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Merck Manual
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The trusted provider of medical information since 1899
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H
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Professional /
Pulmonary Disorders /
Interstitial Lung Diseases /
... /
Drug-Induced Pulmonary Disease /
IN THIS TOPIC

Treatment

Prevention

OTHER TOPICS IN THIS CHAPTER

Interstitial Lung Diseases
Overview of Interstitial Lung Disease
Drug-Induced Pulmonary Disease
Overview of Eosinophilic Pulmonary Diseases
Acute Eosinophilic Pneumonia
Chronic Eosinophilic Pneumonia
Löffler Syndrome
Hypersensitivity Pneumonitis
Overview of Idiopathic Interstitial Pneumonias
Acute Interstitial Pneumonia
Cryptogenic Organizing Pneumonia
Desquamative Interstitial Pneumonia
Idiopathic Pleuroparenchymal Fibroelastosis
Idiopathic Pulmonary Fibrosis
Lymphocytic Interstitial Pneumonia
Nonspecific Interstitial Pneumonia
Respiratory Bronchiolitis–Associated Interstitial Lung Disease
Lymphangioleiomyomatosis
Pulmonary Alveolar Proteinosis
Pulmonary Langerhans Cell Histiocytosis

Test your knowledge

Allergic Bronchopulmonary Aspergillosis (ABPA)
Treatment of allergic bronchopulmonary aspergillosis (ABPA) is based on the disease stage. Patients who are administered itraconazole as treatment are typically at which of the following stages of this disease? 

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Drug-Induced Pulmonary Disease

By

Joyce Lee

, MD, MAS, University of Colorado Denver

Last full review/revision Sep 2019| Content last modified Sep 2019
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NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version
Topic Resources

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, nitrofurantoin) 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: Substances With Toxic Pulmonary Effects).

(See also Overview of Interstitial Lung Disease.)

Table
icon

Substances With Toxic Pulmonary Effects

Condition

Drug or Agent

Asthma

Aspirin, beta-blockers (eg, timolol), cocaine, dipyridamole, IV hydrocortisone (rarely in aspirin-sensitive patients with asthma), interleukin-2, methylphenidate, nitrofurantoin, protamine, sulfasalazine, vinca alkaloids (with mitomycin-C)

Organizing pneumonia

Amiodarone, bleomycin, cocaine, cyclophosphamide, methotrexate, minocycline, mitomycin-C, penicillamine, sulfasalazine, tetracycline

Hypersensitivity pneumonitis

Azathioprine plus 6-mercaptopurine, busulfan, fluoxetine, radiation

Interstitial pneumonia or fibrosis

Amphotericin B, bleomycin, busulfan, carbamazepine, chlorambucil, cocaine, cyclophosphamide, diphenylhydantoin, flecainide, heroin, melphalan, methadone, methotrexate, methylphenidate, methysergide, mineral oil (via chronic microaspiration), nitrofurantoin, nitrosoureas, procarbazine, silicone (sc injection), tocainide, vinca alkaloids (with mitomycin-C)

Noncardiac pulmonary edema

Beta-adrenergic agonists (eg, ritodrine, terbutaline), chlordiazepoxide, cocaine, cytarabine, ethiodized oil (IV, and via chronic microaspiration), gemcitabine, heroin, hydrochlorothiazide, methadone, mitomycin-C, phenothiazines, protamine, sulfasalazine, tocolytic agents, tricyclic antidepressants, tumor necrosis factor, vinca alkaloids (with mitomycin-C)

Parenchymal hemorrhage

Anticoagulants, azathioprine plus 6-mercaptopurine, cocaine, mineral oil (via chronic microaspiration), nitrofurantoin, radiation

Pleural effusion

Amiodarone, anticoagulants, bleomycin, bromocriptine, busulfan, granulocyte-macrophage colony-stimulating factor, IL-2, methotrexate, methysergide, mitomycin-C, nitrofurantoin, para-aminosalicylic acid, procarbazine, radiation, tocolytic drugs (eg, terbutaline)

Pulmonary infiltrate with eosinophilia

Amiodarone, amphotericin B, bleomycin, carbamazepine, diphenylhydantoin, ethambutol, etoposide, granulocyte-macrophage colony-stimulating factor, isoniazid, methotrexate, minocycline, mitomycin-C, nitrofurantoin, para-aminosalicylic acid, procarbazine, radiation, sulfasalazine, sulfonamides, tetracycline, trazodone

Pulmonary vascular disease

Appetite suppressants (eg, dexfenfluramine, fenfluramine, phentermine), busulfan, cocaine, heroin, methadone, methylphenidate, nitrosoureas, radiation

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

Treatment

  • Stopping the drug

Treatment is stopping the drug that is causing pulmonary disease.

Prevention

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.

Drugs Mentioned In This Article

Drug Name Select Trade
hydrochlorothiazide
 MICROZIDE
chlordiazepoxide
 LIBRIUM
cyclophosphamide
 CYTOXAN (LYOPHILIZED)
methylphenidate
 CONCERTA, RITALIN
hydrocortisone
 CORTEF, SOLU-CORTEF
mercaptopurine
 PURINETHOL
nitrofurantoin
 FURADANTIN, MACROBID, MACRODANTIN
bromocriptine
 PARLODEL
penicillamine
 CUPRIMINE
carbamazepine
 TEGRETOL
sulfasalazine
 AZULFIDINE
methotrexate
 OTREXUP
Azathioprine
 IMURAN
chlorambucil
 LEUKERAN
tetracycline
 ACHROMYCIN V
dipyridamole
 PERSANTINE
procarbazine
 MATULANE
phentermine
 ADIPEX-P
gemcitabine
 GEMZAR
minocycline
 MINOCIN
terbutaline
 No US brand name
Amiodarone
 CORDARONE
fluoxetine
 PROZAC, SARAFEM
ethambutol
 MYAMBUTOL
mitomycin
 MITOSOL
trazodone
 OLEPTRO
etoposide
 ETOPOPHOS
isoniazid
 LANIAZID
methadone
 DOLOPHINE
melphalan
 ALKERAN
busulfan
 MYLERAN
timolol
 TIMOPTIC
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© 2020 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA)
Overview of Interstitial Lung Disease
Overview of Eosinophilic Pulmonary Diseases
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