Drug-Induced Pulmonary Disease: Interstitial Lung Diseases: Merck Manual Professional

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Drug-Induced Pulmonary Disease

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Drug-Induced Pulmonary Disease

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Drug-induced pulmonary disease is not a single disorder, but rather a common clinical problem in which a patient without previous pulmonary disease develops respiratory symptoms, chest x-ray changes, deterioration of pulmonary function, histologic changes, or several of these findings in association with drug therapy. Over 150 drugs or categories of drugs have been reported to cause pulmonary disease; the mechanism is rarely known, but many drugs are thought to provoke a hypersensitivity response. Some drugs (eg, nitrofurantoinSome Trade Names
FURADANTIN
MACROBID
MACRODANTIN
Click for Drug Monograph
) can cause different injury patterns in different patients.

Depending on the drug, drug-induced syndromes can cause interstitial fibrosis, organizing pneumonia, asthma, noncardiogenic pulmonary edema, pleural effusions, pulmonary eosinophilia, pulmonary hemorrhage, or veno-occlusive disease (see Table 4: Interstitial Lung Diseases: Substances With Toxic Pulmonary Effects).

Table 4

Substances With Toxic Pulmonary Effects
Condition	Drug or Agent
Asthma	AspirinSome Trade Names BUFFERIN ECOTRIN GENACOTE Click for Drug Monograph , β-blockers (eg, timololSome Trade Names BLOCADREN TIMOPTIC Click for Drug Monograph ), cocaine, dipyridamoleSome Trade Names PERSANTINE Click for Drug Monograph , IV hydrocortisoneSome Trade Names CORTEF SOLU-CORTEF Click for Drug Monograph (rarely in aspirinSome Trade Names BUFFERIN ECOTRIN GENACOTE Click for Drug Monograph -sensitive patients with asthma), IL-2, methylphenidateSome Trade Names CONCERTA RITALIN Click for Drug Monograph , nitrofurantoinSome Trade Names FURADANTIN MACROBID MACRODANTIN Click for Drug Monograph , protamine, sulfasalazineSome Trade Names AZULFIDINE Click for Drug Monograph , vinca alkaloids (with mitomycinSome Trade Names MUTAMYCIN Click for Drug Monograph )
Organizing pneumonia	AmiodaroneSome Trade Names CORDARONE Click for Drug Monograph , bleomycinSome Trade Names BLENOXANE Click for Drug Monograph , cocaine, cyclophosphamideSome Trade Names CYTOXAN Click for Drug Monograph , methotrexateSome Trade Names RHEUMATREX Click for Drug Monograph , minocyclineSome Trade Names MINOCIN Click for Drug Monograph , mitomycinSome Trade Names MUTAMYCIN Click for Drug Monograph -C, penicillamineSome Trade Names CUPRIMINE Click for Drug Monograph , sulfasalazineSome Trade Names AZULFIDINE Click for Drug Monograph , tetracyclineSome Trade Names ACHROMYCIN V TETRACYN TETREX Click for Drug Monograph
Hypersensitivity pneumonitis	AzathioprineSome Trade Names IMURAN Click for Drug Monograph plus 6-mercaptopurineSome Trade Names PURINETHOL Click for Drug Monograph , busulfanSome Trade Names MYLERAN Click for Drug Monograph , fluoxetineSome Trade Names PROZAC SARAFEM Click for Drug Monograph , radiation
Interstitial pneumonia or fibrosis	Amphotericin BSome Trade Names ABELCET AMBISOME AMPHOCIN AMPHOTEC Click for Drug Monograph , bleomycinSome Trade Names BLENOXANE Click for Drug Monograph , busulfanSome Trade Names MYLERAN Click for Drug Monograph , carbamazepineSome Trade Names TEGRETOL Click for Drug Monograph , chlorambucilSome Trade Names LEUKERAN Click for Drug Monograph , cocaine, cyclophosphamideSome Trade Names CYTOXAN Click for Drug Monograph , diphenylhydantoin, flecainideSome Trade Names TAMBOCOR Click for Drug Monograph , heroin, melphalanSome Trade Names ALKERAN Click for Drug Monograph , methadoneSome Trade Names DOLOPHINE Click for Drug Monograph , methotrexateSome Trade Names RHEUMATREX Click for Drug Monograph , methylphenidateSome Trade Names CONCERTA RITALIN Click for Drug Monograph , methysergide, mineral oil (via chronic microaspiration), nitrofurantoinSome Trade Names FURADANTIN MACROBID MACRODANTIN Click for Drug Monograph , nitrosoureas, procarbazineSome Trade Names MATULANE Click for Drug Monograph , silicone (sc injection), tocainideSome Trade Names TONOCARD , vinca alkaloids (with mitomycinSome Trade Names MUTAMYCIN Click for Drug Monograph )
