DILE Drug induced Lupus Erythematosis [Archive] - The Lupus Site Message Boards

Lily

08-03-2005, 12:59 AM

http://www.lupus.org/education/brochures/drug.html

and from the Postgrad Medicine site

http://www.postgradmed.com/issues/1999/11_99/greenberg.htm

<div class='quotetop'>QUOTE</div><div class='quotemain'>Drug-induced lupus
In 1945, the first lupuslike reaction to a medication was reported with sulfasalazine (Azulfidine). Since then, 70 drugs have been implicated as causing or exacerbating SLE. Many of these are listed in table 2. Drug-induced lupus is most frequent in older patients. Men and women are equally at risk. The most common symptoms are fever, fatigue, arthralgia, and serositis.

Table 2. Medications that may cause drug-induced lupus?
Atenolol (Tenormin)
Captopril (Capoten)
Carbamazepine
Chlorpromazine HCl (Thorazine)
Clonidine HCl (Catapres)
Danazol (Danocrine)
Diclofenac (Cataflam, Voltaren)
Disopyramide (Norpace)
Ethosuximide (Zarontin)
Gold compounds
Griseofulvin
Hydralazine HCl (Apresoline)
Ibuprofen
Interferon alfa
Isoniazid (Laniazid, Nydrazid)
Labetalol HCl (Normodyne, Trandate)
Leuprolide acetate (Lupron)
Levodopa (Dopar, Larodopa)
Lithium carbonate
Lovastatin (Mevacor)
Mephenytoin (Mesantoin)
Methyldopa (Aldomet)
Methysergide maleate (Sansert)
Minoxidil (Loniten, Rogaine)
Nalidixic acid (NegGram)
Nitrofurantoin (Furadantin, Macrobid, Macrodantin)
Oral contraceptives
Penicillamine (Cuprimine, Depen)
Penicillin
Phenelzine sulfate (Nardil)
Phenytoin sodium (Dilantin)
Prazosin (Minipress)
Primidone (Mysoline)
Procainamide HCl (Procan, Pronestyl)
Promethazine HCl (Anergan, Phenergan)
Propylthiouracil
Psoralen
Quinidine
Spironolactone (Aldactone)
Streptomycin sulfate
Sulindac (Clinoril)
Sulfasalazine (Azulfidine)
Tetracycline
Thioridazine HCl (Mellaril)
Timolol maleate (Betimol, Timoptic)
Tolazamide (Tolinase)
Tolmetin sodium (Tolectin)
Trimethadione (Tridione) [/b][/quote]

love
Lily

Douglas

12-23-2005, 05:39 AM

Thank you, Lily, for posting this information. It seems obvious to all who know me that my SLE is of the DILE variety. The more information I find, the better and more prepared I feel. This is all so new to me, being a "textbook case" instead of "biochemically interesting" or "unique"! I am very grateful to know what is going on after 30 years of Lupus.

tandarat

12-23-2005, 09:02 PM

Interesting. I was on atenolol from 1998 to earlier this year. My lupus does not appear to be drug induced, but I found it interesting that this was on the list, as well as ibuprofen (I was an advil "junkie" while fighting joint pain and other problems that ended up being lupus....I was aware of rebound pain and headaches but not the fact that it could cause lupus-like symptoms. I'm now off of atenolol because of some bradycardia issues that came up a couple of hospital stays ago (but had to go on another beta blocker due to tachycardia, which the atenolol was used to control before...go figure), and have greatly reduced the amount of ibuprofen I take now I'm on more effective pain killers.

I'm curious...if you already have lupus, can these drugs make your symptoms worse, or do they just cause DILE?

Thanks,

Michelle

raggedyann1

12-23-2005, 10:50 PM

Michelle,

I had a similar question as I was taking d-penicillmaine a year or so after diagnosis for RA. Asked my rheumy earlier this year if that could have caused the lupus and that perhaps my original RA dx only(had for a short time) was correct and the med caused the lupus. He told me no. That was not a case of DILE but a med that can cause lupus.

DILE is very rare and some classes of drugs are more likely to cause DILE than some of the other meds listed in this thread. People with DILE usually have the symptoms go away once the medication is removed from their system. Not always but usually.

