Drugs that cause Lupus

Drugs that cause Lupus

 

What is Drug induced lupus?

Drug induced lupus is a condition that develops, generally after long term use of certain medications. These medications cause an autoimmune response (the body attacks its own cells) producing symptoms similar to those of Systemic Lupus Erythematosus (SLE), but it is not generally as severe as SLE. Symptoms that occur in both disorders include: muscle and joint pain and swelling; flu-like symptoms such as fatigue and fever. Once the suspected medication is stopped, symptoms should decline within days. Usually symptoms disappear within one or two weeks, there are reported cases of drug induced lupus that do not go away completely after the offending drug is removed. There is a variant of drug induced lupus where the symptoms are less generalised and relate more to prominent skin manifestations. This is known as drug induced subacute cutaneous lupus erythematosus (DISCLE).

Drug-induced lupus can be diagnosed with certainty only by resolution of symptoms and their failure to recur after stopping the medication. Besides stopping the offending drug, non-steroidal anti-inflammatory drugs (NSAIDs) may be used to help symptoms resolve faster. In patients with severe symptoms of drug induced lupus, corticosteroids may be used to help reduce inflammation.

There is a list of over 100 drugs that can cause lupus, the symptoms will often appear after a person has been on high doses of the medication over a number of years. While lupus-inducing drugs are typically those used to treat chronic diseases, no obvious common denominator links the  drugs, although the clinical features and laboratory abnormalities in lupus induced by most drugs are remarkably similar. 

 

Most Common Drugs that Cause the Disorder

Most cases of drug-induced lupus have been associated with Procainamide, Hydralazine, Isoniazid and Quinidine. The risk for developing lupus-like disease from any of the other drugs is low; with some drugs, only one or two cases have been reported.

Antibiotics – Minocycline, isoniazid, rifabutin
Antifungals – Griseofulvin and voriconazole
Anticonvulsants – Valproate, ethosuximide, carbamazepine,  and hydantoins
Hormonal therapy – Leuprolide acetate
Antihypertensives – Hydralazine, methyldopa, and captopril
Anti-inflammatories – Penicillamine and sulfasalazine
Antipsychotics – Chlorpromazine
Cholesterol-lowering agents – Lovastatin, simvastatin (DISCLE), atorvastatin, and gemfibrozil
Biologics – Interleukins (eg, IL-2), interferons (eg, alfa, beta, gamma), TNF-α (etanercept, infliximab, adalimumab),  and rituximab
Inhalers – Tiotropium bromide inhaler
Chemotherapy agents -Docetaxel, paclitaxel, cabazitaxel (DISCLE), gemcitabine (DISCLE)
Other drug categories – Ophthalmic timolol

 

Additional Drugs that may Cause Lupus include the following:

  • Acebutolol
  • Amiodarone (SLE and SCLE)
  • Atenolol
  • Bupropion
  • Cefepime
  • Diltiazem
  • Doxorubicin (DISCLE)
  • Doxycycline (DISCLE)
  • Esomeprazole (DISCLE)
  • Fluorouracil
  • Glyburide
  • Gold salt
  • Hydroxychloroquine
  • Imiquimod (DISCLE)
  • Lamotrigine
  • Lansoprazole (DISCLE)
  • Lithium
  • Mephenytoin
  • Methimazole (bullous SLE)
  • Nitrofurantoin
  • Olanzapine
  • Omeprazole (DISCLE)
  • Oral contraceptives
  • Phenytoin
  • Practolol
  • Propylthiouracil
  • Reserpine
  • Rifampin
  • Rifamycin
  • Sertraline
  • Tetracycline
  • Ticlopidine
  • Trimethadione

Drug-induced lupus should not be confused with drug side-effects, such as gastrointestinal, neurologic, or allergic symptoms that often occur after short-term therapy with various medications. These problems usually occur within a few hours or days of taking the medication. Drug-induced lupus typically comes after many months or years of continuous therapy with the causative drug. Drug-induced lupus erythematosus resolves within days to months after withdrawal of the culprit drug in a patient with no underlying immune system dysfunction.