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28th
EDITION
Neil H. Shear, MD, FRCPC, FACP

Professor of Dermatology and
Clinical Pharmacology and Toxicology
University of Toronto, Canada
Twenty-eighth edition published 2022
by CRC Press
4 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
and by CRC Press

6000 Broken Sound Parkway NW, Suite 300, Boca Raton, FL 33487-2742
© 2022 Taylor & Francis Group, LLC
CRC Press is an imprint of Informa UK Limited
The right of Neil H. Shear to be identified as Editor of this work has been asserted in accordance with sections 77 and 78 of the
Copyright, Designs and Patents Act 1988.
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 medical science, any information or advice on
dosages, procedures or diagnoses should be independently verified. The reader is strongly urged to consult the relevant
national drug formulary and the drug companies’ and device or material manufacturers’ printed instructions, and their
websites, before administering or utilizing any of the drugs, devices or materials mentioned 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 the copyright holders of all material reproduced in
this publication and apologize to copyright holders if permission to publish in this form has not been obtained. If any
copyright material has not been acknowledged please write and let us know so we may rectify in any future reprint.
All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical,
or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or
retrieval system, without permission in writing from the publishers.
For permission to photocopy or use material electronically from this work, access www.copyright.com or contact the Copyright
Clearance Center, Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400. For works that are not available on
CCC please contact mpkbookspermissions@tandf.co.uk
Trademark notice: Product or corporate names may be trademarks or registered trademarks and are used only for identification
and explanation without intent to infringe.
British Library Cataloguing-in-Publication Data

A catalogue record for this book is available from the British Library
ISBN: 978-1-032-19999-3 (hbk)

ISBN: 978-1-032-19972-6 (pbk)
ISBN: 978-1-003-26180-3 (ebk)
DOI: 10.1201/9781003261803
Publisher's note: This book has been prepared from camera-ready copy provided by the authors.
Color profile: Generic CMYK printer profile
Composite Default screen
CONTENTS
Introductory notes v
Drug profiles: generic names A–Z 1
Descriptions of important reactions 375
Drugs that cause important reactions 381
Investigational drugs for the treatment of COVID-19 415
Main classes of drugs 417
Class reactions 423
ACE inhibitors 423
Antiarrhythmics 425
Antibiotics, imidazole 427
Antibiotics, macrolide 428
Anticonvulsants 429
Antidepressants, tricyclic 432
Antihistamines (H1) 433
Antimalarials 434
Antipsychotics 436
Antiretrovirals 438
Benzodiazepines 440
Beta blockers 441
Biologics, immune checkpoint inhibitors 442
Biologics, monoclonal antibodies 444
Bisphosphonates 448
Calcium channel blockers 449
Cephalosporins 451
Corticosteroids, topical 452
Disease-modifying antirheumatic drugs (DMARDS) 454
DPP-4 inhibitors 459
Epidermal growth factor receptor (EGFR) inhibitors 460
Fluoroquinolones 463
Non-steroidal anti-inflammatory drugs (NSAIDS) 465
Proton pump inhibitors (PPI) 468
Statins 470
TNF inhibitors 471
Tyrosine-kinase inhibitors 474
Genetic tables 478
Concordance of synonyms and trade names with
generic names 491
iii
Z:\Informa\A11579 - DERM 28th\A11579 - DERM 28th Edition_UK #4.vp

24 August 2021 16:30:54
A Note from the Editor

Patients frequently ask about their prescribed drug: “Is it safe?” This text is meant to help all prescribers, dispensers and
patients understand what the risk of harm might be; whether it is from a drug reaction or interaction, Litt’s D.E.R.M. is the go-
to information source. How does this information help answer the unanswerable? Simply put, safety is a process, not a
question. With the right information at hand a safe environment can thrive; the most up-to-date relevant data help peel away
background noise from a seemingly infinite number of sources. This new edition adds additional support to a risk management
environment, and we will continue to provide the most up-to-date and relevant information; so we include known genetic
risks that are associated with drug reactions and can be screened prior to drug therapy. I look forward to feedback and
suggestions.
Litt’s D.E.R.M. is more than a text. It is part of a community of resources to make prescribing safe and to help optimize
therapy. To that end remember that the on-line information in the database is almost double what you see in the text. And it
too is kept up-to-date! For me in my practice I am in love with the Litt app – an easy portal to the online database, particularly
if you are moving between various work spaces. One patient on three critical drugs developed a rash on day 8 of treatment;
the Litt app gave me easy access to the likelihood of an exanthematous rash for each, and I could provide a clear, quantitative,
and thoughtful direction for the immediate future. For this edition, the publishers are offering 12 months’ free access to the
database to buyers of a new (not resold) copy of this current edition of the print manual in 2022: please contact Robert Peden
at the publishers (Robert.Peden@tandf.co.uk) with proof of purchase for further details.
Drug eruptions are still very important in all aspects of medicine. And the number of drugs and reactions continues to increase
with great diversity! Systemic effects are also more commonly recognized; the skin is just the beginning.
Also, we must note the potential issues arising during the search for treatments for Covid-19. We now include, both in print
and in the online database, an up-to-date summary of drugs under investigation for treating these patients, now numbering in
the millions globally; the database also includes reports on any adverse reactions to the Covid-19 vaccines.
I am so grateful to the team at CRC Press who continue to keep the Litt manual and database current and to provide the best
breadth and relevant information to support a safer environment in medicine.
Thank you for supporting our activities.
Neil H. Shear, M.D., F.R.C.P.C., F.A.C.P.
Litt’s Drug Eruption & Reaction Manual – at a glance

