Microsoft word - 200509-drug-induced photosensitivity.doc

Detail-Document #200509
−This Detail-Document accompanies the related article published in− PHARMACIST’S LETTER / PRESCRIBER’S LETTER
Drug-Induced Photosensitivity
Lead author: Kelly M. Shields, Pharm.D. Drugs Reported to Cause Photosensitivity Reactions 1-11
Therapeutic Class
(Zyrtec), cyproheptadine (Periactin), diphenhydramine (Benadryl), loratadine (Claritin), promethazine (Phenergan) systemic administration of antihistamines. Anti-infectives Fluoroquinolones: ciprofloxacin (Cipro), gemifloxacin (Factive), levofloxacin (Levaquin), lomefloxacin (Maxaquin), moxifloxacin (Avelox), norfloxacin (Noroxin), Tetracyclines: demeclocycline (Declomycin), doxycycline (Vibramycin), minocycline (Minocin), oxytetracycline (Terramycin), Others: azithromycin (Zithromax), capreomycin (Capastat), ceftazidime (Fortaz), cefazolin (Ancef), cycloserine (Seromycin), dapsone, ethionamide (Trecator-SC), isoniazid (Nydrazid), metronidazole (Flagyl), nalidixic acid (NegGram), pyrazinamide, sulfamethoxazole/trimethoprim (Bactrim), sulfasalazine (Azulfidine), sulfisoxazole (Gantrisin) (Ancobon), griseofulvin (Fulvicin, Gris-PEG), terconazole (Terazol) voriconazole (VFEND) (Norvir), saquinavir (Fortovase, Invirase), zalcitabine (Hivid) (Plaquenil), pyrimethamine (Daraprim), pyrimethamine/sulfadoxine (Fansidar), quinine (Symmetrel), acyclovir (Zovirax) (Targretin), capecitabine (Xeloda), dacarbazine (DTIC), epirubicin (Ellence), fluorouracil (5-FU), interferon alfa (Intron A, Alferon-N), methotrexate (Mexate), pentostatin (Nipent), procarbazine (Matulane), tretinoin, oral (Vesanoid), vinblastine (Velban, Velbe) Copyright 2004 by Therapeutic Research Center Pharmacist’s Letter / Prescriber’s Letter ~ P.O. Box 8190, Stockton, CA 95208 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249 ~ (Detail-Document #200509: Page 2 of 4)
Therapeutic Class
(Corzide), chlorthalidone (Thalitone), hydroflumethiazide (Diucardin), indapamide (Lozol), methyclothiazide (Enduron), metolazone (Zaroxolyn), polythiazide (Renese) Diuretics, Other: furosemide (Lasix), Antihypertensives: captopril (Capoten), diltiazem (Cardizem, Tiazac), enalapril (Vasotec), nifedipine (Procardia), sotalol (Betapace) Statins: fluvastatin (Lescol), lovastatin (Mevacor), pravastatin (Pravachol), simvastatin (Zocor) Other: amiodarone (Cordarone, Pacerone), fenofibrate (Tricor), quinidine (Tegretol), felbamate (Felbatol), Incidence is generally low gabapentin (Neurontin), lamotrigine (Lamictal), oxcarbazepine (Trileptal), topiramate (Topamax), valproic acid (Depakene) Antipsychotics Antipsychotics,Phenothiazines: chlorpromazine Phenothiazines-reactions (Thorazine), fluphenazine (Prolixin), perphenazine (Trilafon), prochlorperazine (Compazine), thioridazine (Mellaril), trifluoperazine (Stelazine) Antipsychotics, Other: clozapine (Clozaril), haloperidol (Haldol), loxapine (Loxitane), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), thiothixene (Navane), ziprasidone (Geodon) (Elavil), amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil), maprotiline (Ludiomil), nortriptyline (Pamelor), protriptyline (Vivactil), trimipramine Selective serotonin reuptake inhibitors: citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft) Antidepressant, Other: bupropion (Wellbutrin), mirtazapine (Remeron), nefazodone (Serzone), trazodone (Desyrel), venlafaxine (Effexor) (Librium), zaleplon (Sonata), zolpidem Copyright 2004 by Therapeutic Research Center Pharmacist’s Letter / Prescriber’s Letter ~ P.O. Box 8190, Stockton, CA 95208 ~ (Detail-Document #200509: Page 3 of 4)
Therapeutic Class
NSAIDs: celecoxib (Celebrex), diclofenac (Voltaren, Cataflam), diflunisal (Dolobid), etodolac (Lodine), ibuprofen (Motrin), ketoprofen (Orudis), mefenamic acid (Ponstel), meloxicam (Mobic), nabumetone (Relafen), naproxen (Anaprox), oxaprozin (Daypro), piroxicam (Feldene), rofecoxib (Vioxx), sulindac (Clinoril), valdecoxib (Bextra) Other: cyclobenzaprine (Flexeril), dantrolene (Dantrium), sumatriptan (Imitrex) Sulfonylureas: acetohexamide (Dymelor), chlorpropamide (Diabinese), glimepiride (Amaryl), glipizide (Glucotrol), glyburide (DiaBeta, Micronase), tolazamide (Tolinase), tolbutamide (Orinase) benzocaine (Americaine), coal tar, hexachlorophene (PHisoHex), isotretinoin (Accutane), methoxsalen (Uvadex, Oxsoralen), minoxidil (Rogaine), tacrolimus (Prograf, Protopic), tazarotene (Tazorac), tretinoin, topical (Renova, Retin-A) Sunscreen agents: PABA, cinnamates, benzyphenones (Peridex, Hibiclens), gold salts, selegiline (Eldepryl), thalidomide (Thalomid) bitter orange, chlorella, dong quai, gossypol, supplements makes this listing incomplete. Many of the drugs listed in the proceeding response. The reaction usually manifests as table were labeled as photosensitizing based on unclear data. Unclear and incomplete reporting of Phototoxic reactions are chemically-induced adverse drug reactions lead to this confusion. reactions when the drug absorbs UVA light and Chemicals that are planar, tricyclic, or polycyclic causes cellular damage. This reaction can be seen absorb ultraviolet light, which lead them to be with initial exposure to a drug, may be dose- related, and doesn’t demonstrate cross-sensitivity. It usually has rapid onset and manifests as an Types of Photosensitivity
exaggerated sunburn. This reaction will be seen Drug-induced photosensitivity may present in only on skin areas exposed to the sun.10-13 a variety of ways. Most reactions are generally classified as either phototoxic or photoallergic. Management of Photosensitivity
Photoallergy is a relatively rare, immunological Prevention of photosensitivity reactions is response, which is not dose-related. The allergy based on patient education. Patients should be develops after multiple days of continuous educated to minimize sun exposure. Use of UVA- exposure. It occurs when light causes a drug to protective sunscreens and physical barriers such act as a hapten, triggering a hypersensitivity as clothing can provide additional light protection. Copyright 2004 by Therapeutic Research Center Pharmacist’s Letter / Prescriber’s Letter ~ P.O. Box 8190, Stockton, CA 95208 ~ (Detail-Document #200509: Page 4 of 4)
Sunscreens that provide UVA coverage include: 2. Dukes MNG, Aronson JK. Meyler’s side effects of avobenzone, dioxybenzone, oxybenzone, titanium drugs. 14th ed. Amsterdam: Elsevier; 2000. 3. Cohen HE. Red Book. 2003 ed. Montvale (NJ): dioxide, zinc oxide. Remind patients of the need to frequently reapply while in the sun. Patients 4. Warnock JK, Morris DW. Adverse cutaneous should definitely be counseled to avoid sources of reactions to mood stabilizers. Am J Clin Dermatol high-intensity light such as tanning beds. Additionally, as some reactions may be dose- 5. Warnock JK, Morris DW. Adverse cutaneous reactions to antipsychotics. Am J Clin Dermatol related, a decrease in dose may be considered to help minimize the reaction or possibly selection of 6. Arana GW. An overview of side effects caused by typical antipsychotics. J Clin Psychiatry An acute attack may be managed in a number 7. Dogra S, Kanwar AJ. Clopidogrel bisulphate- of different ways based on severity. A mild induced photosensitivity lichenoid eruption. Br J reaction may be handled similarly to a sunburn, with skin protectants and topical or systemic 8. McEvoy GK. AHFS Drug Information 2004 analgesics.12 Patients may also benefit from [database on the Internet]. Bethesda(MD): application of cooling creams or gels. If patients American Society of Health System Pharmacy. C2004 [updated 2004 Jan 1; cited 2004 April 19]. have blisters that are broken, antibacterial creams may be necessary to prevent infection.10 Severe 9. Jellin JM, Gregory PJ, Batz F, et al. Therapeutic reactions may be handled by oral or topic Research Faculty. Natural Medicines corticosteroids.13 Antihistamines may also Comprehensive Database. http://www.naturaldata (Accessed April 17, 2004). alleviate pruritus associated with reactions. photosensitivity. Drug Saf 2002;25:345-72. 11. Allen JE. Drug-induced photosensitivity. Clin Users of this document are cautioned to use their own professional judgment and consult any other necessary 12. Berbardi RR. Handbook of nonprescription drugs. or appropriate sources prior to making clinical 14th ed. Washington DC: American Pharmacists judgments based on the content of this document. Our editors have researched the information with input 13. Morison WL. Photosensitivity. N Engl J Med from experts, government agencies, and national organizations. Information and Internet links in this article were current as of the date of publication. References
Handbook of clinical drug data. 10th ed. New York: McGraw-Hill; 2002. The most practical knowledge in the least time… 3120 West March Lane, P.O. Box 8190, Stockton, CA 95208 ~ TEL (209) 472-2240 ~ FAX (209) 472-2249 Copyright 2004 by Therapeutic Research Center Subscribers to Pharmacist’s Letter and Prescriber’s Letter can get Detail-Documents, like this one, on any topic covered in any issue by going to or


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