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 Comments
(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
www.pharmacistsletter.com ~ www.prescribersletter.com
(Detail-Document #200509: Page 2 of 4) Therapeutic Class Comments
(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
www.pharmacistsletter.com ~ www.prescribersletter.com
(Detail-Document #200509: Page 3 of 4) Therapeutic Class Comments
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
www.pharmacistsletter.com ~ www.prescribersletter.com
(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 base.com. (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 Medfrom 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…
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Copyright 2004 by Therapeutic Research Center
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