This 28th edition has been revised and updated throughout to present a quick clinical reference guide to adverse drug
reactions (ADRs), side effects, drug interactions and other safety information for prescription and over-the-counter
medications.
There is also material on reactions caused by classes of drugs, enabling you to see at a glance whether a reaction is common to
all the drugs in that particular class, or to a majority of them, or only to a significant few.
The aims of this edition remain:

1. To help medical practitioners make informed and safe decisions when diagnosing and prescribing, and also when
generally seeking information.
2. To help healthcare professionals remain pharmacovigilant.
3. To provide all physicians, lecturers, educators and pharmacists with an easy-to-use and reliable quick reference tool.
Space in the manual is, unfortunately, constrained. The full and comprehensive picture for all drugs – from which our informa-
tion derives – can be found in the Litt database (www.drugeruptiondata.com), which is updated continually. The Litt database
was originated by Jerome Z. Litt; it is now edited by Neil H. Shear, with advice and input by Rupert Purchase, DPhil, CChem,
FRSC. A 12-month access to the database is now included for those who buy a new (not resold) copy of this current edition of
the print manual in 2022: please contact Robert Peden at the publishers (Robert.Peden@tandf.co.uk) with proof of purchase
for further details.

25 August 2021 14:55:19
A note on ADRs
The incidence and severity of ADRs are influenced by a number of factors:
1. Patient-related factors:
Age – geriatric, pediatric, adolescent . . . older patients are taking more medications-hence more of a possibility of develop-
ing reactions; pediatric patients have more delicate skins; hormonal changes occur in adolescents . . . All these factors play
roles in the development of possible adverse reactions.
Gender – 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 hyper-
sensitivity drug reactions if the patient has asthma or lupus erythematosus.
Genetics – 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 angioedema with the use of ACE inhibitors (see further the
tables of class reactions).
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, subcutaneous, and topical administrations are more likely to cause
hypersensitivity reactions; oral medications are less likely to result in drug hypersensitivity.
The terms “drug allergy,” “drug hypersensitivity,“ and “drug reaction” are often used interchangeably. “Drug allergy” specifi-
cally refers to a reaction mediated by IgE; “drug hypersensitivity” is an immune-mediated response to a drug agent in a sensi-
tized 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 supple-
ments such as St. John’s wort, ginkgo biloba, and echinacea can be responsible for various hypersensitivity reactions. For
example, St. John’s wort, in particular, interacts adversely with SSRIs and tricyclic antidepressants.
vi

25 August 2021 14:55:19
Contents of the book, and how to use them

1. The A–Z
The major portion of the manual lists in alphabetical order the 1500 most consulted and most important generic
drugs, biologics, and supplements, and the adverse reactions that can arise from their use. If you do not find a drug in
the main A–Z listing under the name you know it by, you can turn to the concordance of synonyms and trade names to
find the generic name it will be listed under.
Trade (brand) name(s) are 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 markets the drug.
Many of the names of 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, where known.
Drug interactions: many severe, hazardous drug-drug interactions are recorded. Only clinically significant drug inter-
actions that have been reported to trigger potential harm and that could be life threatening have been included here in
the profile. These interactions are predictable and well documented in controlled studies; they should be avoided.
Pregnancy category: for new drugs approved on or after 30 June 2015 this field gives (where available) a brief
summary of the full statement reflecting the risk for pregnant women as given in the prescribing guidelines; health care
providers are advised to check the individual label where necessary. An explanation of the categories for older drugs
(A, B, C, D and X) can be found on our website www.drugeruptiondata.com.
Any “Black box” Warning required by the FDA or Notes on use then follow.
Adverse Drug Reactions: under each drug profile is a list of related ADRs. These adverse events have been classified
under the following categories: Skin, Hair, Nails, Mucosal; Cardiovascular, Central Nervous System, Endocrine/
Metabolic, Gastrointestinal/Hepatic, Genitourinary, Hematologic, Local, Neuromuscular/Skeletal, Ocular, Otic,
Renal, Respiratory, Other.
Within each category, the reactions are listed alphabetically. Thus, the order of listing does not reflect severity or
frequency in any way.
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.
The number of reports is given for each reaction in square brackets. The incidence of the most important reactions is
given in parentheses where indicated (usually from the full prescribing information for the relevant drug). For
example, the profile for Amoxicillin begins:
Skin
AGEP [28]
Anaphylactoid reactions/Anaphylaxis [17]
Angioedema (<10%) [5]
This means that we have 28 journal articles referring to occurrence of AGEP (acute generalized exanthematous
pustulosis); 17 articles mentioning the occurrence of anaphylaxis; and 5 articles discussing angioedema, as reactions to
Amoxicillin within the Skin category. All these articles appear on the website www.drugeruptiondata.com together
with links to the article abstracts on PubMed®. Additionally, the incidence of angioedema as a reaction has been
reported as up to 10%.
On some occasions, there are very few adverse reactions to a specific drug. These drugs are still included in the
manual as there is a positive significance in negative findings.
vii

