What Drugs Can Cause Pericarditis?

What Drugs can Cause Pericarditis?

Medication-induced pericardial inflammation is an uncommon condition. The precise progress of drug-induced pericarditis is unknown (idiopathic pericarditis). Some of the drugs commonly observed to induce this condition include isoniazid, cyclosporine, procainamide, dantrolene, doxorubicin, penicillin, hydralazine, warfarin, and heparin. The chronic consumption of the drug may be the reason for getting this condition. The adverse reaction of the drug to the body is the risk factor for pericarditis.

What Drugs Can Cause Pericarditis?

Interferon-based Drugs

Interferon-based drugs used for many purposes for treating various cancers and virus infections. It has the same properties which our body naturally synthesis, but when used for a chronic condition, it induces several side effects. Some of the most common side effects include flu-like illness, chest pain, alopecia, rash, pancytopenia, myalgias, and hepatotoxicity. Interferon drug-mediated pericarditis is not well-defined, exceptionally infrequent and among the different synthesis, interferon alpha is known to be the most cardiotoxic. It causes an autoimmune reaction through various mechanisms including production of gamma-globulins and interleukin-6 and inhibition of allospecific suppressor T lymphocytes, as well as activation of natural killer cells.

Actinomycin-D, anthracyclines, bleomycin, bromocriptine, cisplatin combined with 5-fluorouracil, cyclophosphamide, cytarabine, methysergide, minoxidil, morrhuate sodium, phenylbutazone, and tocainide have been associated with the development of pericarditis. Among these drugs, mesalamine and sulfasalazine-containing have strong potential in the cause of pericarditis. Pharma companies of oral and rectal mesalamine and sulfasalazine producers, list pericarditis as an uncommon adverse drug reaction in their information pamphlet. The underlying relationship between pericarditis and medicines with same pharmacologic activity, such as olsalazine and balsalazide, is uncertain. Methysergide drug is an ergot alkaloid used prophylactically for the treatment of a migraine and cluster headaches. Patient has shown developed constrictive pericarditis while on long-term methysergide therapy and now no longer used for first-line treatment.

In drug-induced systemic lupus erythematosus, chest pain is the major symptoms caused by inflammation of the lining that surrounds the lungs (pleuritis) and the heart (pericarditis). Cardiac manifestations are generally unusual in hydralazine-induced lupus. Pericarditis occurs less than 5% in hydralazine-induced lupus as compared to 20% in the spontaneously occurring systemic lupus erythematosus. Recurrent pericardial effusion cases were reported because of drug-induced systemic lupus erythematosus, which result in mitral valve repair. Carbamazepine as an anti-convulsive drug has been identified to cause lupus disease in several cases.

The anti-coagulant drugs have a significant part in inducing the pericardial effusion. Warfarin, heparin, and antithrombotic agents such as aspirin and dipyridamole have a role in persuading major pericardial effusion along with vascular complications, gastrointestinal hemorrhage. Major pericardial effusion is defined as cardiac tamponade with a level of fluid > 10 mm which require immediate treatment such as pericardial puncture or surgery. Minor pericardial effusion is defined as a level of fluid < 10 mm, which can be managed with drug treatment.

Signs and Symptoms of Medication-Induced Pericardial Inflammation

The signs and symptoms of medication-induced pericardial inflammation include immunoglobulin E-mediated allergic reaction, direct cardiac toxicity, humoral antibody response, and cell-mediated hypersensitivity, and peripheral eosinophilia. Difficulty breathing, which gets worse especially while reclining or lying down, Swelling of the legs and feet (edema), low-grade fever, chills, sweating, chest pain; and pain in chest increases on coughing or swallowing. The severity of medication-induced pericardial inflammation may vary and it is difficult to predict who gets mild or severe symptoms.

The best therapy for drug-induced pericarditis involves the prompt withdrawal of the risk associated with drug intake and treatment of its signs and symptoms. If the condition is not treated on time, it may lead to life-threatening symptoms. Treatment with nonsteroidal anti-inflammatory drugs and colchicine outcomes in good recovery additionally, diuretics help to decrease excess fluid accumulation in the body may be administered

The best combination drugs are is ibuprofen and colchicine. Ibuprofen has several advantages, for instances, it gradually increases the coronary blood flow while the other drug has poor coronary blood flow. Indomethacin usually controls pain but has a poor adverse effect profile and reduces coronary flow. The use of colchicine tends to prevent recurrent pericarditis.

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Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:September 19, 2018

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