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Li t t ’s

DRUG
ERUPTION
REFERENCE MANUAL
16th
INCLUDING Edition
DRUG INTERACTIONS

15th EDITION
Jerome Z. Litt, MD
Assistant Clinical Professor of Dermatology
Case Western Reserve University School of Medicine
Cleveland, Ohio, USA
CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742
© 2010 by Taylor & Francis Group, LLC
CRC Press is an imprint of Taylor & Francis Group, an Informa business

No claim to original U.S. Government works

Version Date: 20130315

International Standard Book Number-13: 978-1-84184-766-5 (eBook - PDF)

This book contains information obtained from authentic and highly regarded sources. While all reasonable efforts have been made to publish reliable
data and information, neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made.
The publishers wish to make clear that any views or opinions expressed in this book by individual editors, authors or contributors are personal to them
and do not necessarily reflect the views/opinions of the publishers. The information or guidance contained in this book is intended for use by medical,
scientific or health-care professionals and is provided strictly as a supplement to the medical or other professional’s own judgement, their knowledge of
the patient’s medical history, relevant manufacturer’s instructions and the appropriate best practice guidelines. Because of the rapid advances in medi-
cal science, any information or advice on dosages, procedures or diagnoses should be independently verified. The reader is strongly urged to consult the
drug companies’ printed instructions, and their websites, before administering any of the drugs recommended in this book. This book does not indicate
whether a particular treatment is appropriate or suitable for a particular individual. Ultimately it is the sole responsibility of the medical professional to
make his or her own professional judgements, so as to advise and treat patients appropriately. The authors and publishers have also attempted to trace
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CONTENTS

Introduction v

Drug eruptions and reactions A–Z 1

Index of generic and trade names 632

Description of the most common eruption patterns 688

iii
To Vel – my Muse
 Foreword
Any drug has the potential to cause an adverse effect. An adverse effect, be it an adverse drug reaction (ADR) or an adverse
drug event, is an unwanted, unpleasant, noxious, or harmful consequence associated with the use of a medication that has
been administered in a standard dose by the proper route, for the purpose of prophylaxis, diagnosis, or treatment. Death is
the ultimate adverse drug event.
ADRs are a major problem in drug therapy. They are the most common of all iatrogenic illnesses that complicate 5–15%
of therapeutic drug courses, and are a leading cause of morbidity and mortality in healthcare. ADRs should therefore be
considered in the differential diagnosis of a wide variety of medical disorders. More and more people – particularly the elderly
– are taking more and more prescription and over-the-counter medications. In addition, new drugs are appearing in the
medical marketplace on an almost daily basis. It is unsurprising, then, that more and more drug reactions and cutaneous
eruptions are emerging.
The FDA reports that 319,741 people in the United States were hospitalized as a result of serious adverse drug events in
2008, and of these cases, 15.6% – almost 50,000 – patients died. In fact, from January 2000 to June 2009 the FDA has
reported nearly 2 million cases of serious adverse drug events, of which 17 % (336,448) have resulted in death. About 5% of
hospital admissions in the United States are estimated to be for the treatment of ADRs. Moreover, as many as one-third of all
emergency department and urgent care-center visits are drug related.
Prevention, diagnosis and treatment of adverse drug events are becoming more and more complex, and it is to be expected
that physicians in all specialties and medical students are often perplexed by the nature of ADRs. To this end, I now offer a
new, improved book that has evolved from the treasured drug eruption reference manual of previous editions. I hope that
you will find this comprehensive new edition informative and valuable.
Enjoy!
Jerome Z. Litt, M.D.
January, 2010

The Drug Eruptions & Reactions Manual (D.E.R.M.) – what’s new

For 15 years, this title has been a reference manual for cutaneous eruptions. The 16th edition has been expanded and
enhanced to present a comprehensive listing of all adverse drug reactions (ADRs), side effects, drug interactions and other
safety information for prescription and over-the-counter medications. The aims of this book are:
1. To help medical practitioners make informed decisions: when diagnosing and when prescribing, and also when gener-
ally seeking information.
2. To provide physicians, lecturers, educators, pharmacists and students with an easy-to-use and reliable reference tool.

Drugs: This manual describes and catalogues the adverse side effects of more than 1350 commonly prescribed and over-the-
counter generic drugs – more than 90 of which are new to this edition. All drugs have also been indexed by their Trade
(Brand) names for easy accessibility.

ADRs: Under each drug profile is a list of related adverse drug reactions. To create this improved book, drug entries have
been enhanced by over 2700 adverse events listings. In addition, these adverse events have been newly classified under the
following categories:
Skin, Hair, Nails, Mucosal, Cardiovascular, Central nervous system, Neuromuscular/Skeletal, Gastrointestinal/Hepatic,
Respiratory, Endocrine/Metabolic, Hematologic, Renal, Genitourinary, Otic, Ocular, and Local.
In addition to the improved listing of ADRs, this manual still retains its comprehensive documentation of cutaneous eruptions
and mucosal adverse effects.

Drug interactions: As with previous editions, D.E.R.M. #16 contains details of many severe, hazardous drug-drug inter-
actions. Only clinically significant drug interactions that have been reported to trigger potential harm and that could be life-
threatening have been included. These interactions are predictable and well documented in controlled studies; they should be
avoided.

v
Some generic drugs from earlier editions have been eliminated from the print copy because either they have either been with-
drawn from the marketplace or they are rarely, if ever, prescribed today. These drug profiles (together with all the informa-
tion in this book) are available – and always will be – to subscribers on our website: www.drugeruptiondata.com

Where has all this data come from?

In the past, several reference works were consulted in the course of compiling the very first few editions of this manual.
These included:
(2002): Stockley IH, Stockley’s Drug Interactions, Pharmaceutical Press, London and Chicago
(1998): Kauppinen K et al, Skin Reactions to Drugs, CRC Press, Boca Raton
(1996): Bruinsma W, A Guide to Drug Eruptions, The File of Medicines, PO Box 21, 1474 HJ Oosthuizen, Netherlands.
(1994): Goldstein S & Wintroub BU, Adverse Cutaneous Reactions to Medication, CoMedica, New York.
(1992): Zürcher K & Krebs A, Cutaneous Drug Reactions, Karger, Basel.
(1992): Breathnach SM & Hintner H, Adverse Drug Reactions and the Skin, Blackwell, Oxford.
(1988): Bork K, Cutaneous Side Effects of Drugs, WB Saunders, Philadelphia.
Now, the majority of the information in this Manual has been gleaned from the ~19 million citations assembled under
PubMed® by the U.S. National Library of Medicine® (NLM).
Journal article citations for many of the reactions listed come from the J Am Acad Dermatol, Arch Dermatol, Cutis, Int J Dermatol,
Contact Dermatitis, Br J Dermatol, JAMA, Lancet, BMJ, Aust J Dermatol, N Engl J Med, Ann Intern Med, and many other prominent
and easily accessible journals. There are occasional allusions to the incidence of many of the listed ADRs. Percentages are
obtained from these peer reviewed and published articles.
Online resources such as the eMC (Electronic Medicines Compendium) and the FDA (U.S. Food and Drug Administration)
have also been referred to when compiling drug profiles.
Observations (read anecdotes) are derived from information obtained via the Internet from more than 1500 reliable and
responsible dermatologists worldwide, and via Dr Litt’s personal correspondence.
A number of drug profiles have been researched by the Editorial team at Informa Healthcare. Thanks for these additions are
due to Dr Kelly Cornish, PhD, Mario Christodoulou, BSc. and Malavika Ramaswamy, MSc.
We are continuously adding to Litt’s D.E.R.M. database (the online ADR checking tool from which the D.E.R.M. printed
book is created) and we welcome any ADR related observations that you may have. Email us with observations at
[email protected]. All relevant input will be catalogued and you will be given appropriate attribution and
recognition on our website: www.drugeruptiondata.com

Author’s note on ADRs

Adverse drug reactions are the most common iatrogenic illness, complicating, at times, up to 15% of therapeutic drug
courses. Despite the frequency and sometimes life-threatening nature of ADRs, they remain underreported and thus are an
underestimated cause of morbidity and mortality.
ADRs can be very broadly classified as immunologic or non-immunologic, and can have a wide ranging effect on patients.
Some examples include:*

Immunologic Drug Examples Notes

Reactions

IgE-mediated Anaphylaxis from Beta-lactam antibiotics Could be severe and life-threatening

Cytotoxic Hemolytic anemia from penicillin Could be serious

Immune complex Serum sickness from tetanus antitoxin Could be serious

Cell-mediated, delayed Contact dermatitis from nickel Minor, not serious

vi
Non-immunologic Drug Examples Notes
Reactions

Specific T-cell activation Exanthem from sulfonamides Minor, not serious

Fas/Fas ligand induced Stevens-Johnson syndrome; Toxic Both these ADRs are severe and life
epidermal necrolysis threatening.

