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Treatment

Fortunately, not all people with sarcoidosis need to resort to medication, because in some patients the sarcoidosis will go away on its own. These people do remain under the supervision of one or more doctors during this time. In other words, they wait to see how the sarcoidosis develops. This wait-and-see policy applies to approximately half of the sarcoidosis patients.

Even these people that do not need medication can have a lot of symptoms and feel very sick. But because medication has many side effects and requires long-term use in a high dosage, drug treatment will always be given with due consideration.

The medication that is prescribed when necessary does not cure sarcoidosis, it just suppresses the inflammation. Initially, this is done with corticosteroids in the form of prednisone.

The optimal treatment

not every drug has been shown to be equally suitable for suppressing inflammation in sarcoidosis. Of course, doctors prefer to provide the most appropriate, most effective medication. The medication that has proven to be most effective over time is called the first-line medication, i.e. the “preferred medication.” If that does not work (enough) or has too many side effects, one can choose second-line medication or third-line medication.

It also may happen that a drug works less well over time and therefore must be replaced by another medication.

Every person is different and therefore reacts differently to medication. It is essential that you keep a close eye on your reaction to the medication. Discuss this regularly with your doctor. His judgment partly depends on your information.

First-line medication

Drug treatment is, however, necessary if there is loss of function or (imminent) damage to organs, or if the sarcoidosis occurs in the heart, nervous system or eyes. The inflammation must then be suppressed with medication. This is done initially with corticosteroids (prednisone) usually in tablet form.

Second-line medication

If the effect of the corticosteroids is insufficient or if there are serious side effects, other drugs are sometimes added to be able to reduce or even discontinue the corticosteroids. This is done with so-called DMARDs (Disease-Modifying Anti-Rheumatic-Drugs), drugs that suppress the entire immune system. Of course, these drugs are not without side effects either. Examples of these DMARDSs are methotrexate, azathioprine and mycophenolate.

Third-line medication

If the corticosteroids and/or DMARDs have insufficient effect, the next option is biologicals. Biologicals are drugs whose active ingredient is produced by or derived from a living organism. This also makes these drugs expensive. Nowadays, manufacturers are also able to replicate biologicals. These ‘copied’ biologicals are called biosimilars.

Local treatments

In addition to the aforementioned systemic medications (medications administered by infusion or tablet and therefore effective throughout the body), local treatments may also be an option with some forms of sarcoidosis. For example, an ointment with corticosteroids may be prescribed for sarcoidosis of the skin and eye drops with corticosteroids may be used for ocular sarcoidosis.

Pain management

Klachten van spieren en gewrichten komen vaak voor bij sarcoïdose. Ter bestrijding van deze pijnklachten zijn de meest gangbare medicijnen paracetamol en zogeheten Niet Steroïde Anti-Inflammatoire Drugs (NSAID’s). NSAID’s werken ook ontstekingsremmend maar zijn veel minder krachtig dan corticosteroïden.

Medication use

Medications are not miracle drugs. There are many factors that determine whether a medication has the right effect and whether or not it has side effects. You can partly influence this yourself, namely by taking your medication in the right way. Because several medications are often used together, the interaction between them is also important.

Tips for medication use

  1. Take medications at a set time. This will prevent you from forgetting. A useful tool is the dosage box that you can buy at any pharmacy.
  2. Stick to the dosage and instructions on the label. These can sometimes differ from the dosage and instructions given in the leaflet.
  3. If you need to take a medicine several times a day, spread the times out over the day as prescribed.
  4. If you are taking several different medications, a medication passport is recommended. Always bring this with you when visiting a doctor or pharmacist and ask them to update it.
  5. Store medicines in the original container in a dry, cool place, out of reach of children and pets, and no longer than the expiration date. Return medications that are past their date to the pharmacy or give them to the chemo cart.
  6. Take powders, tablets, and capsules with a full glass of water unless the label says otherwise. If you have trouble swallowing the medication, ask your pharmacist about a different form of administration.
  7. If you have any doubts and the leaflet does not answer your questions, always consult your doctor or pharmacist.

For more information on medications, you can also visit: www.apotheek.nl (Dutch)

Interaction between medications

If you are taking several medicines, there may be some interactions: under the influence of one medicine, another medicine may be weaker or stronger. It is therefore important that a doctor knows which other medicines you are taking. Because your pharmacist keeps a list of all your medicines, he can detect a possible interaction with each new prescription. If necessary, he will seek a solution in consultation with the doctor who prescribed the medicine. Over-the-counter medicines can also influence the effect of a number of other medicines. You can find information about interactions in the product leaflet, but you are strongly advised not to use these drugs without consulting your doctor or pharmacist.

Brand name or substance name

In general, there are more agents with the same active ingredient. For example, the corticosteroid drugs Prednisolone, Pred Forte, Prednisolone Minims and Ultracortenol all contain the active ingredient prednisolone. They do not differ in quality, but in form of administration and price. Doctors nowadays put the substance name on their prescriptions as much as possible, so that the pharmacist can deliver the most inexpensive drug.

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