25 August 2021 14:55:19
2. Important eruptions / reactions

i) This section of the manual includes a listing of descriptions of important eruption and reaction patterns. Over 40
eruptions/reactions are described here in alphabetical order, from Acanthosis nigricans to Xerostomia.
(Descriptions of several other reactions, and lists of drugs associated with these reactions, can be found on our
website – www.drugeruptiondata.com.)
ii) Reinstated for this edition by popular demand is the list of drugs that cause the most important reactions, as a quick
reference guide.
iii) We include a list of the drugs being investigated as treatments for Covid-19.
iv) We then have a list of the main classes of drugs, from 5-HT1 agonists to Xanthine alkaloids, as a quick reference guide.
v) There follows a newly enlarged section of tables of class reactions, enabling you to see at a glance whether a reaction is
common to all the drugs in that particular class, or to a majority of them, or only to a significant few.
vi) Next are tables of reported genetic associations with cutaneous adverse drug reactions and recommendations from
various sources regarding genetic screening to prevent cutaneous adverse drug reactions.
3. The Concordance
The final part of the manual is a concordance to match synonyms (noted in italic) and trade names with the generic
drug name. If you know only the synonym or trade name, you can use this list to find the corresponding generic name
to look up in the main A–Z listing section of the book.
viii

25 August 2021 14:55:19
Being a drug reaction sleuth!

Neil H Shear
I’ll start off with a real referral sent to me a few years ago (I expect it will sound familiar to all dermatologists):
“Dear Neil,
I am just seeing a patient at the hospital.
The patient took amoxicillin and clarithromycin 1 week before & ceftriaxone 45 min before getting a rash.
I think it very unlikely that ceftriaxone is the cause. As far as I know he never had it before.
The reason for this note is that our Respiratory Physician feels strongly that ceftriaxone is the cause.
What do you think?”
What I do like about this is the fact that this is a written (email) request, so any reply I give has some demonstrable existence,
as against a phone call or hall chat relying on memory only.
However, a common mistake would be to answer the question “What do you think?” There is very limited information about
this patient whom I did not see and will never see. The first step in a proper consultation is DIAGNOSIS of the possible drug
reaction. There are 3 key components for making a diagnosis:
– Appearance of the rash
– Systemic issues
– Histology
My mnemonic is Remember: Appearance, Systemic, Histology (RASH).
Thinking back on the referral sent to me I have very little information to help make a diagnosis.
What was the “rash” and were there systemic symptoms and signs? I don’t know. So I will need to ask for more detailed infor-
mation if this consultation continues.
The second step is to determine CAUSALITY. Note the referral is focused on an assumption that I will pick a single drug that
caused the “rash”. Unfortunately, that is not how life works. There are at a minimum 3 possible causes that we know of from
the history of drugs given. We don’t know if the patient was on other drugs or has a drug allergy history. In this case I will have
to assume there are NO systemic features and that the “rash” is a “simple exanthem”.
Causality assessments demand:
– A quantitative approach (numbers matter)
– Using a Bayesian type of approach we can generate probabilities that each drug we know of might have caused a reaction.
So now I need to see what the baseline rate of “rash” is for each drug. This is where Litt comes in . . .
Amoxicillin
Looking at the Amoxicillin listing in the database (Fig 1) or the Amoxicillin summary in the manual I can see that there are 33
reports of the reaction and that the background rate is estimated at >5%. This is not the final step, but it gives me some
evidence to demonstrate that, although each of these drugs
could cause rash, one is much more likely than the others.
Figure 1
ix

25 August 2021 14:55:24
After we have the background rate from Litt we can think of data that might modify the background rate. Nothing is as helpful
as knowing the timing of drug exposure to onset of a rash. In this instance we know that aminopenicillin rashes come on
around day 8 to 10 after exposure. That is very powerful additional information.
Ceftriaxone
There are comparatively few (7) reports and lower reported background rates (none in the package insert information) for
this reaction in the database (Fig 2) and manual for a drug that is widely used. Clearly exanthems are not a major clinical issue,
and the figures here are reassuringly low – not nearly as high as Amoxicillin, although not impossible.
Figure 2
Clarithromycin
Figure 3 shows the very few (3) reports from the database and manual of this drug causing a rash; the lack of any reported
background rate supports the conclusion it is not a major clinical issue.
Figure 3
We have to come to some conclusion and all possibilities need to be represented. Based on Amoxicillin being a common cause
of an exanthem (AND on the timing), we have to give it a big lead. Then we think of “I don’t know” and “I will never know”,
which I always mark down as 15% each. We now know the other antibiotics have a much small risk. So 30% for the
unknowns, 5% or so for the drugs that were unlikely, leaves the remainder for Amoxicillin.
The numbers are approximations based on the data to hand. Having other unknowns reflects real life: maybe it was due to
some contrast media? Or a comorbid risk? Or dozens of other possibilities. And truly sometimes we never know.
Now I am ready (and armed with data I can defend rationally) to send my report back to the referring doctor:
“Dear colleague
Thank you for sending information about your patient. I have not seen the patient and some key information is missing. My report is
based on what information I have but clearly that could change with more data.
Assuming the patient had a simple exanthem and no fever etc., the estimated likelihood of what caused the rash is as follows:
Amoxicillin: 65%
Ceftriaxone: 4%
Clarithromycin: 1%
Other unknown exposures or risks: 15%
We will never know: 15%”
CONCLUSIONS
LESSON 1: Look for good quality clinical data.
LESSON 2: Give opinions in text, not conversation.
LESSON 3: Use a structured summary that is uniform, every time, to increase the impact and be on target.
LESSON 4: Be quantitative; it is clear and respected.
I hope this enhances your search for quality information and enhanced patient safety.