Miscellaneous Anticonvulsant hypersensitivity syndrome; Could be severe and serious

Lupus-like syndrome

Pharmacologic side effect Dry mouth from antihistamine Mild, not serious

Secondary pharmacologic Candidiasis from oral antibiotics Moderate level of seriousness (but could
side effect be severe and life-threatening in
immunocompromised patients)

Toxicity Hepatotoxicity from methotrexate Could be serious

Drug–drug interactions Seizure from theophylline while taking Could be serious

erythromycin

Overdose Excessive lidocaine causing anaphylaxis Could be serious

or hypersensitivity

Pseudoallergic Anaphylactoid reactions from Significant risk of being a serious reaction

radiocontrast media

Idiosyncratic Hemolytic anemia from primaquine or Could be serious

dapsone

Intolerance Tinnitus from aspirin Mild, not serious or severe

* This table has been adapted from American Family Physician, November 1, 2003, M. Riedel and A. Casillas

ADRs have also been classified into these six types:

• Dose-related, e.g. digoxin toxicity
• Non-dose-related, e.g. immunological reactions
• Dose-related and time-related, e.g. corticosteroids
• Time-related, e.g. tardive dyskinesia
• Withdrawal, e.g. opiate or beta-blocker withdrawal
• Unexpected failure of therapy, e.g. inadequate dose of an oral contraceptive

The incidence and severity of ADRs are influenced by a number of factors:

1. Patient-related factors:
• Age – geriatric, pediatric, middle-aged, adolescent . . . Older patients are taking more medications-hence more of a
possibility of developing reactions; pediatric patients have more delicate skins; hormonal changes in adolescents. All these
factors play roles in the development of possible adverse reactions.
• Sex – male or female (and if the latter, then pregnant, breast-feeding, menopausal).
• Disease – not only the disease being treated, but also other pre-existing health conditions and comorbid diseases. For
example, atopic patients are at increased risk for serious allergic reactions. Also, there would be an increased risk for
hypersensitivity drug reactions if the patient has asthma or lupus erythematosus.

vii
• Genetics – for example a patient could have abnormal drug metabolism by cytochrome P450 due to inheriting abnormal
alleles.
• Geography – Patients living in sunny climes could develop photoxicities from photosensitizing drugs more readily than
those who inhabit cooler, less sunny climates.

2. Drug-related factors:
• Type/class of drug. For example, there is a heightened risk of hypersensitivity with the use of beta-blockers.
• Duration of therapy – the longer a patient maintains the therapy, the greater the possibility that he/she could develop a
reaction.
• Dosage – the greater the dosage, the more likely an adverse side effect.
• Bioavailability – the extent to and rate at which the drug enters systemic circulation, thereby accessing the site of action.
• Interactions with other drugs – for example, synergistic QT prolongation can occur when two QT prolonging agents, such
as erythromycin + ritonavir, are used together.
• Route of administration – intramuscular, intravenous and topical administrations are more likely to cause hypersensitivity
reactions; oral medications are less likely to result in drug hypersensitivity.
With all of the facts listed both in this section and in my foreword, one would have thought that prevention, diagnosis and treatment
of ADRs were complex enough. . . Unfortunately, the situation is further complicated by the variety of ways in which we talk about
adverse drug reactions! The terms ‘drug allergy,’ ‘drug hypersensitivity,’ and ‘drug reaction’ are often used interchangeably. Drug
allergy specifically refers to a reaction mediated by IgE; drug hypersensitivity is an immune-mediated response to a drug agent in a
sensitized patient; and drug reactions comprise all adverse events related to drug administration, regardless of etiology.

Vigilance at point of care:

While the possibilities for adverse drug reactions seem endless, we must be on the lookout for any new medication(s) the
patient might be taking. A thorough, detailed history of all medications must be made in order to elicit any remote possibility
that the drug in question might be the culprit for the side effect. People do not often realize that the common over-the-
counter analgesics – aspirin, tylenol, advil, motrin, naprosyn, and others – are actually medications. Herbals and supplements
such as St. John’s Wort, ginkgo biloba, and echinacea can be responsible for various hypersensitivity reactions. For instance,
St. John’s Wort, in particular, interacts adversely with SSRIs and tricyclic antidepressents.
Listen to your patients! They will often tell you what you need to know when it comes to adverse effects of medication.

Contents of the book, and how to use them

This book has three parts.
1. The A–Z
The major portion of the manual – the body of the work – lists in A–Z order the 1300-odd generic drugs and supple-
ments, and the adverse reactions that can arise from their use. A note outlining hazardous interactions only appears
alongside those drugs for which severe/hazardous drug interactions are reported.
In several instances, appropriate references are included below the listed adverse effects in order to provide clinical evi-
dence and support for the occurrence of the side effect with that particular drug. A maximum of two references per
ADR are included so that this 16th edition cites more than 20,800 references and sources: from journal articles and
books along with observations from dermatologists from all over the world. These references date back to 1980.
(You will find over 41,000 references on our website, from as far back as 1922. Visit www.drugeruptiondata.com
where you could request a free trial to the database.)
On some occasions, there are very few or no adverse reactions to a specific drug. These drugs are still included in the
manual as there is a positive significance in negative findings.

viii
 2. The Index
The next part of the manual is an index of all the generic drugs and their corresponding Trade names (over 6000). If
you need to look up a Trade name drug, use the index to find the corresponding generic name so that you can then
look-up the relevant entry in the A–Z section.

3. Common eruptions
This manual includes a description of the most common eruption patterns; acting as a quick reference section for
those cutaneous reactions that occur most often. This section describes 35 eruptions in alphabetical order, from
Acanthosis nigricans to Vasculitis.
(Descriptions to several other reactions can be found on our website – www.drugeruptiondata.com)

Notes on style and conventions

Drug information
• The Generic drug name is at the top of each drug profile. A listing of Synonyms (where applicable) follows.
• Trade (Brand) name(s) are then listed alphabetically. When there are many Trade Names, the ten (or so) most commonly
recognized ones are listed.
• Following the Trade Names is – in parentheses – the latest name of the pharmaceutical company that is marketing the
drug. Many of the names of the companies have changed from earlier editions of this manual because of acquisitions,
mergers, and other factors in the pharmaceutical industry.
• Next appear the Indication(s), the Class in which the drug belongs and the Half-Life of each drug, when known.
• On occasion, an important or pertinent Note (most often pertaining to potentially severe drug-drug interactions) will
follow.

Reactions
• These are the Adverse Reactions to the particular generic drug. They are classified into seventeen different categories:
Skin, Hair, Nails, Mucosal, Cardiovascular, Central Nervous System, Neuromuscular/Skeletal, Gastrointestinal/Hepatic,
Respiratory, Endocrine/Metabolic, Hematologic, Renal, Genitourinary, Otic, Ocular, Local, Other.
• Within each category, the reactions are listed alphabetically. Thus, the order of listing does not reflect severity or frequency
in any way. However, there are occasional allusions to the incidence of many of the listed ADRs in percentages.
• The terminology used to list reaction patterns has been simplified as far as possible by eliminating, for the most part, tags
such as ‘like’ (as in ‘-Psoriasis-like’) ‘-reactivation’ ‘-syndrome’ ‘-dissemination’ ‘-iform’, etc.
• Many of the listed ADRs carry supporting references.

