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Drug-induced lung lesions
Last reviewed: 04.07.2025
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Drug-induced lung lesions are not an independent nosological entity, but represent a common clinical problem when a patient who has not previously suffered from lung diseases begins to notice clinical manifestations from these organs or changes are detected on a chest X-ray, deterioration of pulmonary function and/or histological changes against the background of drug therapy.
[ What causes drug-induced lung injury?
More than 150 individual drugs or drug classes are known to cause lung injury; the mechanism of injury is rarely known, but many drugs probably cause a hypersensitivity reaction.
| Bronchial asthma | Aspirin, beta blockers (timolol), cocaine, dipyridamole, hydrocortisone, IL-2, methylphenidate, nitrofurantoin, protamine, sulfasalazine, vinca alkaloids (in combination with mitomycin) |
| Obliterating bronchiolitis with organizing pneumonia | Amiodarone, bleomycin, cocaine, cyclophosphamide, methotrexate, minocycline, mitomycin C, penicillamine, sulfasalazine, tetracycline |
| Hypersensitivity pneumonitis | Azathioprine in combination with 6-mercaptopurine, busulfan, fluoxetine, radiation |
| Interstitial pneumonia or fibrosis | Amphotericin B, bleomycin, busulfan, carbamazepine, chlorambucil, cocaine, cyclophosphamide, phenytoin, flecainide, heroin, melphalan, methadone, methotrexate, methylphenidate, methysergide, mineral oil, nitrofurantoin, nitrates, procarbazine, silicone, tocainide, vinca alkaloids (in combination with mitomycin) |
| Non-cardiogenic pulmonary edema | Terbutaline, ritodrine, chlordiazepoxide, cocaine, cytarabine, ethylated oils, gemcitabine, heroin, hydrochlorothiazide, methadone, mitomycin C, phenothiazines, protamine, sulfasalazine, tocolytics, tricyclic antidepressants, tumor necrosis factor, vinca alkaloids (in combination with mitomycin) |
| Parenchymatous hemorrhage | Anticoagulants, azathioprine in combination with 6-mercaptopurine, cocaine, mineral oils, nitrofurantoin, irradiation |
| Pleural effusion | Amiodarone, anticoagulants, bleomycin, bromocriptine, busulfan, granulocyte-macrophage colony-stimulating factor, IL-2, methotrexate, methysergide, mitomycin C, nitrofurantoin, para-aminosalicylic acid, procarbazine, radiation, tocolytics |
| Pulmonary eosinophilic infiltrate | Amiodarone, amphotericin B, bleomycin, carbamazepine, phenytoin, ethambutol, etoposide, granulocyte-macrophage colony-stimulating factor, isoniazid, methotrexate, minocycline, mitomycin C, nitrofurantoin, para-aminosalicylic acid, procarbazine, radiation, sulfasalazine, sulfonamides, tetracycline, trazodone |
| Pulmonary vasculitis | Anorectics (dexfenfluramine, fenfluramine, phentermine), busulfan, cocaine, heroin, methadone, methylphenidate, nitrates, radiation |
Symptoms of drug-induced lung injury
Depending on the drug, drug-induced lung injury may resemble interstitial fibrosis, bronchiolitis obliterans with organizing pneumonia, asthma, noncardiogenic pulmonary edema, pleural effusion, pulmonary eosinophilic infiltration, pulmonary hemorrhage, or veno-occlusive disease with corresponding changes on chest radiograph or CT and pulmonary function tests.
Treatment of drug-induced lung injury
Treatment of drug-induced lung injury consists of discontinuing the drug. Screening of pulmonary function tests is commonly performed in patients before or during therapy with drugs that may cause pulmonary toxicity, but the effectiveness of screening in predicting or early detection of toxicity has not been proven.