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DILE Drug induced Lupus Erythematosis

3937 Views 41 Replies 27 Participants Last post by  paperbagprincessNZ
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Thanks Lily!

My father is on two of the meds mentioned, and he has been having difficulties lately. Will pass on the info, so he can discuss with his Rhumey! He has been Dx'd with RA...........but all of his complaints mirror mine! I keep telling him he has Lupus! (and I believe I'm right~)

Excellent article,Lily.

I will pin it so everyone gets a chance to read it. I won't "lock" the post,so people can still respond.
Hi all
i can identify with one of the Anticonvulsants mentioned in the article and that Anticonvulsant is carbamazepine (tegretol) i took it for 11 years and still suffering from the effects of it

and from the Postgrad Medicine site

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)
Chlorpromazine HCl (Thorazine)
Clonidine HCl (Catapres)
Danazol (Danocrine)
Diclofenac (Cataflam, Voltaren)
Disopyramide (Norpace)
Ethosuximide (Zarontin)
Gold compounds
Hydralazine HCl (Apresoline)
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)
Phenelzine sulfate (Nardil)
Phenytoin sodium (Dilantin)
Prazosin (Minipress)
Primidone (Mysoline)
Procainamide HCl (Procan, Pronestyl)
Promethazine HCl (Anergan, Phenergan)
Spironolactone (Aldactone)
Streptomycin sulfate
Sulindac (Clinoril)
Sulfasalazine (Azulfidine)
Thioridazine HCl (Mellaril)
Timolol maleate (Betimol, Timoptic)
Tolazamide (Tolinase)
Tolmetin sodium (Tolectin)
Trimethadione (Tridione) [/b][/quote]

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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.
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?



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.

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?


QUOTE(raggedyann1 @ Dec 23 2005, 09:50 PM) [post=387883]Quoted post[/post]


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.
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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.

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.

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.

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.
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I'm amazed about the drug list

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.

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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
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 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!

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

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.

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 [/COLOR] :p [/COLOR]
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.

Minocycline Induced lupus

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

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.

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