References
• The term passim (most often used after a cited reference) means ‘in passing’.
• As a departure from the official, conventional and established style, references are listed as follows:
– The year in parentheses
– Last name and initial(s) of the principal author
– A plus sign (+) after the author’s name represents one or more co-authors
– Journal name (standard abbreviation where possible), in italics
– Volume number (often followed by a parenthetical part or supplemental number).
– First page-number of the article
• Books when cited are italicized, followed by the publisher and page number.

ix
 ABATACEPT

(1999): Spruance SL, Skin and Allergy News October, 37

ABACAVIR Rhabdomyolysis
Trade names: Trizivir (GSK); Ziagen (GSK) (2005): Fontaine C+, AIDS 19(16), 1927 (with ciprofibrate)
Indications: HIV infections in combination with other Respiratory
antiretrovirals Cough
Category: Nucleoside analog reverse transcriptase inhibitor (2002): Peyriere H+, Allerg Immunol (Paris) 34(10), 359
Half-life: 1.5 hours (2001): Hetherington S+, Clin Ther 23(10), 1603 (10%)
Clinically important, potentially hazardous interactions Renal
with: arbutamine, argatroban, arsenic, lopinavir Nephrotoxicity
(2006): Ahmad M, J Postgrad Med 52(4), 296 (Fanconi syndrome)
Skin Other
Acute febrile neutrophilic dermatosis (Sweet’s syndrome) Death
(2004): Del Giudice P+, J Am Acad Dermatol 51(3), 474 (2003): Peyriere H+, Ann Pharmacother 37(10), 1392 (1.8%)
Anaphylactoid reactions/Anaphylaxis (3%)
(2001): Frissen PH+, AIDS 15, 289
(1999): Spruance SL, Skin and Allergy News October, 37 (3–4%) ABARELIX
Edema
(1999): Spruance SL, Skin and Allergy News October, 37 Trade name: Plenaxis (Praecis)
Erythema multiforme Indications: Prostate cancer (advanced)
Erythroderma Category: Gonadotropin-releasing hormone antagonist
(2001): Shapiro M+, The AIDS Reader 11, 222 Half-life: 13.2 days
Exanthems Clinically important, potentially hazardous interactions
(1999): Nathanson N (generalized) (from Internet) (observation) with: amiodarone, procainamide, quinidine, sotalol
(1999): Spruance SL, Skin and Allergy News October, 37
Hypersensitivity (5%)
(2007): Luther J+, Am J Clin Dermatol 8(4), 221 Skin
(2006): James JS, AIDS Treat News 419, 6 Allergic reactions
Lipoatrophy (2006): Beer TM+, Anticancer Drugs 17(9), 1075
(2005): Nolan D+, Sex Health 2(3), 153 Cellulitis
(2004): McComsey GA+, Clin Infect Dis 38(2), 263 Herpes simplex
Lipodystrophy Hot flashes (79%)
(2002): Bernasconi E+, J Acquir Immune Defic Syndr 31(1), 50 Peripheral edema (15%)
Pruritus Pruritus
(1998): Saag M+, AIDS 12, F203 Urticaria
Rash (10–69%)
(2003): Lanzafame M+, Infez Med 11(1), 40 Central Nervous System
(2002): Kessler HA+, Clin Infect Dis 34(4), 535 Headache (12%)
Stevens–Johnson syndrome Pain (31%)
(2002): Bossi P+, Clin Infect Dis 35(7), 902 Vertigo (12%)
Toxic epidermal necrolysis Neuromuscular/Skeletal
Mucosal Asthenia (10%)
Mucocutaneous lymph node syndrome (Kawasaki Back pain (31%)
syndrome) Mastodynia (20%)
(2002): Toerner JG+, Clin Infect Dis 34(1), 131 Respiratory
Oral ulceration Upper respiratory infection (12%)
(1999): Spruance SL, Skin and Allergy News October, 37
Oral vesiculation Endocrine/Metabolic
(2002): Fantry LE+, AIDS Patient Care STDS 16(1), 5 Gynecomastia (30%)
Central Nervous System
Chills
(1999): Escaut L+, AIDS 13, 1419 ABATACEPT
Fever Trade name: Orencia (Bristol-Myers Squibb)
(2003): Lanzafame M+, Infez Med 11(1), 40
Indications: Rheumatoid arthritis
Headache Category: T-cell co-stimulation modulator
(2006): Castillo SA+, Drug Saf 29(9), 811 (16%)
(with lamivudine) Half-life: 12–23 days
Paresthesias Clinically important, potentially hazardous interactions
Perioral paresthesias with: certolizumab pegol, tnf antagonists
(2001): McMahon D+, Antivir Ther 6(2), 105
Vertigo Skin
(2006): Castillo SA+, Drug Saf 29(9), 811 (27%)
Anaphylactoid reactions/Anaphylaxis
(with lamivudine)
Hypersensitivity (<1%)
Neuromuscular/Skeletal Infections
Myalgia/Myositis/Myopathy/Myotoxicity (2006): Nogid A+, Clin Ther 28(11), 1764 (53.8%)
(1999): Escaut L+, AIDS 13, 1419 Pruritus (<1%)

Litt’s D.E.R.M. © 2010 Informa UK Ltd 1

ABATACEPT

Rash (4%) Hematologic

Urticaria (<1%) Hemorrhage
Cardiovascular (2002): Choi RK+, Mayo Clin Proc 77(12), 1340
Flushing (<1%) Local
Hypertension Injection-site reactions (3.6%)
(2005): Allison C, Issues Emerg Health Technol 73, 1 (7%) (2004): Dery JP+, Am J Cardiol 93(8), 979
Hypotension (<1%) Other
Central Nervous System Death
Headache (2006): McCorry RB+, J Invasive Cardiol 18(6), E173
(2006): Nogid A+, Clin Ther 28(11), 1764 (18.2%) (2006): Usman MH+, Heart Lung 35(6), 423
(2005): Allison C, Issues Emerg Health Technol 73, 1 (18%)
Vertigo (9%)
Neuromuscular/Skeletal ACAMPROSATE
Back pain
(2005): Allison C, Issues Emerg Health Technol 73, 1 Trade names: Aotal; Campral (Forest) (Lipha)
Indications: Alcohol dependence
Respiratory Category: Antialcoholism
Cough (8%) Half-life: 20–33 hours
Nasopharyngitis Clinically important, potentially hazardous interactions
(2006): Nogid A+, Clin Ther 28(11), 1764
with: None
Upper respiratory infection
(2006): Nogid A+, Clin Ther 28(11), 1764 (12.7%)
Local Skin
Injection-site reactions Abscess (<1%)
Acne (<1%)
Allergic reactions (<1%)
ABCIXIMAB Dermatitis
(2002): Soyka M+, Drugs R D 3(1), 1
Synonym: C7E3 Diaphoresis (2%)
Trade name: ReoPro (Lilly) (Centocor) Ecchymoses (<1%)
Indications: Thrombotic arterial disease Eczema (<1%)
Category: Antiplatelet; Glycoprotein IIb / IIIa inhibitor Erythema
Half-life: 10–30 minutes – given intravenously Erythema multiforme
Clinically important, potentially hazardous interactions (1992): Fortier-Beaulieu M+, Lancet 339(8799), 991
with: fondaparinux, reteplase Exanthems (<1%)
Exfoliative dermatitis (<1%)
Facial edema (<0.1%)
Skin Infections (>1%)
Acute generalized exanthematous pustulosis (AGEP) Peripheral edema (>1%)
Allergic reactions Photosensitivity (<0.1%)
Anaphylactoid reactions/Anaphylaxis Pruritus (4%)
(2002): Pharand C+, Pharmacotherapy 22(3), 380 (2003): Oscar MA+, Therapie 58(4), 371
(2001): Iakovou Y+, Cardiology 95(4), 215 (2002): Soyka M+, Drugs R D 3(1), 1 (37 cases)
Cellulitis (0.3%) Rash (>1%)
Edema Urticaria (<1%)
(2002): Pharand C+, Pharmacotherapy 22(3), 380 Vesiculobullous eruption (<1%)
Peripheral edema (1.6%) Xerosis (<1%)
Petechiae (0.3%)
Pruritus (0.3%) Hair
(2002): Pharand C+, Pharmacotherapy 22(3), 380 Alopecia
Mucosal Mucosal
Gingival bleeding Dysgeusia (>1%)
(2005): Lee DH+, Acta Radiol 46(5), 534 (2 cases) Oral ulceration (<0.1%)
Sialorrhea (<0.1%)
Cardiovascular Xerostomia (2%)
Hypotension
(2003): Hawkins C+, Allergy 58(7), 688 Cardiovascular
Myocardial infarction Chest pain (>1%)
(2004): Kastrati A+, N Engl J Med 350(3), 232 Phlebitis (<1%)
(2003): Ajani AE+, Cardiovasc Radiat Med 4(1), 12 (1%) Central Nervous System
Central Nervous System Chills (>1%)
Headache Depression (5%)
Hyperesthesia (1%) Fever (<1%)
Neuromuscular/Skeletal Headache (>1%)
Myalgia/Myositis/Myopathy/Myotoxicity (0.3%) (2002): Soyka M+, Drugs R D 3(1), 1 (28 cases)