Noncardiac pulmonary edema	β-Adrenergic agonists (eg, ritodrine, terbutalineSome Trade Names BRETHINE BRICANYL Click for Drug Monograph ), chlordiazepoxideSome Trade Names LIBRIUM Click for Drug Monograph , cocaine, cytarabineSome Trade Names CYTOSAR-U , ethiodized oil (IV, and via chronic microaspiration), gemcitabineSome Trade Names GEMZAR Click for Drug Monograph , heroin, hydrochlorothiazideSome Trade Names ESIDRIX HYDRODIURIL Click for Drug Monograph , methadoneSome Trade Names DOLOPHINE Click for Drug Monograph , mitomycinSome Trade Names MUTAMYCIN Click for Drug Monograph -C, phenothiazines, protamine, sulfasalazineSome Trade Names AZULFIDINE Click for Drug Monograph , tocolytic agents, tricyclic antidepressants, tumor necrosis factor, vinca alkaloids (with mitomycinSome Trade Names MUTAMYCIN Click for Drug Monograph )
Parenchymal hemorrhage	Anticoagulants, azathioprineSome Trade Names IMURAN Click for Drug Monograph plus 6-mercaptopurineSome Trade Names PURINETHOL Click for Drug Monograph , cocaine, mineral oil (via chronic microaspiration), nitrofurantoinSome Trade Names FURADANTIN MACROBID MACRODANTIN Click for Drug Monograph , radiation
Pleural effusion	AmiodaroneSome Trade Names CORDARONE Click for Drug Monograph , anticoagulants, bleomycinSome Trade Names BLENOXANE Click for Drug Monograph , bromocriptineSome Trade Names PARLODEL Click for Drug Monograph , busulfanSome Trade Names MYLERAN Click for Drug Monograph , granulocyte-macrophage colony-stimulating factor, IL-2, methotrexateSome Trade Names RHEUMATREX Click for Drug Monograph , methysergide, mitomycinSome Trade Names MUTAMYCIN Click for Drug Monograph -C, nitrofurantoinSome Trade Names FURADANTIN MACROBID MACRODANTIN Click for Drug Monograph , para-aminosalicylic acid, procarbazineSome Trade Names MATULANE Click for Drug Monograph , radiation, tocolytic agents
Pulmonary infiltrate with eosinophilia	AmiodaroneSome Trade Names CORDARONE Click for Drug Monograph , amphotericin BSome Trade Names ABELCET AMBISOME AMPHOCIN AMPHOTEC Click for Drug Monograph , bleomycinSome Trade Names BLENOXANE Click for Drug Monograph , carbamazepineSome Trade Names TEGRETOL Click for Drug Monograph , diphenylhydantoin, ethambutolSome Trade Names MYAMBUTOL Click for Drug Monograph , etoposideSome Trade Names ETOPOPHOS VEPESID Click for Drug Monograph , granulocyte-macrophage colony-stimulating factor, isoniazidSome Trade Names INH NYDRAZID Click for Drug Monograph , methotrexateSome Trade Names RHEUMATREX Click for Drug Monograph , minocyclineSome Trade Names MINOCIN Click for Drug Monograph , mitomycinSome Trade Names MUTAMYCIN Click for Drug Monograph -C, nitrofurantoinSome Trade Names FURADANTIN MACROBID MACRODANTIN Click for Drug Monograph , para-aminosalicylic acid, procarbazineSome Trade Names MATULANE Click for Drug Monograph , radiation, sulfasalazineSome Trade Names AZULFIDINE Click for Drug Monograph , sulfonamides, tetracyclineSome Trade Names ACHROMYCIN V TETRACYN TETREX Click for Drug Monograph , trazodoneSome Trade Names DESYREL Click for Drug Monograph
Pulmonary vascular disease	Appetite suppressants (eg, dexfenfluramine, fenfluramine, phentermineSome Trade Names ADIPEX-P IONAMIN Click for Drug Monograph ), busulfanSome Trade Names MYLERAN Click for Drug Monograph , cocaine, heroin, methadoneSome Trade Names DOLOPHINE Click for Drug Monograph , methylphenidateSome Trade Names CONCERTA RITALIN Click for Drug Monograph , nitrosoureas, radiation

Diagnosis is based on observation of responses to withdrawal from and, if practical, reintroduction to the suspected drug.

Treatment is stopping the drug. A screening pulmonary function test is commonly done in patients about to begin or already taking drugs with pulmonary toxicities, but the benefits of screening for prediction or early detection of toxicity are unproved.

Last full review/revision May 2008 by Talmadge E. King, Jr., MD

Content last modified May 2008

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