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Coping with Adjunctive Medications

by Jennifer Williams

As all pemphigus and pemphigoid sufferers are quite aware, high doses of steroids are generally used in the first phase of treatment to control the blistering. Often to relieve the unpleasant side effects of such great doses, an immunosuppressive drug (used to prevent production of antibodies) is added into the mix to lessen the steroid dosage. As the side effects of steroids subside, patients are faced with a new challenge: coping with side effects of the immunosuppressive drugs.


The most commonly used drugs used with pemphigus or pemphigoid patients are:

CellCept is a powerful immunosuppressant used as therapy to prevent organ rejection. The most common side effects associated with CellCept include diarrhea, leukopenia (reduction of white blood cells), sepsis (illness caused by infection of the bloodstream) and vomiting.

Azathioprine (Imuran) is an immunosuppressive antimetabolite. Antimetabolite means that it blocks the normal division (mitosis) and functions of cells. It is another anti-rejection drug taken by transplant patients. Side effects include nausea, vomiting, fever, chills, loss of appetite, diarrhea, shortness of breath, blood in the urine or stool, unusual bruising, fatigue, missed menstrual period, yellowing of the eyes and skin, hair loss, muscle or joint pain, and darkening of the skin and fingernails.

Cyclophosphamide (Cytoxan) is an immunosuppressive often used in the treatment of cancer. It interferes with the multiplication of specific cells and slows or stops their growth and spread in the body. Side effects can include nausea, vomiting, decreased blood counts (bone marrow depression), hair loss (Alopecia) and irritation of the bladder.

Cyclosporine, is an immunosuppressive used to prevent rejection of kidney, liver, and heart transplants. Common side effects are upset stomach, vomiting, diarrhea, loss of appetite, increased hair growth and sinusitis.

Methotrexate, an antimetabolite, is generally used as a treatment for many types of cancer. It can cause temporary reduction in the production of blood cells by the bone marrow, sore mouth and taste change, diarrhea, fatigue and a general feeling of weakness.

Dapsone (DDS) is an antibiotic used to treat leprosy, skin infections and pneumonia. Side effects consist of upset stomach, vomiting, sore throat, fever, rash, yellowing of the skin or eyes and unusual bruising.

Tetracycline and Minocycline are antibiotics often used to treat skin diseases. Increased sensitivity of skin to sunlight (rare with minocycline) is a common side effect. Less common reactions include abdominal pain, headache, loss of appetite, nausea and vomiting, visual changes and yellowing skin.

Hydroxychloroquine (Plaguenil) is an antimalarial used most often to prevent and treat acute attacks of malaria. The side effects vary widely with each individual, but can include difficulty breathing, dizziness, loss of appetite, constipation, diarrhea, vomiting, insomnia, anemia, hair loss, blood, kidney, stomach and liver problems and gastro-intestinal problems.

Below is a list of foods that can combat some of these side effects. Foods are generally the best way for your body to absorb the vitamins and minerals it lacks. If you have trouble with any of these foods, you may want to consider a supplement. An important note to consider is that too much Vitamin B-complex or Vitamin C can boost your immunity, therefore reducing the effectiveness of the immunosuppressive and steroid treatment.