2 Litt’s D.E.R.M. © 2010 Informa UK Ltd

 ACEBUTOLOL

Pain (3%) ACEBUTOLOL

Paresthesias (2%)
Seizures (<1%) Trade names: Acecor; Acetanol; Alol; Apo-Acebutolol; Monitan;
Twitching (<0.1%) Neptal; Novo-Acebutolol; Nu-Acebutolol; Prent; Rhodiasectral;
Vertigo (3%) Rhotral; Sectral
Neuromuscular/Skeletal Indications: Hypertension, angina, ventricular arrhythmias
Arthralgia (>1%) Category: Adrenergic beta-receptor antagonist; Antiarrhythmic
Asthenia (6%) class II
(2002): Soyka M+, Drugs R D 3(1), 1 (16 cases) Half-life: 3–7 hours
Back pain (>1%) Clinically important, potentially hazardous interactions
Leg cramps (<1%) with: clonidine, verapamil
Myalgia/Myositis/Myopathy/Myotoxicity (>1%) Note: Cutaneous side effects of beta-receptor blockaders are
Tremor (>1%) clinically polymorphous. They apparently appear after several months
Gastrointestinal/Hepatic of continuous therapy. Atypical psoriasiform, lichen planus-like, and
Abdominal pain (>1%) eczematous chronic rashes are mainly observed. (1983): Hödl St, Z
Hautkr (German) 1:58, 17
Dysphagia (<1%)
Respiratory
Cough (>1%) Skin
Flu-like syndrome (>1%) Dermatitis
Rhinitis (>1%) Diaphoresis
(1995): Schmutz JL+, Dermatology 190, 86
Genitourinary
Edema (1–10%)
Vaginitis (<1%)
Erythema multiforme (<1%)
Otic Exanthems (4%)
Tinnitus (<1%) (1985): Singh BN+, Drugs 29, 531
Ocular Exfoliative dermatitis
Amblyopia (<1%) Facial edema (<1%)
Diplopia (<1%) Hyperkeratosis (palms and soles)
Ophthalmitis (<0.1%) Lichenoid eruption
Photophobia (<0.1%) (1982): Taylor AEM+, Clin Exp Dermatol 7, 219
Lupus erythematosus (<1%)
Other (2005): Fenniche S+, Skin Pharmacol Physiol 18(5), 230
Death (<0.1%) (1997): Burlingame RW, Clin Lab Med 17, 367
Pigmentation
Pityriasis rubra pilaris
ACARBOSE Pruritus (<2%)
Psoriasis
Trade names: Glucobay; Glumida; Prandase; Precose (Bayer) (1986): Czernielewski J+, Lancet 1, 808
Indications: Non-insulin dependent diabetes type II (1984): Arntzen N+, Acta Derm Venereol (Stockh) 64, 346
Category: Alpha-glucosidase inhibitor Rash (1–10%)
Half-life: 2.7–9 hours Raynaud’s phenomenon
(1984): Eliasson K+, Acta Med Scand 215, 333
Toxic epidermal necrolysis
Skin
Urticaria
Acute generalized exanthematous pustulosis (AGEP) (2005): Chiffoleau A+, Therapie 60(6), 593
(2003): Poszepczynska-Guigne E+, Ann Dermatol Venereol
130(4), 439 Vasculitis
(1988): Bonnefoy M+, Ann Dermatol Venereol (French) 115, 27
Erythema (<1%)
(2000): Schmutz JL+, Ann Dermatol Venereol 127, 869 Xerosis
(polymorphous) Hair
Erythema multiforme Alopecia
(1999): Kono T+, Lancet 354, 396 (generalized) Nails
Rash Nail dystrophy
Urticaria (<1%) Nail pigmentation
Mucosal Onycholysis
Ageusia Pincer nails (reverse transverse curvature of the nails)
(1996): Martin Bun N+, Med Clin (Barc) (Spanish) 28, 399 (1998): Greiner D+, J Am Acad Dermatol 39, 486
Gastrointestinal/Hepatic Mucosal
Hepatotoxicity Dysgeusia
(2006): Hsiao SH+, Ann Pharmacother 40(1), 151 Oral lichenoid eruption
(2002): Chitturi S+, Semin Liver Dis 22(2), 169 Xerostomia (<1%)
Cardiovascular
Bradycardia
(2000): Joye F, Presse Med 29(18), 1027

Litt’s D.E.R.M. © 2010 Informa UK Ltd 3

ACEBUTOLOL

Hypotension Gastrointestinal/Hepatic
(2000): Joye F, Presse Med 29(18), 1027 Abdominal pain
Central Nervous System Hepatotoxicity
Hyperesthesia (<2%) (2006): Lapeyre-Mestre M+, Fundam Clin Pharmacol 20(4), 391
Myasthenia gravis (2001): Fernandez-Avala Novo M+, Rev Clin Esp 201(10), 616
(1990): Confavreux C+, Eur Neurol 30(5), 279 Respiratory
Neuromuscular/Skeletal Dyspnea
Myalgia/Myositis/Myopathy/Myotoxicity (1–10%) Other
Genitourinary Death
Peyronie’s disease (2003): Palop Larrea V+, Aten Primaria 32(2), 122 (following
(1979): Pryor JP+, Lancet 1, 331 injection)
Ocular
Oculo-mucocutaneous syndrome
(1982): Cocco G+, Curr Ther Res 31, 362 ACENOCOUMAROL
Trade names: Acenox; Acitrom; Sinthrome (Alliance); Sintrom
(Alliance)
ACECLOFENAC Indications: Thromboembolic diseases
Category: Anticoagulant
Trade names: Aflamin; Arrestin; Beofenac; Preservex (UCB
Half-life: 8–11 hours
Pharma)
Clinically important, potentially hazardous interactions
Indications: Ankylosing spondylitis, Osteoarthritis, inflammatory
with: allopurinol, amiodarone, aspirin, cimetidine, danazol,
disease of the joints
disulfiram, econazole, heparin
Category: Analgesic; Non-steroidal anti-inflammatory
Half-life: 4 hours
Clinically important, potentially hazardous interactions Skin
with: lithium Allergic reactions
Blue toe syndrome
(2001): Righini M+, Thromb Haemost 85(4), 744
Skin Bullae
Anaphylactoid reactions/Anaphylaxis (1993): Elis A+, J Intern Med 234(6), 615
(2006): Rojas-Hijazo B+, Allergy 61(4), 511 Exanthems
Contact dermatitis (1998): Kamm W+, Rev Med Suisse Romande 118(6), 565
(2006): Pitarch Bort G+, Contact Dermatitis 55(6), 365 Hypersensitivity
(2001): Goday Bujan JJ+, Contact Dermatitis 45(3), 170
Necrosis
Fixed eruption (2004): Muniesa C+, Br J Dermatol 151(2), 502
(2007): Linares T+, Contact Dermatitis 56(5), 291 (2004): Valdivielso M+, J Eur Acad Dermatol Venereol 18(2), 211
Hypersensitivity Purpura
(1993): Gomez Rodriguez N+, Med Clin (Barc) 101(6), 239 (2007): Aouam K+, Pharmacoepidemiol Drug Saf 16(1), 113
Photosensitivity (2004): Borras-Blasco J+, Ann Pharmacother 38(2), 261
(2007): Vargas F+, Pharmazie 62(5), 337 Rash
(2001): Goday Bujan JJ+, Contact Dermatitis 45(3), 170 (2007): Aouam K+, Pharmacoepidemiol Drug Saf 16(1), 113
Pruritus Urticaria
Psoriasis (Pustular) (Generalized) Vasculitis
(2006): Vergara A+, J Eur Acad Dermatol Venereol 20(8), 1028 (2007): Aouam K+, Pharmacoepidemiol Drug Saf 16(1), 113
Purpura (1999): Jimenez-Gonzalo FJ+, Haematologica 84(5), 462
Rash
Stevens–Johnson syndrome Hair
(2003): Ludwig C+, Dtsch Med Wochenschr 128(10), 487 Alopecia
Toxic epidermal necrolysis Cardiovascular
(2003): Ludwig C+, Dtsch Med Wochenschr 128(10), 487 Chest pain
Urticaria Stroke
Vasculitis Central Nervous System
(1997): Morros R+, Br J Rheumatol 36(4), 503
Confusion
(1995): Epelde F+, Ann Pharmacother 29(11), 1168
Fever
Mucosal (2007): Aouam K+, Pharmacoepidemiol Drug Saf 16(1), 113
Dysgeusia (1996): Renou C+, Rev Med Interne 17(1), 93
Stomatitis Headache
Central Nervous System Vertigo
Confusion Neuromuscular/Skeletal
(1994): Pallares Querol M, Aten Primaria 13(6), 331 Back pain
Headache Gastrointestinal/Hepatic
Vertigo Abdominal pain
(1996): Kornasoff D+, Rheumatol Int 15(6), 225
(2006): Arnaiz Garcia AM+, An Med Interna 23(11), 558
Hepatotoxicity

