Drug Induced Lupus

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Drug Induced Lupus

Drug Induced Lupus (DIL or DILE) is Lupus that is caused by medication, generally after long term use. Once the drug is discontinued, the symptoms typically disappear. There are many medications that may cause DILE.

Only three of these medications are "high" risk. 5-20% of patients taking these drugs for 2 years will develop DILE. These three medications are:

procainamide (Pronestyl) - an antiarrhythmic agent

hydralazine (Apresoline) - an antihypertensive drug

quinidine (Quinaglute) - an antiarrhythmic agent

Only 1% or less of patients taking the other medications known to cause DILE will develop symptoms. The other medications are:

Antiarrhythmics

Disopyramide (Norpace)

Isoniazid

Propafenone (Rythmol)

Antibiotics

Isoniazid (INH, Nydrazid)

Nitrofurantoin (Macrodantin)

Minocycline (Minocin)

Anticonvulsants

Phenytoin (Dilantin)

Carbamazepine (Tegretol, Carbatrol, Equetro,)

Trimethadione (Tridone)

Primidone (Mysoline)

Ethosuximide (Zarontin)

Antihypertensives

Methyldopa (Aldomet)

Captopril (Capoten)

Acebutolol (Sectral)

Enalapril (Vasotec)

Hydrochlorothiazide (HCTZ)

Clonidine (Catapres)

Atenolol (Tenormin)

Labetalol (Normodyne, Trandate)

Pindolol (Visken)

Propranolol (Inderal)

Minoxidil (Loniten)

Diltiazem (Cardizem, Tiazac)

Prazosin (Minipress)

Anti-Inflammatories

D-Penicillamine (Cuprimine)

Sulfasalazine (Azulfidine)

Phenylbutazone (Butazolidin)

Antipsychotics

Chlorpromazine (Thorazine)

Perphenazine (Trilafon)

Phenelzine (Nardil)

Chlorprothixene (Taractan)

Lithium carbonate (Eskalith)

Antithyroidals

Propylthiouracil (Propyl-thyracil)

Arthritis Agents

Infliximab (Remicade)

Adalimumab (Humira)

Penicillamine (Cuprimine)

Etanercept (Enbrel)

Diuretics

Chlorthalidone (Hygroton)

Hydrochlorothiazide (Diuchlor h)

Miscellaneous

Lovastatin (Mevacor)

Levodopa (Dopar)

Aminoglutethimide (Cytadren)

Alpha-interferon (Wellferon)

Cimetidine (Tagamet)

Glyburide (Diabeta, Micronase)

Timolol eye drops (Timoptic)

Symptoms

Most people complain of flu like symptoms, primarily muscle and joint pain. Fever and inflammation of the heart or lung are also common.

Diagnosis

An ANA test will be positive in most DILE patients. A test designed to look for a specific DNA complex called a anti-histone test is a sensitive marker although only about 1/3 of DILE patients will have these antibodies.

Treatment

Discontinuation of the suspected offending drug will likely improve symptoms within a few days. NSAIDS may also be used to speed the improvement of symptoms. For severe cases of DILE affecting vital organs, corticosteroids may be used to reduce symptoms quickly.

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