Symptoms Helpful Vitamin Food Source
Fatigue, insomnia VITAMIN B (Complex) whole grains, liver and brewer’s yeast
Depression, constipation, shortness of breath, weakness, fatigue, loss of appetite VITAMIN B-1 (thiamine) pork, nuts, wheat germ, poultry, fish brown rice, egg yolks, legumes, whole grains, blackstrap molasses, brewer’s yeast, whole wheat, seafood, potatoes
Inflammation of the mouth, eye problems, dizziness, poor digestion, sore tongue VITAMIN B-2 (riboflavin) cheese, milk, egg yolks, brewer’s yeast, nuts whole grains, blackstrap molasses, yogurt, poultry, green vegetables
Possible loss of muscle control, nervousness, mouth disorders, irritability, muscular weakness, anemia, arthritis, hair loss VITAMIN B-6 (pyridoxine) Milk, cabbage, cantaloupe, legumes, blackstrap molasses, meat, peas, wheat germ, whole grains, brown rice, prunes, fish, leafy green, vegetables, brewer’s yeast, prunes, soya beans.
General weakness, poor appetite, anemia, nervousness VITAMIN B-12 (cobalamin) Pork, beef, cheese, milk/milk products, eggs, fish, kidney, cereals, yeast extracts.
Exhaustion, loss of appetite, impairment of fat metabolism, muscle pain, depression BIOTIN (vitamin H) Sardines, liver, legumes, egg yolks, unpolished rice, lentils, mung bean sprouts, whole grains, brewer’s yeast, oats, nuts, wheat germ.
Liver, kidney and stomach problems, intolerance to fats CHOLINE Leafy green vegetables, heart, lecithin, egg yolks, brewer’s yeast, fish, legumes, soybeans, wheat germ.
Gastro-intestinal disorders, B-12 deficiency, anemia FOLIC ACID B-9 (folate) Root vegetables, tuna, milk/milk products, kidney, liver, oysters, salmon, leafy green vegetables, brewer’s yeast, whole grains, wheat germ.
Eye problems, high cholesterol, skin problems, constipation INOSITOL Citrus fruits, nut, milk, meat brewer’s yeast, blackstrap molasses, whole grains, vegetables.
Gastro-intestinal disturbances, nervous disorders, muscular aches, loss of appetite, insomnia, tiredness, halitosis NIACIN B-3 (nicotinic acid) Beans, green vegetables, rice, bran, whole wheat, nuts, brewer’s yeast, fish, dairy products, poultry, lean meats, milk, eggs, cheese, peas.
Stomach stress, vomiting, diarrhea, kidney trouble PANTOTHENIC ACID B-5 Egg yolks, orange juice, brewer’s yeast, legumes, liver, whole grains, mushrooms, salmon, wheat germ, beans.
Anemia, constipation, tiredness, headaches, digestion problems PABA (para-aminobenzoic acid) Leafy green vegetables, yogurt, wheat germ, blackstrap molasses, brewer’s yeast.
Muscular weaknesses, anemia, appetite loss, swollen joints, slow healing wounds & fractures, bleeding gums, easy bruising, low resistance to infections VITAMIN C (ascorbic acid) Tomatoes, acerola cherries, sprouted alfalfa seeds, peppers, citrus fruits, papaya, potatoes, cantaloupe, broccoli, strawberries, chillies.
Muscle weakness, diarrhea, insomnia, nervousness, soft bones and teeth, myopia VITAMIN D (calciferol) Fat, butter, fish liver oil, herring, sardines, egg yolks, salmon, tuna, margarine. Also, sunlight on human skin is beneficial.
Fragility of red blood cells, dry dull hair, sterility, impotency, gastro-intestinal problems, heart disease, enlarged prostate. VITAMIN E (tocopherol/ tocopheryl) Margarine, cold pressed oils, whole wheat, sweet potatoes, molasses, nuts, dark green vegetables, eggs, oatmeal, wheat germ.
Diarrhea, underweight, gallstones VITAMIN F (unsaturated fatty acids) (linoleic acid) Butter, wheat germ, vegetables, oils, sunflower seeds.
Intestinal malabsorption, nose bleeding, diarrhea, cellular disease VITAMIN K (phylloquinone) Cauliflower, soybeans, polyunsaturated oils, fish liver oils, egg yolks, yogurt, kelp, cow’s milk, alfalfa, leafy green vegetables, blackstrap molasses.
Tendency to bruise and bleed easily (same as symptoms caused by deficiency of vitamin C) VITAMIN P (bioflavoniods, rutin, hesperidin) Buckwheat, black currants, cherries, grapes, fruits.

Liver problems can also occur with immunosuppressives and some of the othe drugs. Milk thistle may be very effective in helping to bring the liver functions back to normal. Evidence exists that milk thistle may protect the liver through a number of mechanisms: antioxidant activity, toxin blockade at the membrane level, enhancement of protein synthesis, antifibriotic activity, and possible anti-inflammatory or immunomodulating effects. A with any supplement they may be some side effects, but the reports on side effects have been minimal. REMEMBER, DO NOT TAKE ANYTHING WITHOUT THE PERMISSION OF YOUR DOCTOR, AND CHECK WITH YOUR DOCTOR OR YOUR PHARMACIST FOR ANY INTERACTION BETWEEN ANY DRUGS YOU ARE TAKING AND ANY OVER-THE-COUNTER DRUGS YOU MIGHT BE TAKING.

Additionally, sipping various herbal teas such as fennel, ginger, chamomile, fenugreek, lemon balm and peppermint throughout the day, should promote calmness and general well being.

The most important idea to grasp from this article is that eating whole foods and avoiding processed foods as much as possible will contribute greatly to your health and to lessening the magnitude of the side effects. For instance, choose whole wheat pastas and breads, brown rice, high-fiber cereals, fruits and vegetables. It is also important to get as many omega-3 essential fatty acids or polyunsaturated fatty acids as possible. They are found most abundantly in flaxseed (linseed) oil, rapeseed (canola) oil, chia seeds, walnuts and walnut oil, the Mediterranean plant, purslane, grass-reared meat, and dark green leafy vegetables. Oily fish are another rich source; herring, mackerel, sardines, pilchards, salmon, and trout. Fresh tuna is a good source, although canned tuna is not as the oil is lost in processing and replaced by another, eg sunflower or soya oil. Vegetarian omega-3 ALA supplements are available, usually as flaxseed (linseed) oil.

Finding the right combination of foods and vitamins to reduce the effects of drugs can be tricky and time consuming. Sometimes, taking something for the side effects of immunosuppressives could enhance the side effects of steroids. It is extremely important you keep in mind that overdoing anything is probably not good for your system. For example, doctors tell you to eat a lot of fish for Omega-3 fatty acids. However, some fish are high in mercury and other chemicals so eating too much fish could be detrimental. To get enough Omega-3s there are other foods you can add in such as walnuts and soybean products. There can also buy Omega-3s at your local health food store.

As always, we tell people who are sensitive to some foods such as garlic or onions that might complicate PV, to watch the amounts of those foods. At this stage, the science of food and pemphigus is theoretical. However, there are many patients who have had problems with many of the foods considered triggers for PV.

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Опубликовано в Health and Lifestyle


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