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

THE MERCK MANUAL MEDICAL LIBRARY: The Merck Manual of Diagnosis and Therapy

Index

Sections

Symptoms

A	B	C	D	E	F	G	H	I
J	K	L	M	N	O	P	Q	R
S	T	U	V	W	X	Y	Z

In This Topic

	Drug-Induced Pulmonary Disease

Section		Pulmonary Disorders

Subject		Interstitial Lung Diseases

Topics		Introduction·Drug-Induced Pulmonary Disease· Eosinophilic Pulmonary Diseases· Hypersensitivity Pneumonitis· Idiopathic Interstitial Pneumonias· Lymphangioleiomyomatosis· Lymphoid Interstitial Pneumonia· Pulmonary Alveolar Proteinosis· Pulmonary Langerhans' Cell Histiocytosis

Drug-Induced Pulmonary Disease

Buy the Book

Update Me

	E-mail alerts
	The Merck Manual Minute

	Print This Topic
	Email This Topic

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 Some 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 produce 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	Aspirin Some Trade Names BUFFERIN ECOTRIN GENACOTE Click for Drug Monograph , β-blockers (eg, timolol Some Trade Names BLOCADREN TIMOPTIC Click for Drug Monograph ), cocaine, dipyridamole Some Trade Names PERSANTINE Click for Drug Monograph , IV hydrocortisone Some Trade Names CORTEF SOLU-CORTEF Click for Drug Monograph (rarely, in aspirin Some Trade Names BUFFERIN ECOTRIN GENACOTE Click for Drug Monograph -sensitive patients with asthma), IL-2, methylphenidate Some Trade Names CONCERTA RITALIN Click for Drug Monograph , nitrofurantoin Some Trade Names FURADANTIN MACROBID MACRODANTIN Click for Drug Monograph , protamine, sulfasalazine Some Trade Names AZULFIDINE Click for Drug Monograph , vinca alkaloids (with mitomycin Some Trade Names MUTAMYCIN Click for Drug Monograph )
Organizing pneumonia	Amiodarone Some Trade Names CORDARONE Click for Drug Monograph , bleomycin Some Trade Names BLENOXANE Click for Drug Monograph , cocaine, cyclophosphamide Some Trade Names CYTOXAN Click for Drug Monograph , methotrexate Some Trade Names RHEUMATREX Click for Drug Monograph , minocycline Some Trade Names MINOCIN Click for Drug Monograph , mitomycin Some Trade Names MUTAMYCIN Click for Drug Monograph -C, penicillamine Some Trade Names CUPRIMINE Click for Drug Monograph , sulfasalazine Some Trade Names AZULFIDINE Click for Drug Monograph , tetracycline Some Trade Names ACHROMYCIN V TETRACYN TETREX Click for Drug Monograph
Hypersensitivity pneumonitis	Azathioprine Some Trade Names IMURAN Click for Drug Monograph plus 6- mercaptopurine Some Trade Names PURINETHOL Click for Drug Monograph , busulfan Some Trade Names MYLERAN Click for Drug Monograph , fluoxetine Some Trade Names PROZAC SARAFEM Click for Drug Monograph , radiation
Interstitial pneumonia or fibrosis	Amphotericin B Some Trade Names ABELCET AMBISOME AMPHOCIN AMPHOTEC Click for Drug Monograph , bleomycin Some Trade Names BLENOXANE Click for Drug Monograph , busulfan Some Trade Names MYLERAN Click for Drug Monograph , carbamazepine Some Trade Names TEGRETOL Click for Drug Monograph , chlorambucil Some Trade Names LEUKERAN Click for Drug Monograph , cocaine, cyclophosphamide Some Trade Names CYTOXAN Click for Drug Monograph , diphenylhydantoin, flecainide Some Trade Names TAMBOCOR Click for Drug Monograph , heroin, melphalan Some Trade Names ALKERAN Click for Drug Monograph , methadone Some Trade Names DOLOPHINE Click for Drug Monograph , methotrexate Some Trade Names RHEUMATREX Click for Drug Monograph , methylphenidate Some Trade Names CONCERTA RITALIN Click for Drug Monograph , methysergide, mineral oil (via chronic microaspiration), nitrofurantoin Some Trade Names FURADANTIN MACROBID MACRODANTIN Click for Drug Monograph , nitrosoureas, procarbazine Some Trade Names MATULANE Click for Drug Monograph , silicone (sc injection), tocainide Some Trade Names TONOCARD , vinca alkaloids (with mitomycin Some Trade Names MUTAMYCIN Click for Drug Monograph )