4 Litt’s D.E.R.M. © 2010 Informa UK Ltd

 ACETAMINOPHEN

(1997): Quintana MR+, Haematologica 82(6), 732 (2006): Nnoruka EN+, Int J Dermatol 45(9), 1062 (3%)
Respiratory Hypersensitivity (<1%)
Dyspnea (2007): Kidon MI+, Int Arch Allergy Immunol 144(1), 51
(1998): Kamm W+, Rev Med Suisse Romande 118(6), 565 (2001): Grant JA+, Ann Allergy Asthma 87(3), 227 (rare)
Lichenoid keratoses
Endocrine/Metabolic (2007): Wohl Y+, J Eur Acad Dermatol Venereol 21(4), 548
Appetite decreased Linear IgA dermatosis
Genitourinary (2003): Avci O+, J Am Acad Dermatol 48(2), 299
Priapism Neutrophilic eccrine hidradenitis
(2004): Touloupidis S+, Andrologia 36(1), 47 (2006): EL Sayed F+, J Eur Acad Dermatol Venereol 20(10), 1338
(1988): Kuttner BJ+, Cutis 41, 403
Ocular
Pemphigus
Vision blurred (1990): Brenner S+, Acta Derm Venereol 70, 357
Penile edema
(1997): Cabanes Higuero N+, Med Clin (Barc) (Spanish)
ACETAMINOPHEN 109, 685
Photosensitivity
Synonyms: APAP; paracetamol (1999): Popescu C, Bucharest, Romania (from Internet)
Trade names: Abenol; Anacin-3 (Wyeth); Anaflon; Ben-U-Ron; (observation)
Bromo-Seltzer; Darvocet-N (aaiPharma); Datril; Doliprane; Pigmented purpuric eruption (Schamberg’s disease)
Excedrin (Bristol-Myers Squibb); Geluprane; Liquiprin; Lorcet (1992): Abeck D+, J Am Acad Dermatol 27, 123
(Forest); Mapap; Neopap; Panadol (GSK); Percocet (Endo); Pityriasis rosea
Percogesic; Phenaphen; Sinutab; Tylenol (Ortho-McNeil); (1993): Yosipovitch G+, Harefuah (Israel) 124, 198; 247
Valadol; Vicodin (Abbott) Pruritus
Indications: Pain, fever (2001): Grant JA+, Ann Allergy Asthma Immunol 87(3), 227 (rare)
Category: Analgesic, non-narcotic (1985): Stricker BH+, BMJ 291, 938
Half-life: 1–3 hours Purpura
Clinically important, potentially hazardous interactions (2006): Santoro D+, Clin Nephrol 66(2), 131 (with codeine)
(1998): Kwon SJ+, J Dermatol 25, 756
with: alcohol, cholestyramine, didanosine, dong quai, exenatide,
melatonin
Purpura fulminans
(1993): Guccione JL+, Arch Dermatol 129, 1267
Note: Acetaminophen is the active metabolite of phenacetin Pustules
(2005): Daghfous R+, Therapie 60(5), 523 (30%)
Rash (<1%)
Skin Sensitivity
Acute generalized exanthematous pustulosis (AGEP) (1998): Mendizabal SL+, Allergy 53, 457
(2004): Wohl Y+, Skinmed 3(1), 47 Stevens–Johnson syndrome
(2003): Mashiah J+, Arch Dermatol 139(9), 1181 (1995): Kuper K+, Ophthalmologue (German) 92, 823
Allergic granulomatous angiitis (Churg–Strauss syndrome) (1985): Ting HC+, Int J Dermatol 24, 587
(2005): Masuzawa A+, Intern Med 44(5), 496 Toxic epidermal necrolysis
Anaphylactoid reactions/Anaphylaxis (2004): Bygum A+, Pediatr Dermatol 21(3), 236
(2005): Daghfous R+, Therapie 60(5), 523 (2002): Cordova M, (Lima) (Peru) March AAD Poster
(2002): Bachmeyer C+, South Med J 95(7), 759 Urticaria
Angioedema (<1%) (2007): Tsujino Y+, J Dermatol 34(3), 224
(2002): Litt JZ, Beachwood, OH (personal case) (observation) (2006): Santoro D+, Clin Nephrol 66(2), 131 (with codeine)
(patient inadvertently re-challenged herself) Vasculitis
(1997): de Almeida MA+, Allergy Asthma Proc 18, 313 (1995): Harris A+, Br J Dermatol 133, 790
Anticonvulsant hypersensitivity syndrome (1988): Dussarat GV+, Presse Med (French) 17, 1587
(2006): Gaig P+, J Investig Allergol Clin Immunol 16(5), 321 Xanthoderma
Dermatitis (2007): Haught JM+, J Am Acad Dermatol 57(6), 1051
(1997): Mathelier-Fusada P+, Contact Dermatitis 36, 267
(1996): Szczurko C+, Contact Dermatitis 35, 299 Hair
Diaphoresis Alopecia
DRESS syndrome (1998): Litt JZ, Beachwood, OH (personal case) (observation)
(2006): Gaig P+, J Investig Allergol Clin Immunol. 16(5), 321 Nails
Erythema Nail changes
(1985): Stricker BH+, BMJ 291, 938
Mucosal
Erythema multiforme Dysgeusia
(1995): Dubey NK+, Indian Pediatr 32, 1117
(1984): Hurvitz H+, Isr J Med Sci 20, 145 Cardiovascular
Erythema nodosum (<1%) Flushing
Exanthems (1985): Stricker BH+, BMJ 291, 938
(1997): Foong H, Malaysia (from Internet) (observation) Central Nervous System
(1985): Matheson I+, Pediatrics 76, 651 Headache
Exfoliative dermatitis
(1984): Guerin C+, Therapie (French) 39, 47 Neuromuscular/Skeletal
Fixed eruption (<1%) Rhabdomyolysis
(2006): Ayala F+, Dermatitis 17(3), 160 (bullous) (2007): Nelson H+, Pharmacotherapy 27(4), 608 (overdose)

Litt’s D.E.R.M. © 2010 Informa UK Ltd 5

ACETAMINOPHEN Visit www.drugeruptiondata.com for access to

(2001): Yang CC+, Vet Hum Toxicol 43(6), 344 (overdose) (1997): Martinez-Mir I+, Ann Pharmacother 31, 373
Gastrointestinal/Hepatic (1990): Miller LG+, J Fam Pract 31, 199
Hepatotoxicity Xerostomia (<1%)
(2006): Antoniades CG+, Hepatology 44(1), 34 Cardiovascular
(2006): Holubek WJ+, Hepatology 43(4), 880 Extravasation
Renal (1994): Callear A+, Br J Ophthalmol 78, 731
Nephrotoxicity Central Nervous System
(2006): Jochum E+, Med Klin (Munich) 101(10), 830 Headache
(2005): Mour G+, Ren Fail 27(4), 381 Paresthesias (<1%)
Other (1981): Lichter PR, Ophthalmol 88, 266
Death Neuromuscular/Skeletal
(2002): Sheen CL+, Br J Clin Pharmacol 54(4), 430 Myalgia/Myositis/Myopathy/Myotoxicity
(2001): Stevenson R+, Scott Med J 46(3), 84 (overdose) (2002): Ikeda K+, Intern Med 41(9), 743
Otic
Tinnitus
ACETAZOLAMIDE Ocular
Trade names: Acetazolam; Ak-Zol; Dazamide; Defiltran; Glaucoma
Diamox (Wyeth); Diuramid; Novo-Zolamide (2007): Lee GC+, Clin Experiment Ophthalmol 35(1), 55
Indications: Epilepsy, glaucoma
Category: Carbonic anhydrase inhibitor; Diuretic
Half-life: 2–6 hours ACETOHEXAMIDE
Clinically important, potentially hazardous interactions
with: ephedra, lithium, mivacurium Trade names: Dimelin; Dimelor; Dymelor (Barr)
Indications: Non-insulin dependent diabetes type ll
Note: Acetazolamide is a sulfonamide and can be absorbed Category: Sulfonylurea
systemically. Sulfonamides can produce severe, possibly fatal, Half-life: 1–6 hours
reactions such as toxic epidermal necrolysis and Stevens–Johnson
Clinically important, potentially hazardous interactions
syndrome
with: phenylbutazones
Note: Acetohexamide is a sulfonamide and can be absorbed
Skin systemically. Sulfonamides can produce severe, possibly fatal,
Acute generalized exanthematous pustulosis (AGEP) reactions such as toxic epidermal necrolysis and Stevens–Johnson
(1995): Moreau A+, Int J Dermatol 34, 263 (passim) syndrome
(1992): Ogoshi M+, Dermatology 184, 142
Anaphylactoid reactions/Anaphylaxis
(2002): Gallerani M+, Am J Emerg Med 20(4), 371 Skin
(2000): Gerhards LJ+, Ned Tijdschr Geneeskd (Dutch) 144, 1228 Diaphoresis
Bullous dermatitis (<1%) Eczema
Erythema multiforme Erythema (<1%)
Exanthems Exanthems (<1%)
Frostbite Jaundice
(2001): Laemmle T, Wilderness Environ Med 12(4), 290 Lichenoid eruption
Lupus erythematosus Photosensitivity (1–10%)
Photosensitivity Pruritus (<1%)
Pruritus Rash (1–10%)
Psoriasis Urticaria (1–10%)
(1995): Kuroda K+, J Dermatol 22, 784
Hair
Purpura
Alopecia
Pustules
(1992): Ogoshi M+, Dermatology 184, 142 Central Nervous System
Rash (<1%) Coma
Rosacea Headache
(1993): Shah P+, Br J Dermatol 129, 647 Paresthesias
Stevens–Johnson syndrome Endocrine/Metabolic
(2006): Ogasawara K+, Neurol Med Chir (Tokyo) 246(3), 161 Porphyria cutanea tarda
(1981): Sud RN+, Indian J Ophthalmol 29(2), 101
Toxic epidermal necrolysis (<1%)
Urticaria
Hair
Hirsutism
Mucosal
Ageusia
Anosmia
Dysgeusia (>10%) (metallic taste)