26 August 2021 15:43:37
derm_www - 18/8/2021 09:16 [v1.0]
Proof [[1] derm #1] by
Myalgia/Myopathy (5–6%) [2] Central Nervous System

ABACAVIR Renal Headache (12%)
Trade names: Epzicom (ViiV), Triumeq (ViiV), Fanconi syndrome [2] Pain (31%)
Trizivir (ViiV), Ziagen (ViiV) Respiratory Vertigo / dizziness (12%)
Indications: HIV infections in combination with Bronchitis (4%) Endocrine/Metabolic
other antiretrovirals Cough [2] Gynecomastia (30%)
Class: Nucleoside analog reverse transcriptase Pneumonia (4%) Mastodynia (20%)
inhibitor Upper respiratory tract infection [2] Neuromuscular/Skeletal
Half-life: 1.5 hours Other Asthenia / fatigue (10%)
Clinically important, potentially hazardous Adverse effects [4] Back pain (31%)
interactions with: alcohol, arbutamine, Infection (5%) Respiratory
argatroban, arsenic, darunavir, ganciclovir, Upper respiratory tract infection (12%)
lopinavir, methadone, phenobarbital, phenytoin, Other
protease inhibitors, ribavirin, rifampin, tipranavir, ABALOPARATIDE Allergic reactions [2]
valganciclovir
Pregnancy category: C Trade name: Tymlos (Radius Health)
Important contra-indications noted in the Indications: Osteoporosis in postmenopausal ABATACEPT
prescribing guidelines for: nursing mothers women
Note: Check for presence of HLA B*57:01 Class: Parathyroid hormone analog Trade name: Orencia (Bristol-Myers Squibb)
Epzicom is abacavir and lamivudine; Triumeq is Half-life: <2 hours Indications: Rheumatoid arthritis, juvenile
abacavir, dolutegravir and lamivudine; Trizivir is Clinically important, potentially hazardous idiopathic arthritis in pediatric patients 6 years of
abacavir, lamivudine and zidovudine. interactions with: none known age and older
Warning: HYPERSENSITIVITY REACTIONS, Pregnancy category: N/A (Not indicated for Class: Biologic, Biologic disease-modifying
LACTIC ACIDOSIS and SEVERE use in females of reproductive potential) antirheumatic drug (bDMARD), Disease-
HEPATOMEGALY, and EXACERBATIONS OF Important contra-indications noted in the modifying antirheumatic drug (DMARD), T-cell
HEPATITIS B prescribing guidelines for: pediatric patients co-stimulation modulator
Warning: RISK OF OSTEOSARCOMA Half-life: 12–23 days
Skin Clinically important, potentially hazardous
Anaphylactoid reactions / anaphylaxis Cardiovascular interactions with: adalimumab, anakinra,
(includes anaphylactic shock) (3%) [3] Orthostatic hypotension (<4%) certolizumab, denosumab, echinacea, etanercept,
Exanthems [2] Palpitation (5%) golimumab, infliximab, lenalidomide, live vaccines,
Hypersensitivity (8–9%) [69] Tachycardia (2%) [2] natalizumab, pimecrolimus, sipuleucel-T,
Lipoatrophy [2] Central Nervous System tacrolimus, TNF antagonists, trastuzumab
Rash (5–7%) [18] Headache (8%) Pregnancy category: C
Stevens-Johnson syndrome [2] Vertigo / dizziness (2–10%) Important contra-indications noted in the
Toxic epidermal necrolysis [2] Endocrine/Metabolic prescribing guidelines for: nursing mothers;
Hypercalcemia (3%) [3] pediatric patients
Cardiovascular
Myocardial infarction [10] Hyperuricemia (25%)
Central Nervous System Gastrointestinal/Hepatic Skin
Abnormal dreams (10%) [2] Abdominal pain (3%) Basal cell carcinoma [3]
Anxiety (5%) Nausea (8%) Eczema [2]
Chills (6%) Herpes simplex (<5%) [3]
Genitourinary Herpes zoster [3]
Depression (6%) Hypercalciuria (11%)
Fever (pyrexia) (6%) [2] Hypersensitivity [2]
Urolithiasis (2%)
Headache (7–13%) [4] Malignancies [10]
Local Psoriasis [14]
Insomnia [2] Injection-site edema (10%)
Migraine (7%) Rash (4%) [6]
Injection-site erythema (58%) Sjögren’s syndrome [4]
Neuropsychiatric / neuropsychological Injection-site pain (9%)
adverse effect [3] Squamous cell carcinoma [5]
Sleep-related disorder (10%) Neuromuscular/Skeletal Vasculitis (angiitis) / cutaneous vasculitis
Vertigo / dizziness (6%) [3] Asthenia / fatigue (3%) (angiitis) [2]
Endocrine/Metabolic Other Mucosal
ALT increased (6%) Adverse effects [2] Stomatitis (oral mucositis) [3]
AST increased (6%) Cardiovascular
Hypertension (7%) [4]
Hyperamylasemia (2–4%)
Hypertriglyceridemia (2–6%)
ABARELIX Hypotension [2]
Gastrointestinal/Hepatic Trade name: Plenaxis (Praecis) Central Nervous System
Abdominal pain (6%) Indications: Prostate cancer (advanced) Fever (pyrexia) (5%) [2]
Diarrhea (7%) [4] Class: Gonadotropin-releasing hormone (GnRH) Headache (5–18%) [6]
Gastritis / gastric irritation (6%) antagonist Vertigo / dizziness (9%) [3]
Hepatotoxicity / liver injury / acute liver Half-life: 13.2 days Gastrointestinal/Hepatic
injury / drug-induced liver injury (DILI) [4] Clinically important, potentially hazardous Abdominal pain (5%)
Nausea (7–19%) [6] interactions with: amiodarone, procainamide, Diarrhea (5%) [3]
Vomiting (2–10%) quinidine, sotalol Dyspepsia / functional dyspepsia /
Hematologic Pregnancy category: X gastroparesis (6%)
Agranulocytosis / severe selective Important contra-indications noted in the Gastroenteritis [5]
neutropenia [3] prescribing guidelines for: pediatric patients Nausea (5%) [2]
Neutropenia (neutrophils decreased) (2–5%) Vomiting [2]
Neuromuscular/Skeletal Skin Genitourinary
Asthenia / fatigue (7–12%) [2] Hot flashes (79%) Urinary tract infection (5–13%) [10]
Bone or joint pain (5–6%) Peripheral edema (15%)
Litt’s Drug Eruption & Reaction Manual B 2022 by Taylor & Francis Group, LLC 1
