:
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Enter the name of the medication on the search bar at the top. For example, the drugs name "hydroxychloroquine" or the brand name, Plaquenil. Note that Plaquenil will not list generic hydroxychloroquine brands.
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Search for the drug you want to know about using the manufacturer's or packager's name. Click on the underlined entry, e.g., "hydroxychloroquine sulfate tablet". This will lead you to a page with detailed information.
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Scroll down the "view all sections" box to INGREDIENTS AND APPEARANCE. Click on this entry to find a list of ingredients.
Hydroxychloroquine
Article by Donald Thomas, MD about hydroxychloroquine use in lupus (updated 04-2024)
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Benefits. Although better research is needed in Sjogren's, many of the benefits of taking HCQ are similar. See HCQ II, WHY TREAT SJOGREN'S? for what we know about its use in Sjogren's.
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Practical tips about dosage and when to take the pills.
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Managing side effects, including gastrointestinal, rashes, mood changes, and sleep problems.
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Testing HCQ blood levels is recommended to determine if your current dose is not too high or too low. See the TIP below.
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Desensitization method for patients who develop a rash (Discuss with your doctor first)!
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Retinal screening recommendations, based on AAO recommendations.
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Baseline: Testing is performed once just as you are starting hydroxychloroquine (HCQ).
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Five-Year Window: After that, most people can wait 5 years before annual testing is needed.
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Annual Screenings: Two tests are performed once a year on non-Asian patients, while 3 tests are required for Asian patients.
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Frequency Adjustment: Discuss screening frequency with your ophthalmologist; every 6 months is not necessary for most patients.
This is not medical advice: Be sure to discuss your infividualized screening needs with your eye doctor and rheumatologist.
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TIP: Use the article, Hydroxychloroquine: 5mg/kg/day Is Only the Starting Point, to talk to your rheumatologist about monitoring hydroxychloroquine blood levels.
Why? The "Goldilocks" Range
Ideal dosing maximizes the drug's clinical benefit while avoiding the higher blood levels that increase toxicity risks, most notably retinopathy. While this article was written with lupus in mind, hydroxychloroquine (HCQ) works in a similar way in Sjogren’s, and the exact same concepts apply.
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Key Insights From the Authors
Why is checking a whole blood level so important?
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Exposure vs. Dosage: “Whole-blood HCQ levels tell us what we need to know: how much drug the patient is exposed to. They help identify patients who are underdosed, overdosed, or taking HCQ inconsistently.”
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The Biology of Absorption: “Two patients of the same weight may take the same 400 mg dose, yet one may absorb only a fraction of the dose while the other absorbs nearly all of it. Treating them identically because they weigh the same makes little pharmacologic sense.”
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Moving Beyond Weight-Based Dosing: “Weight-based dosing cannot tell us who is underexposed, overexposed, or not taking the medication consistently. For a drug as important as HCQ, weight-based dosing is no longer good enough.”
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Read the full piece: Hydroxychloroquine: 5mg/kg/day Is Only the Starting Point.
For more practical tips, see HCQ III - PRACTICAL CONSIDERATIONS
Methotrexate
Methotrexate is commonly used to treat Sjogren's arthritis and arthralgia. It is taken by mouth or injected once a week. It should never be taken on a daily basis.
Tips from Donald Thomas, MD about methotrexate use
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Myths about methotrexate
This article was written for rheumatoid arthritis, but applies to Sjogren's.