6 Litt’s D.E.R.M. © 2010 Informa UK Ltd

over 35,000 supporting Medline references ACITRETIN

ACETYLCYSTEINE ACIPIMOX
Synonyms: N-acetylcysteine; L-Cysteine; NAC Trade names: Monted; Olbemox; Olbetam (Pharmacia)
Trade names: Agisolvan; Alveolex; Ecomucyl; Encore; Exomuc; Indications: Hyperlipoproteinemia.
Fabrol; Fluimicil; Mucofillin; Mucolit; Mucolitico; Mucoloid; Category: Cholesterol antagonist
Mucomiste; Mucomyst (Bioniche); Mucomyst-10; Mucosil-10; Half-life: 2 hours
Parvolex; Siran Clinically important, potentially hazardous interactions
Indications: Emphysema, bronchitis, tuberculosis, with: fibrates, statins
bronchiectasis, tracheostomy care, antidote for acetaminophen
toxicity
Category: Antidote; Antioxidant Skin
Half-life: N/A Anaphylactoid reactions/Anaphylaxis
Clinically important, potentially hazardous interactions Angioedema
with: carbamazepine, nitroglycerin Edema
(1999): Alcocer L+, Int J Tissue React 21(3), 85
Erythema
Skin Pruritus
Adverse effects Rash
(2003): Kao LW+, Ann Emerg Med 42(6), 741 Urticaria
Anaphylactoid reactions/Anaphylaxis Cardiovascular
(2006): Kanter MZ, Am J Health Syst Pharm 63(19), 1821 Flushing
(2002): Appelboam AV+, Emerg Med J 19(6), 594 (fatal) (2000): Lanes R+, J Pediatr Endocrinol Metab 13(8), 1115
Angioedema (1999): Alcocer L+, Int J Tissue React 21(3), 85
(2001): Tas S+, Br J Dermatol 145(5), 856
(1999): Schmidt LE+, Ugeskr Laeger 161(18), 2669 Central Nervous System
Clammy skin Headache
Dermatitis (1999): Alcocer L+, Int J Tissue React 21(3), 85
(2002): Davison SC+, Contact Dermatitis 47(4), 238 Pyrexia
Diaphoresis (1989): Lavezzari M+, J Int Med Res 17(4), 373
Hypersensitivity Neuromuscular/Skeletal
(1984): Tenenbein M, Vet Hum Toxicol 26, 3 Arthralgia
Pruritus (1999): Alcocer L+, Int J Tissue React 21(3), 85
(1999): Schmidt LE+, Ugeskr Laeger 161(18), 2669 Asthenia
(1984): Tenenbein M, Vet Hum Toxicol 26(Suppl 2), 3 Myalgia/Myositis/Myopathy/Myotoxicity
Rash Gastrointestinal/Hepatic
(1999): Schmidt LE+, Ugeskr Laeger 161(18), 2669
(1994): Chan TY+, Hum Exp Toxicol 13(8), 542 Dyspepsia
Urticaria Nausea
(1984): Tenenbein M, Vet Hum Toxicol 26(Suppl 2), 3 (1999): Alcocer L+, Int J Tissue React 21(3), 85
Vomiting
Mucosal (1999): Alcocer L+, Int J Tissue React 21(3), 85
Stomatitis
Respiratory
Cardiovascular Bronchospasm
Flushing
(1999): Schmidt LE+, Ugeskr Laeger 161(18), 2669 Ocular
(1992): Bonfiglio MF+, Ann Pharmacother 26(1), 22 Keratoconjunctivitis
Central Nervous System
Chills
Fever ACITRETIN
(1994): Chan TY+, Hum Exp Toxicol 13(8), 542 Trade names: Neotigason; Soriatane (Roche)
Seizures Indications: Psoriasis
(1996): Hershkovitz E+, Isr J Med Sci 32(11), 1102
Category: Retinoid
Local Half-life: 49 hours
Injection-site pain Clinically important, potentially hazardous interactions
(1984): Casola G+, Radiology 152(1), 233 with: alcohol, bexarotene, chloroquine, cholestyramine,
Other corticosteroids, danazol, ethanolamine, isotretinoin, lithium,
Death medroxyprogesterone, methotrexate, minocycline, progestins,
(1997): Ardissino D+, J Am Coll Cardiol 29(5), 941 tetracycline, vitamin A

Skin
Atrophy (10–25%)
Bullous dermatitis (1–10%)
Clammy skin (1–10%)
Dermatitis (1–10%)
Diaphoresis (1–10%)