derm_www - 18/8/2021 09:16 [v1.0]
ABATACEPT See all our books at www.crcpress.com
Local Local
Infusion-related reactions [4] Injection-site reaction (4%) ABIRATERONE
Infusion-site reactions (9%) [5] Neuromuscular/Skeletal Trade name: Zytiga (Janssen Biotech)
Injection-site erythema [3] Back pain (17%) Indications: Metastatic castration-resistant
Injection-site hematoma [2] Other prostate cancer (in combination with prednisone)
Injection-site pain [3] Death [3] Class: CYP17 inhibitor, Enzyme inhibitor
Injection-site pruritus [2] Half-life: 12 hours
Injection-site reaction (3%) [8] Clinically important, potentially hazardous
Neuromuscular/Skeletal ABEMACICLIB interactions with: atazanavir, carbamazepine,
Asthenia / fatigue [2] clarithromycin, CYP3A4 inducers or inhibitors,
Back pain (7%) [2] Trade name: Verzenio (Lilly)
indinavir, itraconazole, ketoconazole, nefazodone,
Pain in extremities (3%) Indications: Hormone receptor-positive, human
nelfinavir, phenobarbital, phenytoin, rifabutin,
Respiratory epidermal growth factor 2-negative advanced or
metastatic breast cancer, either as monotherapy rifampin, rifapentine, ritonavir, saquinavir,
Bronchitis (<13%) [4] telithromycin, thioridazine, voriconazole
or in combination with fulvestrant, or as inital
Cough (5–8%) Pregnancy category: X
endocrine-based therapy with an aromatase
Influenza (5–13%) [2] Important contra-indications noted in the
inhibitor
Nasopharyngitis (12%) [6] prescribing guidelines for: nursing mothers;
Pharyngitis [3] Class: CDK4/6 inhibitor
Half-life: 18 hours pediatric patients
Pneumonia (<5%) [7] Note: Contra-indicated in women who are or
Pulmonary toxicity [2] Clinically important, potentially hazardous
interactions with: grapefruit juice, may become pregnant.
Rhinitis (<5%) [2]
Sinusitis (5–13%) [3] ketoconazole, strong CYP3A4 inducers or
inhibitors Skin
Tuberculosis [2] Edema (27%) [21]
Upper respiratory tract infection (>10%) Pregnancy category: N/A (Can cause fetal
harm) Hot flashes (19%) [4]
[9]
Important contra-indications noted in the Cardiovascular
Other prescribing guidelines for: nursing mothers; Arrhythmias (7%)
Adverse effects [24] pediatric patients Atrial fibrillation [3]
Death [2] Cardiac failure (2%)
Infection (36–54%) [25] Cardiotoxicity [6]
Hair
Alopecia (12%) Chest pain (4%)
ABCIXIMAB Hypertension (9%) [27]
Mucosal
Tachycardia [3]
Stomatitis (oral mucositis) (14%)
Synonym: C7E3 Xerostomia (dry mouth) (17%) Central Nervous System
Trade name: ReoPro (Janssen Biotech) Headache [2]
Indications: Thrombotic arterial disease Central Nervous System
Anorexia [3] Endocrine/Metabolic
Class: Antiplatelet, Glycoprotein IIb/IIIa inhibitor, ALT increased (11%) [8]
Monoclonal antibody Dysgeusia (taste perversion) (12%)
Fever (pyrexia) (11%) AST increased (31%) [4]
Half-life: 10–30 minutes – given intravenously Hypercholesterolemia [2]
Clinically important, potentially hazardous
Headache (20%)
Vertigo / dizziness (11%) Hyperglycemia [2]
interactions with: anticoagulants, antiplatelets, Hypertriglyceridemia (63%)
collagenase, dasatinib, dextran, drotrecogin alfa, Endocrine/Metabolic
Hypokalemia [27]
fondaparinux, glucosamine, herbals with ALT increased (31%)
Appetite decreased (45%) [3] Gastrointestinal/Hepatic
anticoagulant properties, lepirudin, monoclonal Constipation [8]
antibodies, NSAIDs, omega-3 fatty acids, AST increased (30%)
Dehydration (10%) Diarrhea (18%) [6]
pentosan, pentoxifylline, prostacyclin analogues, Dyspepsia / functional dyspepsia /
reteplase, salicylates, thrombolytic agents, Serum creatinine increased (13%) [3]
Weight loss (14%) [2] gastroparesis (6%)
tositumomab & iodine131, trastuzumab Hepatic (liver) disorder / hepatic (liver)
Pregnancy category: C Gastrointestinal/Hepatic
dysfunction [2]
Important contra-indications noted in the Abdominal pain (39%) [2]
Hepatotoxicity / liver injury / acute liver
prescribing guidelines for: nursing mothers; Constipation (17%)
injury / drug-induced liver injury (DILI)
pediatric patients Diarrhea (90%) [11]
(2%) [13]
Nausea (64%) [9]
Nausea [9]
Vomiting (35%) [4]
Skin Vomiting [2]
Anaphylactoid reactions / anaphylaxis Hematologic
Genitourinary
(includes anaphylactic shock) [3] Anemia (25%) [3]
Nocturia (6%)
Peripheral edema (2%) Leukocytopenia (leukopenia) (17%) [5]
Urinary frequency (7%)
Neutropenia (neutrophils decreased) (37%)
Cardiovascular Urinary tract infection (12%) [3]
[9]
Bradycardia / sinus bradycardia (5%) Hematologic
Thrombocytopenia (20%) [3]
Chest pain (9%) Anemia [6]
Hypotension (15%) Neuromuscular/Skeletal
Febrile neutropenia [2]
Myocardial infarction [4] Arthralgia (15%)
Neutropenia (neutrophils decreased) [2]
Asthenia / fatigue (65%) [9]
Central Nervous System Thrombocytopenia [3]
Headache (6%) Respiratory
Neuromuscular/Skeletal
Pain (5%) Cough (19%)
Arthralgia [6]
Gastrointestinal/Hepatic Other Asthenia / fatigue [14]
Nausea (12%) Infection (31%) Back pain [6]
Vomiting (7%) Bone or joint pain (30%) [9]
Hematologic Myalgia/Myopathy (26%)
Bleeding [2] Pain in extremities [3]
Thrombocytopenia [15] Rhabdomyolysis [3]
2 Litt’s Drug Eruption & Reaction Manual B 2022 by Taylor & Francis Group, LLC
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Litt’s Drug Eruption & Reaction Manual ACEBUTOLOL