Karen

londonteatime

01-16-2006, 11:19 AM

This is what I wondered for a while, too. I was diagnosed with RA first and, frankly, have a textbook case. The labs, X-rays, exam and symptoms are classic RA. But, early on, some of the Lupus indicators were testing positive, too. Rheumy said we'd have to wait and see on Lupus and he put me on mtx. and Plaquenil to cover both diseases.

I haven't taken any of the drugs on the DILE list -- I've never even overdone the Ibuoprofen. When my symptoms first started more than 2 1/2 years ago, I was put on antibiotic therapy for a few months because of "possible Epstein-Barr and possible Lyme disease." It didn't work, obviously, because I had neither disease.

I had done some research on DILE and hoped that maybe the Lupus symptoms and positive tests were temporary. But it's been two years since I took the antibiotics; more Lupus indicators are positive and organ involvement has begun, too. The antibiotics aren't even on the DILE list. I've accepted it's SLE.

But it's quite the quandry, isn't it?

Julie

<div class='quotetop'>QUOTE(raggedyann1 @ Dec 23 2005, 09:50 PM) Quoted post</div><div class='quotemain'>
Michelle,

Asked my rheumy earlier this year if that could have caused the lupus and that perhaps my original RA dx only(had for a short time) was correct and the med caused the lupus.
Karen
[/b][/quote]

Clare.T

01-16-2006, 01:06 PM

By definition, drug induced lupus goes when the medicine implicated is withdrawn - and would recur if the drug is taken again. DILE is treated as necessary like lupus depending on the symptoms.
Some drugs trigger clinical lupus. Many common medicines might trigger lupus indirectly by increasing photosensitivity.

Of course we all like to know what might have caused our lupus but it doesn't make much difference in practice.

Drugs like Remicade and Enbrel tend to be used cautiously because they can cause ds DNA antibodies which is a concern ,although I haven't seen any reference to clinical lupus resulting.

Cheers
Clare

RJKTE

02-05-2006, 06:36 AM

Drugs like Remicade and Enbrel tend to be used cautiously because they can cause ds DNA antibodies which is a concern ,although I haven't seen any reference to clinical lupus resulting.

Cheers
Clare
[/quote]
Could you explain this further? I am currently on Remicade and although I get wonderful results for about week, I then end up reacting to the drug (I get my lupus symptoms back, like I'm in a flair). . My rheumi has mentioned that I am becoming "allergic" to it. it concerns me. He is talking about switching me to Enbrel.
Looking back however overall the drugs that I've taken, I now wonder if they hadn't made my lupus symptoms worse since they didn't help me any. My reaction to the last 3 drugs I've taken mimicks what I would call my "lupus". So I wonder really how much of my symptoms over the years was really "lupus" or symptoms that my body produces as a reaction to things it doesn't like.
I am also concernend that since the Remicade has stopped working and he is talking about moving on to Enbrel.....what if I react to that....and then eventually the next drug? Has any one already been down this road? I'm beginning to look at stem cell transplants and that seems like a very scary last alternative but looks like one i'm heading toward.
~Jillian

Another drug to look out for is Levoquin.... I was put on it for a supposid intestinal infection. My lupus kept getting worse and worse, increasing my prednisone didn't help. I couldn't figure out why my "lupus" was getting so bad (I could not get out of bed for several weeks due to severe muscle and joint pain, had fevers, the whole 9 yards of what my flairs are like, except this time, much worse). Finally I developed an anaphalactic reaction about 21 days into the med and after stopping and double dosing with double does of prednisone , it took a good week to get it out of my system. I truely thought I was going to die during this experience. Its one of the most toxic antibiotic out there so be aware whould you ever get prescribed it.
~Jillian

red24

07-28-2006, 04:43 PM

I have never been on any of these drugs but yet have Lupus and RA. My causes from getting RA first was a chemical exsposure that I had that caused one of my lobes in my lungs to be removed. My lungs produse bacteria all the time and so that is what caused the LUPUs and RA according to the doctors.