Litt’s D.E.R.M. © 2010 Informa UK Ltd 7

ACITRETIN

(1997): Buccheri L+, Arch Dermatol 133, 711 (18.2%) Paronychia (10–25%)
(1988): Geiger J-M+, Dermatologica 176, 182 (9%) (2002): Hirsch R, Brooklyn, NY (from Internet) (observation)
Edema (1999): Katz HI+, J Am Acad Dermatol 41, S7
(2006): Tey HL+, J Dermatol 33(5), 372 Periungual granuloma
(2001): Liss WA, Pleasanton, CA (from Internet) (observation) (1997): Buccheri L+, Arch Dermatol 133, 711 (9.1%)
Erythema (18%) Pyogenic granuloma
(1997): Buccheri L+, Arch Dermatol 133, 711 (18.2%) (1999): Guzick N, Houston, TX (from Internet) (observation)
Erythema gyratum Subungual hemorrhages
(2003): Bryan ME+, J Drugs Dermatol 2(3), 315 (2007): Aydogan K+, Int J Dermatol 46(5), 494
Erythroderma Mucosal
(2006): Mahe E+, J Eur Acad Dermatol Venereol 20(9), 1133
(2001): Liss WA, Pleasanton, CA (from Internet) (observation)
Bromhidrosis (1–10%)
(2004): Goiham M, Caracas, Venezuela (from Internet)
Exanthems (2–25%) (observation)
(1999): Katz HI+, J Am Acad Dermatol 41, S7 (2001): Liss WA, Pleasanton, CA (from Internet) (observation)
(1990): Ruzicka T+, Arch Dermatol 126, 482 (2%)
Cheilitis (>75%)
Exfoliative dermatitis (25–50%) (2001): Berbis P, Ann Dermatol Venereol 128(6), 737
(2001): Blumenthal HL, Beachwood, OH (observation) (1999): Katz HI+, J Am Acad Dermatol 41, S7 (>75%)
(1999): Katz HI+, J Am Acad Dermatol 41, S7 (25–50%)
Dry mucous membranes
Fissures (1–10%) (2001): Berbis P, Ann Dermatol Venereol 128(6), 737
Fragility Gingivitis (1–10%)
Hyperkeratosis Oral lesions
Milia (1988): Geiger J-M+, Dermatologica 176, 182 (6%)
(1993): Chang A+, Acta Derm Venereol 73, 235 Sialorrhea (1–10%)
Palmar–plantar desquamation (20–80%) Stomatitis (1–10%)
(2001): Ami (from Internet) (observation) (severe)
(2001): Berbis P, Ann Dermatol Venereol 128(6), 737
Ulcerative stomatitis (1–10%)
Phototoxicity Xerostomia (10–60%)
(1999): Katz HI+, J Am Acad Dermatol 41, S7
(1999): Katz HI+, J Am Acad Dermatol 41, S7
(1997): Buccheri L+, Arch Dermatol 133, 711 (63.6%)
Pruritus (10–50%)
(1999): Katz HI+, J Am Acad Dermatol 41, S7 Cardiovascular
(1997): Buccheri L+, Arch Dermatol 133, 711 (54.5%) Capillary leak syndrome
Psoriasis (1–10%) (2007): Vos LE+, J Am Acad Dermatol 56(2), 339
Purpura (1–10%) (2004): Estival JL+, Br J Dermatol 150(1), 150
Pyogenic granuloma (1–10%) Stroke
(2002): Diederen PVMM+, World Congress Dermatol (2002): Royer B+, Ann Pharmacother 36(12), 1879
Poster, 0099 Central Nervous System
Rash (>10%) Chills
Seborrhea (1–10%) (2001): Liss WA, Pleasanton, CA (from Internet) (observation)
Stickiness (3–50%) Depression
(1999): Katz HI+, J Am Acad Dermatol 41, S7 (2005): Starling J 3rd+, J Drugs Dermatol 4(6), 690
(1997): Buccheri L+, Arch Dermatol 133, 711 (18%) Hyperesthesia (10–25%)
Sunburn (1–10%) (1999): Katz HI+, J Am Acad Dermatol 41, S7
Ulcerations (1–10%) Neurotoxicity
Urticaria (2003): Tsambaos D+, Skin Pharmacol Appl Skin Physiol 16(1), 46
Xerosis (25–50%) (2002): Chroni E+, Clin Neuropharmacol 25(6), 310
(2001): Berbis P, Ann Dermatol Venereol 128(6), 737 Paresthesias (10–25%)
(1999): Katz HI+, J Am Acad Dermatol 41, S7 (15–25%) (1999): Katz HI+, J Am Acad Dermatol 41, S7
Hair Pseudotumor cerebri
(2005): Starling J 3rd+, J Drugs Dermatol 4(6), 690
Alopecia (10–75%)
(1999): Katz HI+, J Am Acad Dermatol 41, S7
(2001): Berbis P, Ann Dermatol Venereol 128(6), 737
(2001): Popescu C, Bucharest, Romania (from Internet) Suicidal ideation
(observation) (2006): Arican O+, J Eur Acad Dermatol Venereol 20(4), 464
Alopecia totalis Neuromuscular/Skeletal
(2003): Chave TA+, Br J Dermatol 148(5), 1063 Gouty tophi
(2002): Chave TA+, World Congress Dermatol Poster 0092 (1998): Vanhooteghem O+, Clin Exp Dermatol 23, 274
(regrowth in 6 months) Myalgia/Myositis/Myopathy/Myotoxicity
Alopecia universalis (1996): Lister RK+, Br J Dermatol 134, 989
(1998): Haycox CL, Seattle, WA (from Internet) (observation) Tremor
(1998): Nadel RS, Springfield, MA (from Internet) (observation)
Gastrointestinal/Hepatic
Pili torti
(2001): Davidson DM, Groton, CT (from Internet) (observation) Hepatotoxicity
(2002): Kreiss C+, Am J Gastroenterol 97(3), 775
Nails
Genitourinary
Brittle nails
(1991): Murray HE+, J Am Acad Dermatol 24, 598 (27%) Vulvovaginal candidiasis
(1990): Ruzicka T+, Arch Dermatol 126, 482 (1995): Sturkenboom MC+, J Clin Epidemiol 48, 991
Nail changes (25–50%) Otic
Hearing loss

8 Litt’s D.E.R.M. © 2010 Informa UK Ltd

 ACYCLOVIR

(2005): Mahasitthiwat V, J Med Assoc Thai 88(Suppl 1), S79 (1995): Fazal BA+, Clin Infect Dis 21, 1038
Ocular Stinging (topical)
Maculopathy Urticaria (1–5%)
(2004): Lois N+, Arch Ophthalmol 122(6), 928 (1985): Robinson GE+, Genitourin Med 61, 62
(1983): Richards DM+, Drugs 26, 378
Vasculitis
(1983): Richards DM+, Drugs 26, 378
ACTINOMYCIN-D Vesiculation
(1993): Buck ML+, Ann Pharmacother 27, 1458
(See DACTINOMYCIN)
Hair
Alopecia (<3%)
ACYCLOVIR Mucosal
Dysgeusia (0.3%)
Synonyms: aciclovir; ACV; acycloguanosine
Trade names: Acifur; Acyclo-V; Acyvir; Avirax; Herpefug;
Central Nervous System
Zovirax (GSK); Zyclir
Agitation
(2007): Yang HH+, Int J Dermatol 46(8), 883
Indications: Herpes simplex, herpes zoster
Delirium
Category: Antiviral; Antiviral, topical; Guanine nucleoside analog (2007): Yang HH+, Int J Dermatol 46(8), 883
Half-life: 3 hours (adults) Headache
Clinically important, potentially hazardous interactions (2004): Sra KK+, Skin Therapy Lett 9(8), 1
with: meperidine, tenofovir Neurotoxicity
(2006): Chevret L+, Pediatr Transplant 10(5), 632
(2005): Orion E+, Clin Dermatol 23(2), 182
Skin Paresthesias (<1%)
Acne (<3%) (1993): Goldberg LH+, Arch Dermatol 129, 582 (passim)
Anaphylactoid reactions/Anaphylaxis (<1%)
Burning (topical) Neuromuscular/Skeletal
Dermatitis Tremor
(2001): Lammintausta K+, Contact Dermatitis 45(3), 181 Gastrointestinal/Hepatic
(2000): Serpentier-Daude A+, Ann Dermatol Venereol 127, 191 Abdominal pain
Diaphoresis (2004): Sra KK+, Skin Therapy Lett 9(8), 1
Edema Renal
(1991): Medina S+, Int J Dermatol 30, 305
Nephrotoxicity
Erythema (2006): Bassioukas K+, J Eur Acad Dermatol Venereol 20(9), 1151
(2002): Carrasco L+, Clin Exp Dermatol 27(2), 132 (2006): De Deyne S+, Rev Med Interne 27(11), 892
Erythema nodosum
(1983): Richards DM+, Drugs 26, 378 Genitourinary
Exanthems (1–5%) Vaginitis (candidal)
(1991): Whitley R+, N Engl J Med 324, 444 (1993): Goldberg LH+, Arch Dermatol 129, 582 (passim)
(1985): Robinson GE+, Genitourin Med 61, 62 Otic
Facial edema (3–5%) Auditory hallucinations
(2000): Colin J+, Ophthalmology 107, 1507 (2007): Yang HH+, Int J Dermatol 46(8), 883
Fixed eruption Ocular
(1997): Montoro J+, Contact Dermatitis 36, 225
Periorbital edema (3–5%)
Herpes zoster (recurrent) (2000): Colin J+, Ophthalmology 107, 1507
(1993): Murphy F, The Schoch Letter 43, 28, #104 (observation)
Visual hallucinations
Hypersensitivity (2007): Yang HH+, Int J Dermatol 46(8), 883
(2001): Kawsar M+, Sex Transm Infect 77(3), 204
Lichenoid eruption Local
(1985): Robinson GE+, Genitourin Med 61, 62 Injection-site inflammation (>10%)
Peripheral edema (1989): O’Brien JJ+, Drugs 37, 233
(1991): Medina S+, Int J Dermatol 30, 305 Injection-site necrosis
(1988): Hisler BM+, J Am Acad Dermatol 18, 1142 (1987): Fayol J+, Therapie (French) 42(2), 249
Photo-recall Injection-site thrombophlebitis (9%)
(2002): Carrasco L+, Clin Exp Dermatol 27(2), 132 (1988): Arndt KA, J Am Acad Dermatol 18, 188
(2001): Ann Dermatol Venereol 128(2), 184 Injection-site vesicular eruption
Photosensitivity (1986): Sylvester RK+, JAMA 255, 385
(2001): Schmutz JL+, Ann Dermatol Venereol 128, 184
Pityriasis rosea
(2007): Mavarkar L, Indian J Dermatol Venereol Leprol 73(3), 200
Pruritus (1–10%)
(1993): Goldberg LH+, Arch Dermatol 129, 582 (passim)
Rash (<3%)
(1985): Lundgren G+, Scand J Infect Dis Suppl 47, 137
(1983): Balfour HH+, N Engl J Med 308, 1448
Stevens–Johnson syndrome