Respiratory Other
Cough (11%) ACAMPROSATE Adverse effects [3]
Dyspnea / shortness of breath [3] Trade name: Campral (Forest) (Lipha) Infection (<10%)
Nasopharyngitis [2] Indications: Alcohol dependence
Upper respiratory tract infection (5%) [2]
Other
Class: Amino acid (synthetic)
Half-life: 20–33 hours
ACARBOSE
Adverse effects [8] Clinically important, potentially hazardous Trade names: Glucobay (Bayer), Precose
interactions with: none known (Bayer)
Pregnancy category: C Indications: Non-insulin dependent diabetes
ACALABRUTINIB Important contra-indications noted in the Type II
Trade name: Calquence (AstraZeneca) prescribing guidelines for: nursing mothers; Class: Alpha-glucosidase inhibitor, Antidiabetic
Indications: Treatment of adult patients with pediatric patients Half-life: 2 hours
mantle cell lymphoma (MCL) who have received Note: Contra-indicated in patients with severe Clinically important, potentially hazardous
at least one prior therapy renal impairment. interactions with: alcohol, anabolic steroids,
Class: Bruton’s tyrosine kinase (BTK) inhibitor beta blockers, cholestyramine, corticosteroids,
Half-life: <3 hours Skin diazoxide, digoxin, diuretics, estrogens,
Clinically important, potentially hazardous Diaphoresis (2%) hypoglycemic agents, MAO inhibitors, neomycin,
interactions with: antacids, famotidine, H2- Peripheral edema (<10%) orlistat, pancreatin, pegvisomant, pramlintide,
receptor antagonists, itraconazole, proton pump Pruritus (itching) (4%) [2] progestogens, somatropin, testosterone
inhibitors, ranitidine, rifampin, strong CYP3A Mucosal Pregnancy category: B
inducers, strong or moderate CYP3A inhibitors Xerostomia (dry mouth) (2%) Important contra-indications noted in the
Pregnancy category: N/A (May cause fetal Cardiovascular prescribing guidelines for: nursing mothers;
toxicity based on findings in animal studies) Chest pain (<10%) pediatric patients
Important contra-indications noted in the Hypertension (<10%) Note: Contra-indicated in patients with diabetic
prescribing guidelines for: nursing mothers; Palpitation (<10%) ketoacidosis or cirrhosis; also in patients with
pediatric patients Vasodilation (1–10%) inflammatory bowel disease, colonic ulceration,
partial intestinal obstruction or in patients
Central Nervous System predisposed to intestinal obstruction.
Skin Amnesia (<10%)
Bruise / bruising / contusion / ecchymosis Anorexia (2–5%)
(ecchymoses) (21%) [2] Anxiety (5–8%) [2] Skin
Hematoma (8%) Chills (<10%) AGEP [2]
Malignancies (11%) Depression (4–8%) Gastrointestinal/Hepatic
Petechiae (21%) Headache (<10%) [2] Abdominal distension [2]
Rash (18%) Insomnia (6–9%) Abdominal pain (19%)
Mucosal Pain (2–4%) Diarrhea (31%)
Epistaxis (nosebleed) (6%) Paresthesias (2–3%) Flatulence (74%) [3]
Cardiovascular Somnolence (drowsiness) (<10%) Hepatitis [2]
Atrial fibrillation (3%) Suicidal ideation (1–10%) Hepatotoxicity / liver injury / acute liver
Atrial flutter (3%) Syncope / fainting (<10%) injury / drug-induced liver injury (DILI) [3]
Hypertension [2] Tremor (<10%) Pneumatosis intestinalis / pneumatosis
Vertigo / dizziness (3–4%) cystoides intestinalis [8]
Central Nervous System
Fever (pyrexia) [2] Endocrine/Metabolic Other
Headache (39%) [7] Appetite increased (<10%) Adverse effects [5]
Endocrine/Metabolic Libido decreased (<10%)
Weight gain (<10%)
Weight gain [4]
Gastrointestinal/Hepatic
ACEBUTOLOL
Abdominal pain (15%) Abdominal pain (<10%) Trade name: Sectral (Sanofi-Aventis)
Constipation (15%) Constipation (<10%) Indications: Hypertension, angina, ventricular
Diarrhea (31%) [6] Diarrhea (16%) [6] arrhythmias
Nausea (19%) [2] Dyspepsia / functional dyspepsia / Class: Antiarrhythmic class II, Beta adrenergic
Vomiting (13%) gastroparesis (<10%) blocker, Beta blocker
Flatulence (<4%) [2] Half-life: 3–7 hours
Hematologic Nausea (3–4%) [2] Clinically important, potentially hazardous
Anemia (46%) Vomiting (<10%) [2]
Hemorrhage (8%) interactions with: ACE inhibitors, adrenergic
Neutropenia (neutrophils decreased) (36%) Genitourinary neurone blockers, alcohol, aldesleukin, alpha
Thrombocytopenia (44%) Impotence (<10%) blockers, alprostadil, amiodarone, angiotensin II
Neuromuscular/Skeletal receptor antagonists, antiarrhythmics,
Neuromuscular/Skeletal antidiabetics, anxiolytics and hypnotics, baclofen,
Arthralgia [2] Arthralgia (<10%)
Asthenia / fatigue (5–7%) calcium channel blockers, cardiac glycosides,
Asthenia / fatigue (28%) [3]
Myalgia/Myopathy (21%) [2] Back pain (<10%) clonidine, corticosteroids, diazoxide, diltiazem,
Myalgia/Myopathy (<10%) disopyramide, diuretics, ergotamine, estrogens,
Respiratory flecainide, general anesthetics, hydralazine,
Pneumonia [3] Ocular
Abnormal vision (<10%) insulin, levodopa, MAO inhibitors, mefloquine,
Upper respiratory tract infection [2] methyldopa, methysergide, minoxidil, moxisylyte,
Respiratory
Bronchitis (<10%) moxonidine, nifedipine, nitrates, nitroprusside,
Cough (<10%) NSAIDs, phenothiazines, pilocarpine, prazosin,
Dyspnea / shortness of breath (<10%) tizanidine, verapamil
Flu-like syndrome (<10%) Pregnancy category: B
Pharyngitis (<10%)
Rhinitis (<10%)
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ACEBUTOLOL Updated each week on www.drugeruptiondata.com
Important contra-indications noted in the

