If sarcoidosis does not resolve on its own, your doctor may prescribe medication. Several specialists at NYU Langone may be involved in your care, depending on which organs are affected.
The goal of treatment is to calm the overactive immune system, decrease inflammation, prevent damage to the lungs and other organs, and alleviate discomfort. NYU Langone specialists may prescribe one or more of these medications and may adjust the dosage according to your progress.
Corticosteroids are the most commonly prescribed medications for sarcoidosis. They help decrease inflammation by suppressing infection-fighting white blood cells. The steroid prednisone is prescribed most often. Your doctor chooses the dosage depending on your symptoms.
Steroids are generally taken by mouth for several weeks or months. However, if they are used for a long time, steroids can have serious side effects, such as cataracts, osteoporosis, obesity, and elevated blood sugar levels. For this reason, doctors prescribe steroids with caution and supervise their use closely.
If your symptoms don’t improve with corticosteroids, your doctor may prescribe immunosuppressive medications, which may calm the overactive immune system and decrease inflammation. The immunosuppressants most commonly prescribed for sarcoidosis include methotrexate, azathioprine, and leflunomide. All are taken by mouth, usually once a week.
Methotrexate and azathioprine interfere with the body’s production of blood cells, sometimes resulting in low levels, which can lead to infections, fever, or bleeding. People taking these immunosuppressants are strongly discouraged from drinking alcohol because the medications pose a higher risk of liver damage than similar medications.
Your doctor may prescribe antimalarial drugs if sarcoidosis affects your lungs or brain. Two of these medications, hydroxychloroquine and chloroquine, can decrease inflammation, as well as relieve joint pain and fatigue. They are taken by mouth. Your doctor determines the dosage depending on your symptoms.
For severe symptoms of sarcoidosis, doctors may recommend biologic response modifiers, also known as biologics. They are the newest class of medication used to manage sarcoidosis.
Most biologics work by targeting and stopping the production of immune system chemicals, which are thought to cause joint inflammation and destruction. A class of biologic called tumor necrosis factor antagonists are among those prescribed for sarcoidosis.
Commonly prescribed medications include etancercept, infliximab, golimumab, and adalimumab. Most of these medications are given by injection.
Because biologics affect the immune system’s ability to fight infection, doctors consider your overall health and medical history before recommending them. Most people are tested for tuberculosis before starting a biologic. Even inactive tuberculosis can be reactivated if biologic medications are used.
Nonsteroidal anti-inflammatory drugs, or NSAIDs, are occasionally recommended for people with sarcoidosis to reduce inflammation and relieve the symptoms of arthritis and fever. NSAIDs include aspirin, ibuprofen, and naproxen. They are all taken by mouth and are available over-the-counter in drugstores.
Long-term use of NSAIDs can lead to heartburn, vomiting, or stomach bleeding. It is important to consult your doctor before taking these medications to treat sarcoidosis symptoms.
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