Stop Drug-Induced Lupus

The Hospitalist. 2008 June;2008(06):

June 1, 2008 | The Hospitalist

Other agents that may possibly cause DILE include:

Anti-tumor necrosis factor agents (adalimumab, etanercept, infliximab);
Bupropion;
Fluorouracil;
Interferon;
Lisinopril;
Non-steroidal anti-inflammatory agents;
Propylthiouracil;
Statins; and
Terbinafine.

Diagnosis is made by confirming the patient has:

One or more clinical symptoms;
A positive ANA;
No SLE history prior to using the suspected agent;
Not taken the drug anytime from three weeks to two years before the symptoms appeared; and
Clinical resolution occurs rapidly upon “suspected drug” discontinuation.

A complete blood count should be obtained to evaluate for anemia (rare in DILE, common in SLE). Liver function tests, blood urea nitrogen, creatinine, and urinalysis can be performed to evaluate for other complications.

DILE usually resolves following drug discontinuation, but severe cases may require low doses of systemic corticosteroids. TH

Michele B Kaufman, PharmD, BSc, is a registered pharmacist based in New York City.

References

Vasoo S. Drug-induced lupus: an update. Lupus 2006;15:757-761.
Kauffman CL. Lupus erythematosus, drug-induced. eMedicine 2007. Available at www.emedicine.com/derm/TOPIC107.htm. Accessed April 8, 2008.
MedlinePlus. www.nlm.nih.gov/medlineplus/ print/ency/article/000446.htm. Accessed April 8, 2008.
Schur PH, Rose BD. Drug-induced lupus 2008; Patients UpToDate Version 16.1. Available www.uptodate.com/patients/content/topic.do;jsessionid=1934E0AFFCBBB588269DBFEE5F96BDF4.1002?topicKey=~kU3CGByPyaH&selectedTitle=2~103&source=search_result. Accessed April 8, 2008.
Borchers A, Keen CL, Gershwin ME. Drug-induced lupus. Ann NY Acad Sci. 2007;1108:166-182.

Market watch

First-time generics:

Alendronate once-weekly tablets (generic Fosamax);
Granisetron injection (generic Kytril injection);
Lansoprazole (generic Prevacid); the brand drug patent expires this month; and
Venlafaxine XR (generic Effexor XR); the brand drug patent expires this month.

Approvals:

A fixed-dose combination product of Niaspan 1,000 mg/simvastatin 20 mg (Simcor) has Food and Drug Administration (FDA) approval for hyperlipidemia.

New device:

The FDA has approved Endeavor, a zotarolimus-eluting coronary stent, to be used in patients with coronary artery disease. Patients allergic to zotarolimus, cobalt, nickel, chromium, or molybdenum should not receive the Endeavor stent.

New indications:

Colesevelam tablets (Welchol) have been FDA approved as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. Approval was based on results of three clinical trials that were double-blind, placebo-controlled add-on therapy trials. Patients (n=1,018) had baseline A1C values of 7.5%-9.5%. The subjects received colesevelam in combination with metformin, sulfonylureas, insulin or placebo. Colesevelam is available as 625 mg tablets and dosed three tablets twice daily with a meal or liquid.

Palonosetron injection (Aloxi) has been FDA approved for the prevention of postoperative nausea and vomiting for up to 24 hours after surgery. It was studied in elective gynecologic and abdominal laparoscopic surgery.

New information:

The National Osteoporosis Foundation recently published a new “Clinician’s Guide to Prevention and Treatment of Osteoporosis.” View it online at www.nof.org/professionals/Clinicians_Guide.htm 3/4/08

Withdrawals:

Atenolol injection 0.5mg/ml (Tenormin). Astra Zeneca has discontinued Tenormin due to effective generic products available.

Cefadroxil powder for suspension (Duricef). Warner Chilcott has discontinued Duricef due to effective generic products available.

Humatin capsules (Paromomycin). King Pharmaceuticals has discontinued Humatin due to effective generic products available.—MK