Litt’s D.E.R.M. © 2010 Informa UK Ltd 9

ADALIMUMAB

ADALIMUMAB Vasculitis
(2007): Ramos-Casals M+, Medicine (Baltimore) 86(4), 242
Synonym: D2E7 (5 cases)
Trade name: Humira (Abbott) (2006): Orpin SD+, Br J Dermatol 154(5), 998
Indications: Rheumatoid arthritis Vitiligo
(2008): Smith DI+, J Am Acad Dermatol 58(2 Suppl), S50
Category: Cytokine inhibitor; TNF inhibitor
Half-life: 10–20 days Hair
Clinically important, potentially hazardous interactions Alopecia areata
with: None (2006): Garcia Bartels N+, Arch Dermatol 142(12), 1654
Alopecia universalis
Note: TNF blocking agents may lead to serious infections, (2006): Garcia Bartels N+, Arch Dermatol 142(12), 1654
lymphoma, or fatalities, particularly in patients receiving concomitant Follicular mucinosis
immunosuppressive therapy. Patients should be evaluated for latent (2005): Dalle S+, Br J Dermatol 153(1), 207
tuberculosis prior to treatment with adalimumab.
Nails
Onychocryptosis
Skin (2005): Sfikakis PP+, Arthritis Rheum 52(8), 2513 (3 cases)
Acne Onycholysis
(2008): Sun G+, J Drugs Dermatol 7(1), 69 (2005): Sfikakis PP+, Arthritis Rheum 52(8), 2513 (3 cases)
Allergic reactions (1%) Subungual hyperkeratosis
Angioedema (2005): Sfikakis PP+, Arthritis Rheum 52(8), 2513 (3 cases)
(2006): Sanchez-Cano D+, Clin Exp Rheumatol 24(5 Suppl Central Nervous System
42), S128
Headache
Bacterial infections Multiple sclerosis
(2005): Botsios C, Autoimmun Rev 4(3), 162
(2007): Bensouda-Grimaldi L+, J Rheumatol 34(1), 239
Carcinoma Neurotoxicity
Cellulitis (2008): Van L+, Arch Dermatol 144(6), 804
(2008): Van L+, Arch Dermatol 144(6), 804
Paresthesias
Eosinophilic cellulitis (2005): Berthelot CN+, J Am Acad Dermatol 53(5 Suppl 1), S260
(2006): Boura P+, Ann Rheum Dis 65(6), 839
Erysipelas Neuromuscular/Skeletal
Erythema Back pain (6%)
(2005): Sfikakis PP+, Arthritis Rheum 52(8), 2513 (1 case) (2008): Van L+, Arch Dermatol 144(6), 804
Erythema multiforme (2004): MMWR Morb Mortal Wkly Rep 6;53(30), 683
(2004): Beuthien W+, Arthritis Rheum 50(5), 1690 Tendinopathy/Tendon rupture
Fixed eruption Tremor
Fungal dermatitis Respiratory
Herpes zoster Flu-like syndrome (7%)
Infections (5%) (2008): Van L+, Arch Dermatol 144(6), 804
(2006): Bongartz T+, JAMA 295(19), 2275 Pulmonary fibrosis
(2006): Moul DK+, Arch Dermatol 142(9), 1110 (2006): Huggett MT+, Rheumatology (Oxford) 45(10), 1312
Lupus erythematosus (<0.1%) Upper respiratory infection (17%)
(2007): Ramos-Casals M+, Medicine (Baltimore) 86(4), 242 (2006): Moul DK+, Arch Dermatol 142(9), 1110
(15 cases) Renal
(2007): Sheth N+, Clin Exp Dermatol 32(5), 593
Nephrotoxicity
Lupus syndrome
(2005): Botsios C, Autoimmun Rev 4(3), 162 Ocular
Lymphoma Optic neuritis
(2006): Moul DK+, Arch Dermatol 142(9), 1110 (2006): Chung JH+, J Neurol Sci 244(1–2), 133
Malignancies Local
(2006): Bongartz T+, JAMA 295(19), 2275 Injection-site edema (15.2%)
Melanoma Injection-site erythema (15.2%)
Peripheral edema Injection-site pain (12%)
Pruritus Injection-site reactions
(2004): Youdim A+, Inflamm Bowel Dis 10(4), 333 (2005): Papadakis KA+, Am J Gastroenterol 100(1), 75
Psoriasis (2005): Scheinfeld N, Expert Opin Drug Saf 4(4), 637
(2007): Heymann WR, J Am Acad Dermatol 56(2), 327 (pustular)
(2007): Ubriani R+, Arch Dermatol 143(2), 270 Other
Rash (12%) Death
Side effects
(2006): van der Heijde D+, Arthritis Rheum 54(7), 2136 (75%)
Squamous cell carcinoma
(2008): Van L+, Arch Dermatol 144(6), 804
Urticaria
(2006): George SJ+, Dermatol Online J 12(2), 4
(2006): Sanchez-Cano D+, Clin Exp Rheumatol 24(5 Suppl
42), S128

10 Litt’s D.E.R.M. © 2010 Informa UK Ltd

 ADENOSINE

ADAPALENE Renal
Nephrotoxicity
Trade names: Adaferin; Differin (Galderma) (2005): Izzedine H+, Am J Kidney Dis 45(5), 804
Indications: Acne vulgaris (2004): Izzedine H+, Kidney Int 66(3), 1153 (mild)
Category: Retinoid
Half-life: N/A
Clinically important, potentially hazardous interactions ADENOSINE
with: resorcinol, salicylates
Trade names: Adenic; Adeno-Jec; Adenocard (Astellas);
Adenocur; Adenoject; Adenoscan (King); Adrecar; Atp; Krenosin;
Skin Krenosine
Acne (<1%) Indications: Paroxysmal supraventricular tachycardia, varicose
Burning (<1%) vein complications with stasis dermatitis
(2001): Nyirady J+, J Dermatolog Treat 12(3), 149 Category: Antiarrhythmic class IV; Neurotransmitter
(2001): Tu P+, J Eur Acad Dermatol Venereol 15 (Suppl 3), 31 Half-life: <10 seconds
Dermatitis (<1%) Clinically important, potentially hazardous interactions
Eczema (<1%) with: aminophylline, carbamazepine, dipyridamole
Erythema (<1%)
(2001): Leyden J+, Cutis 67(6 Suppl), 17
(2001): Nyirady J+, J Dermatolog Treat 12(3), 149 Skin
Irritation (<1%) Burning (<1%)
(2003): Brand B+, Cutis 72(6), 455 Diaphoresis (<1%)
(2003): Brand B+, J Am Acad Dermatol 49(3 Suppl), S227 Rash
Pruritus (<1%)
(2001): Nyirady J+, J Dermatolog Treat 12(3), 149 Mucosal
(2001): Tu P+, J Eur Acad Dermatol Venereol 15 (Suppl 3), 31 Dysgeusia (<1%)
Rash (<1%) Cardiovascular
Scaling (<1%) Arrhythmias
(2001): Tu P+, J Eur Acad Dermatol Venereol 15 (Suppl 3), 31 (1990): Parker RB+, Clin Pharm 9(4), 261
(1998): Ellis CN+, Br J Dermatol 139, Suppl 52:41 Atrial fibrillation
Xerosis (<1%) (2006): Cummings M+, J Nucl Cardiol 13(4), 576
(2001): Leyden J+, Cutis 67(6 Suppl), 17 (2006): Kaltman JR+, Pediatr Emerg Care 22(2), 113
(2001): Tu P+, J Eur Acad Dermatol Venereol 15 (Suppl 3), 31 Bradycardia
Ocular (1990): Parker RB+, Clin Pharm 9(4), 261
Conjunctivitis Chest pain
Eyelid edema (<1%) (2004): Sadigh-Lindell B+, J Pain 5(9), 469
(1990): Parker RB+, Clin Pharm 9(4), 261
Coronary Vasospasm
(2006): Faganello G+, Int J Cardiol 113(3), E84
ADEFOVIR Flushing (18%)
Synonym: GS840
Pulmonary edema
(2006): Hersi A+, Can J Cardiol 22(3), 259
Trade names: Hepsera (Gilead); Preveon
Tachycardia
Indications: HIV infection, Hepatitis B infection (2006): Burki NK+, Respir Res 7, 139
Category: Antiretroviral; Nucleotide analog reverse Torsades de pointes
transcriptase inhibitor (1994): Celiker A+, Pacing Clin Electrophysiol 17(11 Pt 1), 1814
Half-life: 16–18 hours Ventricular tachycardia
Clinically important, potentially hazardous interactions (2006): Sandler DA, J Cardiovasc Electrophysiol 17(11), 1251
with: amikacin, amphotericin B, delavirdine, drugs causing kidney
Central Nervous System
toxicity, foscarnet, gentamicin, hydroxyurea, pentamidine,
Headache
tobramycin
Hypesthesia (1%)
Paresthesias (1%)
Skin Vertigo (1%)
Hot flashes Neuromuscular/Skeletal
Pruritus Tendinopathy/Tendon rupture
Rash
Central Nervous System
Headache
(1998): Treatment update 10(1), 1
Pain
(1998): Treatment update 10(1), 1
Neuromuscular/Skeletal
Asthenia
(1998): Treatment update 10(1), 1

Litt’s D.E.R.M. © 2010 Informa UK Ltd 11

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