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.
