Fumaderm®
introduction
Fumaderm® is a drug that is used in the form of tablets for the skin disease psoriasis (Psoriasis vulgaris) is applied. It is the most commonly used drug for psoriasis, and it is used in patients with both severe and moderate psoriasis. There are a total of four different fumaric acid esters that are contained in the drug Fumaderm®. These active ingredients all come from the plant Fumaria officinalis (common ground smoke). Overall, Fumaderm® can help patients to improve or minimize symptoms during an acute attack, but a cure for psoriasis is still not possible.
application areas
Fumaderm® are tablets that are used in patients with psoriasis (psoriasis vulgaris). However, since the side effects of Fumaderm® can be quite high, it is important that Fumaderm® is only used in patients who suffer from the severe form of psoriasis and for whom the benefit of taking Fumaderm® is greater than the risk the side effects. Fumaderm® is now also recommended for patients who suffer from moderate psoriasis. In general, however, Fumaderm® should only be used when the sole external therapy with lotions and creams no longer seems sufficient (see also local therapy for psoriasis).
Furthermore, it is recommended not to take Fumaderm® for longer than 10 years, otherwise the white blood cells (Leukocytes) fall very sharply and thus the patient's immune system is severely weakened, which in turn makes the patient more susceptible to diseases. Fumaderm® can be administered in addition to the external therapy with creams and lotions, but it can also be taken as a sole therapy (so-called monotherapy) (see also therapy for psoriasis). However, it is important to know that the dosage of Fumaderm® must be increased slowly in order to better assess the side effects. You start with a loading dose and slowly increase the dose so that the patient's body can get used to the drug.
Application restrictions
There are various causes that can prevent a patient from taking Fumaderm®. On the one hand, it is possible that a patient is hypersensitive or allergic to one of the active ingredients contained in Fumaderm®. In this case the patient should not take Fumaderm® for their own safety. Furthermore, patients with severe gastrointestinal diseases are not allowed to take Fumaderm®, as it can be very damaging to the gastrointestinal tract.
Patients with severe liver disease or kidney disease should not take Fumaderm® either, as it can severely impair liver function in particular (read about this: Symptoms of Liver Failure).
In general, Fumaderm® should only be used if all other therapy options have failed and only if the patient has a moderate or severe form of psoriasis. In the case of a mild form of psoriasis, the use of Fumaderm® is not recommended, as the side effects then outweigh the benefits of the treatment.
Due to the sometimes very high side effects, children under the age of 18 should not be prescribed the drug Fumaderm®. Pregnant patients or patients who are still breastfeeding their child must not take Fumaderm®. Even with a special form of psoriasis, pustular psoriasis (read about this: Complaints with psoriasis) Fumaderm® must not be used. There are also various drugs that cause the effect of Fumaderm® to be increased or weakened.
At the same time, Fumaderm® can ensure that the effect of these drugs is weakened or increased, which is why it must not be taken together with drugs such as methotrexate, retinoids, psoralens, cyclosporines, immunosuppressants, cytostatics or other drugs that damage the kidneys.
Side effects
Fumaderm® is a drug with a lot of side effects, which is why the benefit of the therapy should be superior to the risk. Very often, that means in one in 10 patients, so-called flushes occur, i.e. sudden reddening of the face with an enormous feeling of heat. On the other hand, allergic reactions occur less frequently, i.e. in 1 in 1,000 to 10,000 patients.
However, side effects of Fumaderm® on the gastrointestinal tract (gastrointestinal tract) are very common. Every 10th patient suffers from diarrhea, every hundredth to a feeling of fullness, epigastric cramps and flatulence. Furthermore, many patients also suffer from nausea.
The side effects mostly occur at the beginning of therapy, but they often persist throughout the entire duration of therapy. In addition, patients may occasionally experience headaches, fatigue and drowsiness. A change in the blood count occurs in most patients, although the extent can vary widely. Regular checks are particularly important here, as otherwise, in the worst case, the patient may have hardly any white blood cells (leukocytes) in the blood and these are no longer reproduced (irreversible pancytopenia).
A rare but dire side effect of Fumaderm® is kidney failure.
dosage
The exact dosage of Fumaderm® should be discussed with a dermatologist, as he can best assess how severely the patient is affected by psoriasis and which dosage is therefore appropriate. It may be necessary to increase the dosage of Fumaderm® for a short period of time during an acute attack, after consulting the doctor in charge. When taking Fumaderm® for the first time, it is also important that the patient slowly gets used to the medication. After taking an initial dose, the dosage of Fumaderm® can be adjusted according to the patient's needs.
Further therapy options can be found in our main article on Psoriasis.
As a rule, most patients initially take Fumaderm® for three weeks. During this time, the patient can get used to the side effects and the body settles for them. The dose is then increased. For example, in the first week after the initial dose has been taken sufficiently, the patient only takes one Fumaderm® tablet a day. In the second week he then takes two tablets, one in the morning and one in the evening. In the third week, the patient can now take one tablet each morning, noon and evening, for a total of three tablets per day. The dose can be adjusted on a weekly basis. This increase scheme is very important so that the patient's body can slowly get used to Fumaderm®.
The maximum dose of Fumaderm® that can be taken is two tablets three times a day, for a total of six tablets per day. However, it is important to know that not every patient has to take these six tablets per day, but that this maximum dose is primarily intended for a phase of the acute attack.
You can find more about therapy during a psorias flare here: Therapy of psoriasis.
It is also important to know that the treatment success of Fumaderm® is only possible from the 4th to 6th Week can be seen. It is very important that the treatment is not simply stopped, but that the patient wait for the drug to work. The exact dosage should always be discussed with the attending physician. It should be so high that the patient no longer shows symptoms of psoriasis while receiving Fumaderm® therapy, and so low that the side effects are as low as possible and tolerable for the patient.
Ingestion
The Fumaderm® tablets are taken with plenty of liquid (preferably water) and preferably immediately after a meal. The tablets have a coating that prevents the stomach acid from breaking down the tablets in the stomach. The Fumaderm® tablets can pass the stomach unhindered and are then opened in the intestine and the active ingredients are released into the blood through the intestinal wall, so that the active ingredient of Fumaderm® reaches the skin via the blood and can develop its effect there.
Controls under Fumaderm treatment
In general, it is important to know that Fumaderm® has quite high side effects and therefore various organs in the body must be checked regularly to ensure that these organs are not damaged by treatment with Fumaderm®. On the one hand, the patient has to have his blood drawn regularly to ensure that the white blood cells (leukocytes), which are important for the immune system, do not decrease due to Fumaderm®.
Since Fumaderm® can also damage the kidneys and liver, it is important that kidney and liver values such as creatinine, SGOT, SGPT, Gamma-GT and AP are checked regularly (read more on the subject Laboratory values). If these values deviate from the norm during treatment with Fumaderm®, this can be an indication that Fumaderm® is damaging the liver or the kidneys. In this case, treatment must be stopped.
The patient's urine must also be checked regularly, as the urine can be used to determine whether the patient is developing what is known as Fanconi syndrome. Treatment with Fumaderm® leads to a loss of function (insufficiency) of the kidneys (please refer Symptoms of renal insufficiency) and to a softening of the bones (Osteomalacia).
Regular monitoring (at the beginning of therapy every two weeks) is very important so that serious side effects of Fumaderm therapy can be recognized directly. If there are abnormal kidney values, a decrease in the concentration of white blood cells (leukocytes) or immune blood cells (lymphocytes), treatment with Fumaderm® must be stopped immediately.
