|Names: Drug induced lupus is also called drug-induced lupus erythematosus (DILE).
What Is Drug Induced Lupus?
Drug induced lupus (DILE) is a temporary form of lupus that is brought on by a reaction to medication. Once the medication is stopped; symptoms usually decline within a few days and disappear within one or two weeks.
What Are The Symptoms?
Specific criteria for the diagnosis of DILE have not yet been established. However, many of the symptoms overlap with symptoms of lupus. These include:
• Flu like symptoms
• Extreme tiredness
• Joint and muscle pain
• Inflammation of the heart and lungs (may cause chest pain)
• Blurred vision
• Skin rash which worsens in sunlight. 'Butterfly' rash across nose and cheeks.
• Loss of appetite and weight loss.
Symptoms tend to appear after 3 to 6 months of taking medication. Usually discomfort is mild but it can worsen if the medication is continued.
Note: DILE symptoms should not be confused with ordinary short-term side effects of medications. Side-effects usually occur within a few hours or days of starting a medication. DILE on the other hand only occurs after many months of continuous therapy.
What Causes It?
DILE is similar to lupus in that it is an autoimmune disorder. This means the body mistakenly attacks healthy tissues in the body causing inflammation (read more about the causes of lupus). Essentially it is a hypersensitive reaction to a medication. Researchers have compiled is a list of medications which are most likely to create this reaction. Typically medications used to treat chronic (long-term) diseases like high blood pressure and heart disease are associated with the highest risk. DILE is more common in men over the age of 50; this is because more men than women are afflicted by chronic illness.
Which Medications Cause Drug Induced Lupus?
At least 38 medications have been identified. These include treatments for:
• Thyroid disease
• Heart disease
• Neuropsychiatric disorders (such as ADHD)
• Some anti-inflammatory agents and antibiotics
The 3 drugs most likely to cause DILE are:
• Hydralazine (Apresoline)
• Procainamide (Pronestyl)
• Quinidine (Quinaglute)
Note: Even with high risk medications only 5 to 20 percent of people treated for 1 to 2 years will develop DILE.
|List Of Drugs And Associated Risk Of Drug Induced Lupus
Drugs to prevent harmful heart arrhythmias
Procainamide (Pronestyl). Risk: high
Quinidine (Quinaglute). Risk: moderate
Disopyramide (Norpace). Risk: very low
Propafenone (Rythmol). Risk: very low
Drugs to treat thyroid disease.
Propylthiouracil (Propyl-thyracil). Risk: low
Blood pressure drugs to treat hypertension
Hydralazine (Apresoline). Risk: high
Methyldopa (Aldomet). Risk: low
Captopril (Capoten). Risk: low
Acebutolol (Sectral). Risk: low
Enalapril (Vasotec). Risk: very low
Clonidine (Catapres). Risk: very low
Atenolol (Tenormin). Risk: very low
Labetalol (Normodyne, Trandate). Risk: very low
Pindolol (Visken). Risk: very low
Minoxidil (Loniten). Risk: very low
Prazosin (Minipress). Risk: very low
To treat bacterial infections
Isoniazid (INH). Risk: low
Nitrofurantoin (Macrodantin). Risk: very low
Minocycline (Minocin). Risk: low
Reduce inflammation in the body
D-Penicillamine (Cuprimine). Risk: low
Sulfasalazine (Azulfidine). Risk: low
Phenylbutazone (Butazolidin). Risk: very low
Water pills, to reduce water retention
Chlorthalidone (Hygroton). Risk: very low
Hydrochlorothiazide (Diuchlor h). Risk: very low
Tranquilizing drugs used to treat psychiatric behavior
Chlorpromazine (Thorazine). Risk: low
Perphenazine (Trilafon). Risk: very low
Phenelzine (Nardil). Risk: very low
Chlorprothixene (Taractan). Risk: very low
Lithium carbonate (Eskalith). Risk: very low
Medications to prevent epileptic seizures
Phenytoin (Dilantin). Risk: very low
Carbamazepine (Tegretol). Risk: low
Trimethadione (Tridone). Risk: very low
Primidone (Mysoline). Risk: very low
Ethosuximide (Zarontin). Risk: very low
Lovastatin (Mevacor, cholesterol lowering drug). Risk: very low
Levodopa (Dopar, treats Parkinson's & restless leg syndrome): very low
Aminoglutethimide (Cytadren, used by athletes). Risk: very low
Alpha-interferon (Wellferon, treats some cancers and hepatitis). Risk: very low
Timolol eye drops (Timoptic). Risk: very low
How Is It Diagnosed?
There is no single test for DILE. Instead your doctor will make an educated guess based on the presence of symptoms and the results of a blood test. A blood test will be performed to check for certain antibodies. It will also help differentiate between DILE and lupus. A chest X-ray and electrocardiogram may be performed to test for signs of lung or heart inflammation.
How Is It Treated?
If possible the suspected medication should be replaced with a similar one. If it is the culprit, symptoms will quickly disappear. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be given to reduce muscle and joint soreness. In severe (but rare) cases high doses of corticosteroids (methylprednisolone or prednisone) and immune system suppressants (cyclophosphamide or azathioprine) will be prescribed for severe joint inflammation and inflammation around the heart or lungs. Corticosteroid creams may be taken to treat skin rashes. Anti-malaria drugs are sometimes prescribed to treat skin and arthritis symptoms (read more about these, lupus treatments).
What Is The Outlook?
By definition, DILE is cured by no longer taking the offending drug. In many cases, symptoms disappear within a few weeks, although in some cases it can take months. Ideally the patient should avoid taking the drug in the future.