What bothers me is that my husband has been on Zarotin for about 6 years. Do you all think I should have him go to the doctors and get test done to see if he has the Lupus? I know how bad I suffer with RA and Lupus I would hate for him to go thru this.

Thanks for all the info on the medications and fed back. I have read them all and have to say I'm quite amazed. I'm in the severe stages now of RA and Lupus. A lot is happening to me health wise and I have to say I'm getting down in the dumps. Last week I was told there was nothing they can do about my back and that I would be in a wheel chair with in a year. Lupus and Ra has hit the spine bad destroying nerves and the spine. I'm having a hard time dealing with it.

Alll have a wonderful day and always think positive.

Deanna

sue90x

08-03-2006, 12:06 PM

I've been victim to penecillin! I ended up in comatose state, with right side TIA already have left side hemiplegia, developed steven-johnsons syndrome, I was photographed for medical students it was so 'classic'
my hubby was told to say his goodbyes, I had a massive 'turnaround' during the night recovered to menigicoccal type state I recall it hurt even to blink.I'd huge casts in urine, and was in a poor state for months after, I now know to keep clear of penecillin for sure. The alllergy developed during the flare, I'd had it numerous times before
I once took diclofenac my daughter has it for back probs I'd run out of pain killers I felt truly terrible- a drunk like state for the whole day, I'd no idea is was on the cautionary list!
take care everyone I'm going to print it off and keep with me!
Sue x

Lily

08-03-2006, 12:39 PM

Hi Sue,

Yes interesting its on the list of meds known to cause drug induced lupus. Until you mentioned it I didnt notice it there. Many lupies are allergic to it though. But this list is for things known to cause a lupus like reaction.........as soon as the drug is withdrawn the symptoms should subside.

Since my teens I've had a deathly allergy to it, I go into anaphalactic shock, only here because of a timely intervention :eek: and a nice needle the doc gave me to bring me back :) I'm sure I had it as a child and didnt react like that though. Interesting!

love
Lily

Lily

09-30-2006, 09:19 AM

http://www.jclinrheum.com/pt/re/jcr/abstract.00124743-200502000-00009.htm;jsessionid=FphBhmyYhnDGy8n7TJshFZvJ4GhtX Tq2HybG3P9QgclLYGrpf7Zk!1513079044!-949856145!8091!-1

love
Lily

Clare.T

09-30-2006, 12:50 PM

About the TNF drugs like Enbrel or Remicade this article seems to sum up the general view about people with lupus using them. I haven't found anything online to suggest that this view has been revised but it is increasing hard to find reliable up to date information online as they are limiting access these days, either by only allowing doctors or institutions access or charging for access

http://www.arthritispharmacy.com/arthritis/Arthritis%20Alert/ARTHRITIS_DRUG_LINKED_TO_RARE_LUPUS_SIDE_EFFECT.ht ml

Most doctors play safe and won't use these drugs for lupus if there are alternatives, but there've got to be times when these drugs are worth trying.

Cheers
Clare

Raeann

09-30-2006, 04:06 PM

Thank you Lily, I never even thought about what medications could cause Lupus, but now that I think back over the past ten years, it's all beginning to make sense.

I took Tetracycline for many years because my dermatologist was treating me for acne cysts. It seemed to help some but not a lot, I tried many different kinds of meds, never even thinking they could be the discoid lesions and have never to this day had a biopsy on any of them.

All my history seems very clear to me now.

The Plaquenil has cleared my skin tremendously and when I do get the lesions they are smaller and go away much quicker.

I do take quite a bit of Ibuprophen and will ask for something different when I go back in January.

Could the Ibuprophen be making my symptoms worse? I am just coming off a low dose of Prednizone only four more days worth (10mg). It has helped me very much. Have not been on it for five years. Thank you again for the information Raeann :p

Lily

10-01-2006, 12:09 AM

Hi Raeann,

In some Lupies Ibuprofen can make their symptoms worse (I'm one) , BUT its such an individual thing. It is however something to be aware of which is why I post these articles and references, just to keep us aware of the possibilities. I'd hate someone to be suffering from a drug induced problem when an alternative med may provide the same relief but with less side effects and problems.

love
Lily

Clare.T

01-21-2007, 09:48 PM

Something worth noting if you know a teen who starts having lupus like symtpoms and is on minocycline.

http://www.uklupus.co.uk/mino.html

http://pediatrics.aappublications.org/cgi/content/full/101/5/926

http://www.med.ucla.edu/modules/wfsection/article.php?articleid=39

If the symptoms go when the drug is stopped then it's drug induced but it seems that in a few predisposed people clinical lupus is triggered.