Noncardiac pulmonary edema	β-Adrenergic agonists (eg, ritodrine, terbutaline Some Trade Names BRETHINE BRICANYL Click for Drug Monograph ), chlordiazepoxide Some Trade Names LIBRIUM Click for Drug Monograph , cocaine, cytarabine Some Trade Names CYTOSAR-U Click for Drug Monograph , ethiodized oil (IV, and via chronic microaspiration), gemcitabine Some Trade Names GEMZAR Click for Drug Monograph , heroin, hydrochlorothiazide Some Trade Names ESIDRIX HYDRODIURIL Click for Drug Monograph , methadone Some Trade Names DOLOPHINE Click for Drug Monograph , mitomycin Some Trade Names MUTAMYCIN Click for Drug Monograph -C, phenothiazines, protamine, sulfasalazine Some Trade Names AZULFIDINE Click for Drug Monograph , tocolytic agents, tricyclic antidepressants, tumor necrosis factor, vinca alkaloids (with mitomycin Some Trade Names MUTAMYCIN Click for Drug Monograph )
Parenchymal hemorrhage	Anticoagulants, azathioprine Some Trade Names IMURAN Click for Drug Monograph plus 6- mercaptopurine Some Trade Names PURINETHOL Click for Drug Monograph , cocaine, mineral oil (via chronic microaspiration), nitrofurantoin Some Trade Names FURADANTIN MACROBID MACRODANTIN Click for Drug Monograph , radiation
Pleural effusion	Amiodarone Some Trade Names CORDARONE Click for Drug Monograph , anticoagulants, bleomycin Some Trade Names BLENOXANE Click for Drug Monograph , bromocriptine Some Trade Names PARLODEL Click for Drug Monograph , busulfan Some Trade Names MYLERAN Click for Drug Monograph , granulocyte-macrophage colony-stimulating factor, IL-2, methotrexate Some Trade Names RHEUMATREX Click for Drug Monograph , methysergide, mitomycin Some Trade Names MUTAMYCIN Click for Drug Monograph -C, nitrofurantoin Some Trade Names FURADANTIN MACROBID MACRODANTIN Click for Drug Monograph , para-aminosalicylic acid, procarbazine Some Trade Names MATULANE Click for Drug Monograph , radiation, tocolytic agents
Pulmonary infiltrate with eosinophilia	Amiodarone Some Trade Names CORDARONE Click for Drug Monograph , amphotericin B Some Trade Names ABELCET AMBISOME AMPHOCIN AMPHOTEC Click for Drug Monograph , bleomycin Some Trade Names BLENOXANE Click for Drug Monograph , carbamazepine Some Trade Names TEGRETOL Click for Drug Monograph , diphenylhydantoin, ethambutol Some Trade Names MYAMBUTOL Click for Drug Monograph , etoposide Some Trade Names ETOPOPHOS VEPESID Click for Drug Monograph , granulocyte-macrophage colony-stimulating factor, isoniazid Some Trade Names INH NYDRAZID Click for Drug Monograph , methotrexate Some Trade Names RHEUMATREX Click for Drug Monograph , minocycline Some Trade Names MINOCIN Click for Drug Monograph , mitomycin Some Trade Names MUTAMYCIN Click for Drug Monograph -C, nitrofurantoin Some Trade Names FURADANTIN MACROBID MACRODANTIN Click for Drug Monograph , para-aminosalicylic acid, procarbazine Some Trade Names MATULANE Click for Drug Monograph , radiation, sulfasalazine Some Trade Names AZULFIDINE Click for Drug Monograph , sulfonamides, tetracycline Some Trade Names ACHROMYCIN V TETRACYN TETREX Click for Drug Monograph , trazodone Some Trade Names DESYREL Click for Drug Monograph
Pulmonary vascular disease	Appetite suppressants (eg, dexfenfluramine, fenfluramine, phentermine Some Trade Names ADIPEX-P IONAMIN Click for Drug Monograph ), busulfan Some Trade Names MYLERAN Click for Drug Monograph , cocaine, heroin, methadone Some Trade Names DOLOPHINE Click for Drug Monograph , methylphenidate Some 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

Previous: Introduction

Next: Eosinophilic Pulmonary Diseases

Audio

Figures

Photographs

Sidebars

Tables

Videos