prescribing guidelines for: nursing mothers; ACECLOFENAC ACENOCOUMAROL
pediatric patients Trade name: Preservex (UCB Pharma) Trade names: Sinthrome (Alliance), Sintrom
Note: Contraindicated in persistently severe Indications: Ankylosing spondylitis, (Alliance)
bradycardia. second- and third-degree heart osteoarthritis, inflammatory disease of the joints Indications: Thromboembolic diseases
block, overt cardiac failure, and cardiogenic Class: Analgesic, Non-steroidal anti-inflammatory Class: Anticoagulant
shock. Cutaneous side effects of beta-receptor (NSAID) Half-life: 8–11 hours
blockers are clinically polymorphous. They Half-life: 4 hours Clinically important, potentially hazardous
apparently appear after several months of
Clinically important, potentially hazardous interactions with: allopurinol, amiodarone,
continuous therapy.
interactions with: lithium aspirin, cimetidine, danazol, disulfiram, econazole,
Pregnancy category: N/A heparin, lepirudin, nandrolone
Skin Important contra-indications noted in the Pregnancy category: X
Edema (2%) prescribing guidelines for: nursing mothers; Important contra-indications noted in the
Exanthems (4%) pediatric patients prescribing guidelines for: nursing mothers
Lichenoid eruption [2] Note: NSAIDs may cause an increased risk of
Lupus erythematosus [14] serious cardiovascular and gastrointestinal
Pruritus (itching) (<2%)
Skin
adverse events, which can be fatal. This risk may Necrosis / skin necrosis [4]
Psoriasis [2] increase with duration of use. Vasculitis (angiitis) / cutaneous vasculitis
Rash (2%)
(angiitis) [4]
Raynaud’s phenomenon [2]
Skin Central Nervous System
Urticaria / hives [2]
Anaphylactoid reactions / anaphylaxis Fever (pyrexia) [2]
Vasculitis (angiitis) / cutaneous vasculitis
(includes anaphylactic shock) [2]
(angiitis) [2] Hematologic
Contact dermatitis [2]
Cardiovascular Prothrombin time (INR) increased [3]
Fixed eruption [2]
Bradycardia / sinus bradycardia (<2%) Photosensitivity [2] Respiratory
Cardiac failure (<2%) Vasculitis (angiitis) / cutaneous vasculitis Dyspnea / shortness of breath [2]
Chest pain (2%) (angiitis) [3]
Hypotension (<2%)
Gastrointestinal/Hepatic ACETAMINOPHEN
Abnormal dreams (3%) injury / drug-induced liver injury (DILI) [7] Synonyms: APAP; paracetamol
Anxiety (<2%) Trade names: Anacin-3 (Wyeth), Darvocet-N
Renal
Depression (2%) (aaiPharma), Excedrin (Bristol-Myers Squibb),
Nephrotoxicity / kidney injury / acute kidney
Headache (6%) Lorcet (Forest), Panadol (GSK), Percocet (Endo),
injury (AKI) / drug-induced kidney injury [2]
Hyperesthesia (<2%) Tylenol (Ortho-McNeil), Vicodin (AbbVie)
Hypoesthesia (numbness) (<2%) Indications: Pain, fever
Insomnia (3%) ACEMETACIN Class: Analgesic; non-narcotic
Vertigo / dizziness (6%) Half-life: <3 hours
Gastrointestinal/Hepatic Synonyms: acemetacine; acemetacinum Clinically important, potentially hazardous
Abdominal pain (<2%) Trade name: Emflex (Merck) interactions with: alcohol, anticonvulsants,
Constipation (4%) Indications: Osteoarthritis, rheumatoid arthritis, barbiturates, busulfan, carbamazepine,
Diarrhea (4%) lower back pain, post-operative pain, cholestyramine, conivaptan, coumarins,
Dyspepsia / functional dyspepsia / inflammation, musculoskeletal disorders, didanosine, dong quai, exenatide, imatinib,
gastroparesis (4%) psychoses isoniazid, liraglutide, melatonin, metoclopramide,
Flatulence (3%) Class: Non-steroidal anti-inflammatory (NSAID)
metyrapone, PEG-interferon, pramlintide,
Nausea (4%) Half-life: <1.1 hours
probenecid, St John’s wort
Vomiting (<2%) Clinically important, potentially hazardous
Pregnancy category: C
Genitourinary interactions with: ACE inhibitors, anti-