It seems that in some places a warning of the possibility is noted on the packaging. Even if it is rare, there should be a general warning as this is for all side effects howver unlikely.

Clare

donna brain

02-07-2007, 10:54 PM

does anyone know if there has ever been any suggestion of this cauing lupus?

Lily

02-08-2007, 05:41 AM

Hi,

No its not on the list, I'm on it and I love the stuff :hehe:

love
Lily

Soundy

06-19-2007, 06:53 PM

I just read thru this and found alot of interesting things ... I have been on several of the meds mentioned before my now withdrawn diagnosis... tetracycline is the one jumped out at me... I was bitten by a cat and the ER doctor put me on it ... that was a Sunday morning ... by Tuesday I had swollen joints all over ,itched and broke out in a rash... I stopped it and went to a doctor who said it was just an allergic reaction put me on pred and penicillin and sent me on my way...after a couple weeks rash was clear but itched horribly when ever in the sun and my hair started falling out... didn't have a regular doctor at this point in time and when I went back the one I saw said I was having an allergic reaction to something ... probably grass since it was hay cutting time..here swallow benadryl...and sent me on my way

This was about 2 years before my steady ongoing problems began... during that time I had several flares of itching , body rash and hairloss... but didn't go back just took bendryl to relieve itch...I have never had a butterfly rash but scaley patches over body especially chest and stomach

L and P

06-30-2007, 11:47 PM

Can Paroxetine cause Lupus

Lily

07-01-2007, 12:51 AM

Not to my knowledge

christianirc

07-01-2007, 07:29 AM

I'm on diltiazem and cimetidine. But diclofenac? The rhuemy put me ON it.

Clare.T

07-01-2007, 10:15 AM

Hi Brenda

:)

I'm wondering why you mention diclofenac.

Cheers
Clare

christianirc

07-01-2007, 05:52 PM

It is listed in Lily's post on the first page.

Lily

07-02-2007, 12:53 AM

Hi Brenda,

It is on that Post Grad site referred to as being one of the possible drugs that could cause a drug induced lupus (althought its not in the list of the ones most likely to cause a problem) . The fact its on that list doesnt mean it will do that with everyone and we have discussed this in the past:

http://www.thelupussite.com/forum/showthread.php?t=58196

If you are on it and you havent had any problems then I wouldnt be concerned. There are lots of NSAIDS available to us and if one doesnt suit then there are other choices.

The very nature of drug induced lupus means that once the drug is withdrawn then they symptoms should go and the ANA return to normal. Its very different to someone who already has lupus and has trouble tolerating a certain med - like me with Ibuprofen for example. If I take it it makes my symptoms worse, but I have Lupus anyway, so its not classed as a drug induced lupus.

The reason I posted this thread was that many people come in here with a few symptoms and think they have Lupus, their docs have failed to realise that it may actually be a drug induced lupus, rather than the 'real thing' and for them the fix is easy. Withdraw the drug.

love
Lily

christianirc

07-02-2007, 02:46 AM

I'm concened about the diltiazem. I'VE been on it for years. We've tried alternates, but nothing has worked. The rheumy knows I take it for PH, so surely he would have mentioned it if he thought it could be DILE instead of SLE, don't you think?

Lily

07-02-2007, 03:12 AM

Hi Brenda,

This article outlines the major differences in SLE and drug induced lupus erythematosis (DILE). http://www.emedicine.com/DERM/topic107.htm

It's hard to pick it but I am sure your doctor would have considered it as a possibility and investigated thoroughly whilst diagnosing you.

Either way, if you need that drug what is the alternative really???.................same with things like Atenenol...............people with heart conditions would probably die without it, so not taking it is not an option :eek: They treat DILE the same way they treat SLE if the patient cannot be taken off the drug causing it.

