What medications cause photosensitivity?

From the Guidelines

Medications that can cause photosensitivity include angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, anti-arrhythmic drugs, anti-depressant drugs, antimicrobial drugs, β-blockers, calcium channel blockers, diuretics, 3-Hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, non-steroidal anti-inflammatory drugs, and psychotropic drugs, as reported in a 2022 study 1. To minimize the risk of photosensitivity, patients taking these medications should protect themselves by wearing broad-spectrum sunscreen (SPF 30+), covering exposed skin with clothing, wearing sunglasses and a wide-brimmed hat, and limiting sun exposure, especially between 10 AM and 4 PM. Some of the specific medications that can cause photosensitivity include:

• Angiotensin-converting enzyme inhibitors such as Ramipril, enalapril, and quinapril
• Angiotensin receptor blockers such as Candesartan, irbesartan, losartan, olmesartan, telmisartan, and valsartan
• Anti-arrhythmic drugs such as amiodarone and dronedarone
• Anti-depressant drugs such as Citalopram, clomipramine, escitalopram, fluoxetine, fluvoxamine, imipramine, paroxetine, sertraline, St. John’s wort, and venlafaxine
• Antimicrobial drugs such as anti-fungals, anti-malarials, anti-tuberculous drugs, anti-retrovirals, β-lactams, fluoroquinolones, nalidixic acid, sulphonamides, and tetracyclines
• β-Blockers such as Tilisolol
• Calcium channel blockers such as amlodipine, diltiazem, and nifedipine
• Diuretics such as Bumetanide, furosemide, indapamide, thiazides, and triamterene
• 3-Hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors such as atorvastatin, pravastatin, and simvastatin
• Non-steroidal anti-inflammatory drugs such as ampiroxicam, celecoxib, diclofenac, ibuprofen, indomethacin, ketoprofen, meclofenamide, nabumetone, naproxen, oxaprozin, piroxicam, sulindac, and tiaprofenic acid
• Psychotropic drugs such as anti-psychotic drugs (aripriprazole, chlorpromazine, clozapine, flupenthixol, haloperidol, olanzapine, risperidone, and thioridazine) and anxiolytics (alprazolam and chlordiazepoxide) It is essential to note that these reactions can occur immediately or take up to 72 hours to develop after sun exposure, and patients should contact their healthcare provider if they experience severe reactions, but not stop taking prescribed medications without medical advice 1.

From the FDA Drug Label

Photosensitivity/Phototoxicity: Moderate to severe photosensitivity/phototoxicity reactions, the latter of which may manifest as exaggerated sunburn reactions (e.g., burning, erythema, exudation, vesicles, blistering, edema) involving areas exposed to light (typically the face, “V” area of the neck, extensor surfaces of the forearms, dorsa of the hands), can be associated with the use of quinolones after sun or UV light exposure. Photosensitivity manifested by an exaggerated sunburn reaction has been observed in some individuals taking tetracyclines. Photosensitivity manifested by an exaggerated sunburn reaction has been observed in some individuals taking tetracyclines.

Medications causing photosensitivity include:

• Ciprofloxacin (PO) 2
• Minocycline (PO) 3
• Doxycycline (PO) 4 These medications can cause photosensitivity reactions, which may manifest as exaggerated sunburn reactions. Patients taking these medications should be advised to minimize or avoid exposure to natural or artificial sunlight and to discontinue treatment at the first sign of skin erythema.

From the Research

Medications Causing Photosensitivity

• Medications that can cause photosensitivity include nonsteroidal anti-inflammatory drugs (NSAIDs), cardiovascular drugs (such as amiodarone), phenothiazines (especially chlorpromazine), retinoids, antibiotics (sulfonamides, tetracyclines, especially demeclocycline and quinolones) 5
• Targeted anticancer therapies such as BRAF kinase inhibitors (vemurafenib, dabrafenib), EGFR inhibitors, VEGFR inhibitors, MEK inhibitors, Bcr-Abl tyrosine kinase inhibitors can also cause photosensitive reactions 5
• Tetracyclines, a group of broad-spectrum antibiotics, can cause photosensitivity reactions, which are divided into phototoxic or photoallergic reactions 6
• Doxycycline, a type of tetracycline, can cause phototoxicity, with clinical symptoms varying from light sunburn-like sensation to large-area photodermatitis 7

Drugs with High Photosensitivity Potential

• Nonsteroidal anti-inflammatory drugs (NSAIDs) 5
• Cardiovascular drugs (such as amiodarone) 5
• Phenothiazines (especially chlorpromazine) 5
• Retinoids 5
• Antibiotics (sulfonamides, tetracyclines, especially demeclocycline and quinolones) 5
• Targeted anticancer therapies such as BRAF kinase inhibitors (vemurafenib, dabrafenib), EGFR inhibitors, VEGFR inhibitors, MEK inhibitors, Bcr-Abl tyrosine kinase inhibitors 5
• Tetracyclines (doxycycline, minocycline, tetracycline, lymecycline, sarecycline, demethylchlortetracycline, chlortetracycline and metacycline) 6

Prevention and Management

• Patients taking potentially photosensitive drugs and treatments on a long-term basis should be warned of the possibility of these side effects on their skin and advised to avoid direct exposure to sunlight and to use adequate photoprotection 5
• If patients carefully protect themselves from the sun, it is often not necessary to stop treatments that include photosensitive drugs 5
• If photosensitive reactions appear, anti-inflammatory and antiallergic therapies should be introduced 5
• Travelers to tropical countries taking doxycycline for malaria prophylaxis need thorough medical counseling to avoid possibly severe phototoxic reactions 7