- Overview of Interstitial Lung Disease
- Drug-Induced Pulmonary Disease
- Overview of Eosinophilic Pulmonary Diseases
- Acute Eosinophilic Pneumonia
- Chronic Eosinophilic Pneumonia
- Löffler Syndrome
- Hypersensitivity Pneumonitis
- Overview of Idiopathic Interstitial Pneumonias
- Idiopathic Pulmonary Fibrosis (IPF)
- Desquamative Interstitial Pneumonia (DIP)
- Nonspecific Interstitial Pneumonia (NSIP)
- Cryptogenic Organizing Pneumonia (COP)
- Respiratory Bronchiolitis–Associated Interstitial Lung Disease (RBILD)
- Acute Interstitial Pneumonia (AIP)
- Lymphoid Interstitial Pneumonia (LIP)
- Idiopathic Pleuroparenchymal Fibroelastosis
- Lymphangioleiomyomatosis
- Pulmonary Alveolar Proteinosis
- Pulmonary Langerhans Cell Histiocytosis
Topic Resources
Drug-induced pulmonary disease is not a single disorder, but rather a spectrum of lung disorders caused by adverse reactions to various medications or substances. Patients without previous pulmonary disease may develop respiratory symptoms, chest radiograph changes, deterioration of pulmonary function, histologic changes, or several of these findings in association with medication therapy or illicit drug use. Over 150 medications or substances have been reported as causing pulmonary disease; the mechanism is rarely known, but many medications are thought to provoke a hypersensitivity response. Some medications (eg, nitrofurantoin) can cause different injury patterns in different patients.. Some medications (eg, nitrofurantoin) can cause different injury patterns in different patients.
Depending on the medication or substance, drug-induced syndromes can cause interstitial fibrosis, organizing pneumonia, asthma, noncardiogenic pulmonary edema, pleural effusions, pulmonary eosinophilia, pulmonary hemorrhage, or veno-occlusive disease (see table Substances With Toxic Pulmonary Effects).
Substances With Toxic Pulmonary Effects
Condition | Medication or Substance* |
|---|---|
Aspirin, beta-blockers (eg, timolol), Aspirin, beta-blockers (eg, timolol),cocaine, dipyridamole, IV hydrocortisone (rarely in patients with sensitivity to , dipyridamole, IV hydrocortisone (rarely in patients with sensitivity toaspirin and asthma), interleukin-2, methylphenidate, nitrofurantoin, protamine, sulfasalazine, vinca alkaloids (with mitomycin)and asthma), interleukin-2, methylphenidate, nitrofurantoin, protamine, sulfasalazine, vinca alkaloids (with mitomycin) | |
Organizing pneumonia | Amiodarone, bleomycin, checkpoint inhibitors, Amiodarone, bleomycin, checkpoint inhibitors,cocaine, cyclophosphamide, methotrexate, minocycline, mitomycin, penicillamine, sulfasalazine, tetracycline, cyclophosphamide, methotrexate, minocycline, mitomycin, penicillamine, sulfasalazine, tetracycline |
Azathioprine plus mercaptopurine, busulfan, fluoxetine, methotrexate, radiationAzathioprine plus mercaptopurine, busulfan, fluoxetine, methotrexate, radiation | |
Interstitial pneumonia or fibrosis | Amphotericin B, bleomycin, busulfan, carbamazepine, checkpoint inhibitors, chlorambucil, Amphotericin B, bleomycin, busulfan, carbamazepine, checkpoint inhibitors, chlorambucil,cocaine, cyclophosphamide, phenytoin, flecainide, , cyclophosphamide, phenytoin, flecainide,heroin, melphalan, methotrexate, methylphenidate, , melphalan, methotrexate, methylphenidate,mineral oil (via chronic microaspiration), nitrofurantoin, nitrosoureas, procarbazine, silicone (subcutaneous injection), tocainide, vinca alkaloids (with mitomycin)(via chronic microaspiration), nitrofurantoin, nitrosoureas, procarbazine, silicone (subcutaneous injection), tocainide, vinca alkaloids (with mitomycin) |
