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DRUG-INDUCED DISEASES
Dhany Prafita E
Departemen/SMF Ilmu Kesehatan Kulit dan Kelamin
Fakultas Kedokteran Universitas Brawijaya/RSUD dr.Saiful Anwar Malang
Adverse Drug Reaction
(ADR)
Type A Type B
Type A
• Common • Pharmacokinetic, • Antihypertensive
(80%)
pharmacodynamic orthostatic
• Non- hypotension
immune • Drug toxicity
• NSAID
mediated • Drug interaction gastritis
• Dose-
dependent • Side effect • Antihistamine
• Predictable • Disease dry mouth
1-5
bioavailability 3,4
3. Hypersensitivity Reactionsoncalo M. Dan Bruynzeel DP. 2007. Mechanisms in Cutaneous Drug. Dalam Zhai H, Wilhelm K, Maibach HI Editor. Marzulli and Maibach’s Dermatotoxicology 7th edition. CRC Press. Florida. h.259-268.
4. Schnyder B dan Pichler WS. 2009. Mechanisms of Drug-Induced Allergy. Mayo Clin Proc. 84(3):268-272.
5. Abdollahi M, Karimpour H, Khalai S. 2003. Review of Drug-Induced Skin Reactions. Journal of Pharmacy Practice and Research. 33(1).
• Less common
• Dose-independent
• Unpredictable
• Immune & non-immune
mediated
Type B • Certain predisposition
• Drug intolerance
• Idiosyncrasy
• Hypersensitivity reactions
1. Schatz SN dan Weber RJ. 2015. Adverse Drug Reactions. PSAP 2015.
https://www.accp.com/docs/bookstore/psap/2015B2.SampleChapter.pdf
3. Hypersensitivity Reaction. Gsoncalo M. Dan Bruynzeel DP. 2007. Mechanisms in Cutaneous Drug. Dalam Zhai H, Wilhelm K, Maibach HI
Editor. Marzulli and Maibach’s Dermatotoxicology 7th edition. CRC Press. Florida. h.259-268.
4. Schnyder B dan Pichler WS. 2009. Mechanisms of Drug-Induced Allergy. Mayo Clin Proc. 84(3):268-272.
drug toxicities/intolerance – toxicity
of a drug (or several drugs) at low and
sometimes subtherapeutic doses
Pichler WJ. 2017. Drug Allergy : Classification and Clinical Features. https://www.uptodate.com/contents/drug-allergy-classification-and-clinical-
features
Type B: Drug hypersensitivity reactions restricted to a small subset of the general population: Rare and mostly unpredictable
Intolerance* Tinnitus after a single aspirin tablet
G6PD deficiency: Hemolytic anemia after antioxidant drugs (eg, dapsone) Δ
Idiosyncrasy¶ (pharmacogenetics) TMPT deficiency: Toxicity during azathioprine therapyΔ
Pseudoallergic reaction (with NSAIDs)
Anaphylaxis from beta-lactam antibiotics
Photoallergy with quinidine
Immune-mediated thrombocytopenia (with heparin)
Immunologic drug reactions (allergy) Serum sickness (with antivenom preparations)
Vasculitis (with phenytoin)
Stevens-Johnson syndrome (with trimethoprim-sulfamethoxazole)
Drug-induced hypersensitivity syndrome (with allopurinol in HLA-B*58:01 individuals)
Pichler WJ. 2017. Drug Allergy : Classification and Clinical Features. https://www.uptodate.com/contents/drug-allergy-classification-and-clinical-features.
Drug
Hypersensitivity
Pembagian Tipe
Reaksi Hipersensitivitas
Coombs & Gell
.
Pichler WJ. 2007. Drug Hypersensitivity Reactions : Classification and Relationshipto T-Cell Activation. Dalam Pichler WJ Editor. Drug Hypersensitivity.
Karger. Basel. H.168-189
Drug-Induced
Diseases
drug-induced lupus
drug-induced drug-induced
eritemathosus
pemphigus psoriasis
(DILE)
drug-induced drug-induced
photosensitivity hyperpigmentation
Imune / Non-immune
Drug-induced pemphigus
Sulfhydryl Captopril,
radical/ penicillamine,
Variety of Thiol drug
pemphigus Similar
manifestation
with the
Phenol Aspirin, rifampin,
classic drug levodopa, heroin
Immune/non-
immune
mechanism
Non-thiol, NSAID, CCB,
non- ACEI
phenol
Certain genetic
predisposition
✢Pretel M, Marques L, Espana A. 2014. Drug-Induced Lupus Erythematous. Actas Dermosifiliogr. 105(1):18-30.
Common DILE
Kim GK dan Del Rosso JQ. 2010. Drug-Provoked Psoriasis : Is It Drug Induced or Drug Aggravated? Understanding Pathophysiology and Clinical Relevance. The Journal of Clinical and Aesthetic
Dermatology. 3(1).
Hong J dan Bernstein D. 2012. A Review of Drug That Induced or Exacerbate Psoriasis. Psoriasis Forum. 18(1).
Drug-induced Photosensitivity
Zuba EB, Koronowska S, Osmola-Mankowska A, Jenerowicz D. 2016. Drug-Induced Photosensitivity. Acta Dermatovenereol Croat. 24(1):55-64
Golongan Obat Obat Reaksi Reaksi
Drugs often Fototoksik Fotoalergi
Terapi Oral
involved in Obat-obatan Furosemide + -
Kardiovaskuar dan Amiodarone + -
drug-induced Diuretik Quinidine + +
photosensitivity Antibiotik
Thiazide
Dapson
+
-
+
+
Sulfonamid + +
Tetracycline + -
Ciprofloxacine + -
Antifungal Griseofulvine + -
Ketoconazole + -
DMARD Hydroxychloroquine - +
NSAID Piroxicam +
Ibuprofen + -
Ketoprofen + +
Terapi Topikal
Zuba EB, Koronowska S, Antineoplastik 5-FU + +
Osmola-Mankowska A,
Jenerowicz D. 2016. Drug-
Furocoumarin Psoralen + +
Induced Photosensitivity. Acta Keratoplastic Coal tar + -
Dermatovenereol Croat.
24(1):55-64 NSAID Ketoprofen + +
Drug-induced Hyperpigmentation
Induced by chemotherapeutic agent
(Bleomycin)
flagellate
hyperpigmentation
Alteration to normal
Localized pigmentation pattern
increase in Toxic effect
of the drug secondary to
melanogenesis inflammation
✢Resende C, Araujo C, Gomes J, Celeste B. Bleomycin-induced flagellate hyperpigmentation. Case Report. BMJ Case Rep. 2013.
✢Larson KN, Gagnon AL, Wison BB. Bleomycin-induced Flagellate. Case Report. Clinical Case Reports 2107; 5(4): 429-430.