Of particular interest to me in the article is the fact they mention birth control pills!! but the thing that must be remembered here is that when they talk about DILE they mean in a patient who had NO signs of lupus prior to taking the drug and its obvious the drug brought it on. It's not the same as someone who had some inkling of problems prior to taking it anyway and this maybe just brought it out of hiding.

love
Lily

christianirc

07-02-2007, 03:26 AM

Thank you so much, Lily, for taking the time to explain all this. I do have to take the diltiazem (cardizem) for the PH or... well... it's not good. I can't take beta blockers or ace inhibitors because I've had severe asthmatic reactions. You're right, if I have to take it I have to take it. I was taking it for a few years before being diagnosed, but we BELIEVE some hospitalizations years prior to starting it were flares. You're right. Call it a zebra or a horse, it needs fed the same way. THANKS!

Surferboy

09-01-2008, 06:35 PM

Forgive me if I'm being a little stupid with what I'm about to ask.... but on the list of drugs that may cause DILE it mentions "hydroxychloroquine" and "ibuprofen" - BUT aren't these drugs used to actually treat Lupus?

Also, a very good few years ago (maybe 5) I was given some super strength antibiotics to treat what the Dr had wrongly diagnosed as "Prostatitis". I took these for about a week and became very ill until another Dr noticed the grave mistake, after which I stopped them. Alas can't remember the name of the antibiotics. But, my question is - is a 1 week course enough time to contract something like SLE or DILE?

cath

09-02-2008, 12:03 AM

Hi Surferboy,

The list of possible side effects of drugs is made as follows: A patient gets a drug prescribed and while taking it gets a symptom and goes to the doctor. If the doctor thinks it might be a side effect (read MIGHT BE, not definately proved so to be), they send a form through to a central registrations center and it gets sent on to the manufacturer, and may eventually get put on a list of possible side effects. If you search hard enough you can find out exactly how frequently a side effect occurs. For example many of the side effects occur less than one in a million. And remember these are not proven side effects but possibly side effects, so in all reality, most probably was not a side effect but a random coincidence.
Especially with DILE, there is a very good probalilty that the reason the person was started on plaquenil in the first place was suspected CTD. That they then get DILE is more likely mislabeling - it should have been called SLE, and the plaquenil did not cause anything except improving the patient's life.

You second paragraph does not make sense. Why is prescribing an antibiotic for an infection a grave mistake? It is logical. Why are you upset about it and what relevence do you think it has to what now?

You cannot contract SLE. You can't get it from a drug. With DILE if you stop the drug the disease goes away with time. DILE also happens straight away while taking the offending med, not 5 years later. Unless you have been lying to your doctor about a medication you are currently taking, you do not have DILE.

Hydroxychloroquinine is the most important useful safe medication we currently have for SLE and Discoid.

X C X

Surferboy

09-02-2008, 05:42 PM

Hi Cath, sorry for the confusion in my paragraph.

What I meant to say was that the Dr prescribed a drug which he most definitely should not have in light of what the symptoms were in my illness. After taking this medication I got a lot worse and so went to the Dr's surgery again, where I saw another Dr. This new Dr was mystified and horrified at the previous Dr's ignorance and at the fact that he had prescribed the drugs he did.

Hope that makes sense :)

As for the antibiotics comment - I was under the impression (from what my GP said) that Lupus sufferers would have an adverse effect to antibiotics.

If I've been misinformed please tell me. Right now I am so worried about catching any kind of infection - cold, cough, flu etc :(

Katharine

09-02-2008, 06:44 PM

Hello Surferboy,

No, antibiotics are very important to lupus patients just as they are to others. Probably more important as having an infection can bring on at best a mini flare, at worst a major one.

The only difference between an SLE patient and anyone else is that they may need stronger antibiotics and over a longer time than normal to get rid of the infection.

As you are not on immunosuppressants for the moment you don't need to worry about getting an infection any more than anyone else. Obviously, you musn't let an infection go if you do have one but I somehow can't see you ignoring anything so I don't think that will happen :wink2:

Katharine