Noncardiac pulmonary edema | Beta-adrenergic agonists (eg, ritodrine, terbutaline), chlordiazepoxide, Beta-adrenergic agonists (eg, ritodrine, terbutaline), chlordiazepoxide,cocaine, cytarabine, ethiodized oil (IV, and via chronic microaspiration), gemcitabine, , cytarabine, ethiodized oil (IV, and via chronic microaspiration), gemcitabine,heroin, hydrochlorothiazide, methadone, mitomycin, phenothiazines, protamine, sulfasalazine, tocolytic drugs (eg, terbutaline), tricyclic antidepressants, tumor necrosis factor, vinca alkaloids (with mitomycin), hydrochlorothiazide, methadone, mitomycin, phenothiazines, protamine, sulfasalazine, tocolytic drugs (eg, terbutaline), tricyclic antidepressants, tumor necrosis factor, vinca alkaloids (with mitomycin) |
Parenchymal hemorrhage | Anticoagulants, azathioprine plus mercaptopurine, Anticoagulants, azathioprine plus mercaptopurine,cocaine, mineral oil (via chronic microaspiration), nitrofurantoin, radiation(via chronic microaspiration), nitrofurantoin, radiation |
Amiodarone, anticoagulants, bleomycin, bromocriptine, busulfan, check-point inhibitors, granulocyte-macrophage colony-stimulating factor, interleukin-2, methotrexate, mitomycin, nitrofurantoin, para-aminosalicylic acid, procarbazine, radiation, tocolytic drugs (eg, terbutaline)Amiodarone, anticoagulants, bleomycin, bromocriptine, busulfan, check-point inhibitors, granulocyte-macrophage colony-stimulating factor, interleukin-2, methotrexate, mitomycin, nitrofurantoin, para-aminosalicylic acid, procarbazine, radiation, tocolytic drugs (eg, terbutaline) | |
Amiodarone, amphotericin B, bleomycin, carbamazepine, checkpoint inhibitors, Amiodarone, amphotericin B, bleomycin, carbamazepine, checkpoint inhibitors,cocaine, phenytoin, ethambutol, etoposide, granulocyte-macrophage colony-stimulating factor, isoniazid, methotrexate, minocycline, mitomycin, nitrofurantoin, para-aminosalicylic acid, procarbazine, radiation, sulfasalazine, sulfonamides, tetracycline, trazodone, phenytoin, ethambutol, etoposide, granulocyte-macrophage colony-stimulating factor, isoniazid, methotrexate, minocycline, mitomycin, nitrofurantoin, para-aminosalicylic acid, procarbazine, radiation, sulfasalazine, sulfonamides, tetracycline, trazodone | |
Pulmonary vascular disease | Appetite suppressants (eg, fenfluramine, phentermine), busulfan, Appetite suppressants (eg, fenfluramine, phentermine), busulfan,cocaine, heroin, methylphenidate, nitrosoureas, methylphenidate, nitrosoureas |
Yavordios S, Beltramo G, Freppel R, et al. Diffuse lung diseases ascribed to drugs: a nationwide observational study over 37 years using the French Pharmacovigilance Database. Eur Respir J 2025;65(2):2400756. doi:10.1183/13993003.00756-2024 | |
* For a comprehensive list of drugs with pulmonary toxicity, see The Drug-Induced Respiratory Disease Website. | |
Diagnosis is based on observation of responses to withdrawal from and, if practical, reintroduction to the suspected medication.
Treatment of Drug-Induced Pulmonary Disease
Stopping the medication or substance
Management involves discontinuation of the offending agent.
Prevention of Drug-Induced Pulmonary Disease
Pulmonary function testing, chest imaging, or both is commonly performed in patients who are initiating or are currently administered medications associated with pulmonary toxicity; however, the benefits of screening for underlying lung disease or monitoring for early detection of toxicity are unproven. In general, it is advisable to limit the use of agents with risk of pulmonary toxicity.
