What medications can cause drug-induced lupus (Systemic Lupus Erythematosus, SLE)?

From the Guidelines

Hydralazine and minoxidil are two medications that can cause drug-induced lupus, with hydralazine being associated with a lupus-like syndrome at higher doses. According to the evidence provided by 1, hydralazine is a direct vasodilator that can cause sodium and water retention, reflex tachycardia, and is associated with drug-induced lupus-like syndrome at higher doses. Minoxidil, another direct vasodilator, is associated with hirsutism and requires a loop diuretic, and can also induce pericardial effusion. Some key points to consider when prescribing these medications include:

• Using hydralazine with a diuretic and beta blocker to minimize side effects
• Monitoring patients for signs of drug-induced lupus, such as joint pain, muscle aches, fever, chest pain, or rash
• Being aware of the potential for minoxidil to cause hirsutism and pericardial effusion
• Considering alternative medications for patients with a history of lupus or autoimmune disorders It's also important to note that the risk of developing drug-induced lupus increases with higher doses and longer duration of treatment, particularly with hydralazine, as mentioned in 1 and 1. Therefore, it is crucial to carefully weigh the benefits and risks of using these medications and to closely monitor patients for any signs of adverse effects. Additionally, other medications such as procainamide, isoniazid, minocycline, quinidine, sulfasalazine, anti-TNF biologics, methyldopa, chlorpromazine, and certain anticonvulsants like phenytoin and carbamazepine can also trigger drug-induced lupus, as mentioned in the example answer.

From the FDA Drug Label

In a few patients hydrALAZINE may produce a clinical picture simulating systemic lupus erythematosus including glomerulonephritis. A lupus erythematosus-like syndrome of arthralgia, pleural or abdominal pain, and sometimes arthritis, pleural effusion, pericarditis, fever, chills, myalgia, and possibly related hematologic or skin lesions is fairly common after prolonged PA administration

• Medications that can cause drug-induced lupus include:
  • Hydralazine (PO) 2
  • Procainamide (PO) 3
• Key points:
  • These medications can produce a clinical picture simulating systemic lupus erythematosus
  • Symptoms and signs usually regress when the drug is discontinued, but residua have been detected many years later
  • Long-term treatment with steroids may be necessary in some cases

From the Research

Medications that can Cause Drug-Induced Lupus

The following medications have been associated with drug-induced lupus:

• Procainamide 4, 5, 6
• Hydralazine 4, 5, 6, 7
• Isoniazid 4, 5, 6, 7
• Methyldopa 4, 6
• Chlorpromazine 4
• Quinidine 4
• Sulfasalazine 4
• Minocycline 6, 7
• Calcium channel blockers 7
• Angiotensin-converting enzyme inhibitors 7
• Thiazide diuretics 7
• Terbinafine 7
• Tumour necrosis factor (TNF)-alpha antagonists 4, 7
• Fluorouracile agents 7
• Anticonvulsants 4
• Beta-blockers 4
• Sulfonamides 4

Characteristics of Drug-Induced Lupus

Drug-induced lupus is characterized by:

• Arthralgia
• Myalgia
• Pleurisy
• Rashes
• Fever
• Antinuclear antibodies in the serum 4, 5, 6, 7
• Anti-histone antibodies 4, 5, 6, 7

Management of Drug-Induced Lupus

Management of drug-induced lupus is based on:

• Withdrawal of the offending drug 4, 5, 6, 7
• Topical and/or systemic corticosteroids and other immunosuppressive agents for resistant cases 7