Dysuria (<2%) coagulants, aspirin, beta blockers, beta-carotene, prescribing guidelines for: nursing mothers
Impotence (<2%) diflunisal, furosemide, haloperidol, lithium, Note: Acetaminophen is the active metabolite of
Nocturia (<2%) methotrexate, potassium sparing diuretics, phenacetin. [IV] = intravenous. As a general point
Urinary frequency (3%) probenecid, salicylates, thiazide diuretics, most reactions listed are those that have
Neuromuscular/Skeletal triamterene, warfarin developed following the normal prescribing doses
Arthralgia (2%) Pregnancy category: N/A (Contra-indicated in for acetaminophen and the overdosing, poisoning,
Asthenia / fatigue (11%) the third trimester of pregnancy) and other toxicities that have been reported have
Back pain (<2%) Important contra-indications noted in the been excluded.
Bone or joint pain (<2%) prescribing guidelines for: nursing mothers
Myalgia/Myopathy (2%) Note: Inhibition of platelet aggregation may
occur. Aggravation of psychiatric disorders,
Skin
Ocular epilepsy or Parkinsonism may occur. Patients
AGEP [10]
Abnormal vision (2%) receiving long-term treatment should be
Anaphylactoid reactions / anaphylaxis
Conjunctivitis (<2%) periodically screened for renal and hepatic
(includes anaphylactic shock) [19]
Ocular pain (<2%) function and blood counts.
Angioedema [8]
Xerophthalmia (<2%) Dermatitis [3]
Respiratory Erythema [3]
Other Erythema multiforme [3]
Dyspnea / shortness of breath (4%) Adverse effects [4]
Pharyngitis (<2%) Exanthems [7]
Side effects [2] Exfoliative dermatitis [2]
Rhinitis (2%)
Wheezing (<2%) Fixed eruption [42]
Hyperhidrosis [2]
Hypersensitivity [12]
Neutrophilic eccrine hidradenitis [2]
Pemphigus [2]
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Litt’s Drug Eruption & Reaction Manual ACIPIMOX
Pruritus (itching) [5] Anaphylactoid reactions / anaphylaxis Important contra-indications noted in the
Purpura [6] (includes anaphylactic shock) [3] prescribing guidelines for: pediatric patients
Rash [IV] [3] Exanthems [2]
Stevens-Johnson syndrome [11] Pemphigus [2] Cardiovascular
Toxic epidermal necrolysis [14] Stevens-Johnson syndrome [7] Bradycardia / sinus bradycardia [7]
Urticaria / hives [17] Toxic epidermal necrolysis [2] Hypotension [8]
Vasculitis (angiitis) / cutaneous vasculitis Central Nervous System Ocular
(angiitis) [4] Depression [2] Intraocular pressure increased [5]
Mucosal Dysgeusia (taste perversion) (>10%) [8]
Respiratory
Xerostomia (dry mouth) [3] Paresthesias [6] Bronchospasm [2]
Cardiovascular Endocrine/Metabolic
Hypertension [IV] [3] Acidosis (including lactic acidosis) [3]
Hypotension [2] Libido decreased [2] ACETYLCYSTEINE
Central Nervous System Weight loss [2]
Agitation [IV] (>5%) Gastrointestinal/Hepatic Synonyms: N-acetylcysteine; L-Cysteine; NAC
Fever (pyrexia) [IV] (5%) Diarrhea [2] Indications: Emphysema, bronchitis,
Headache [IV] (10%) [5] Dyspepsia / functional dyspepsia / tuberculosis, bronchiectasis, tracheostomy care,
Insomnia [IV] (7%) gastroparesis [2] antidote for acetaminophen toxicity
Somnolence (drowsiness) [8] Nausea [2] Class: Antidote, Antioxidant
Vertigo / dizziness [15] Vomiting [2] Half-life: N/A
Endocrine/Metabolic Neuromuscular/Skeletal interactions with: carbamazepine, nitroglycerin
Acidosis (including lactic acidosis) [3] Asthenia / fatigue [4] Pregnancy category: B
Gastrointestinal/Hepatic Ocular Note: As an antidote, it is difficult to differentiate
Abdominal distension [2] Choroidal detachment [2] side effects due to the drug from those due to the
Abdominal pain [IV] [3] Corneal edema [2] effects of the poison.
Constipation [IV] (>5%) [7] Glaucoma [5]
Diarrhea [IV] [2] Myopia [2] Skin
Hepatotoxicity / liver injury / acute liver Renal Anaphylactoid reactions / anaphylaxis
injury / drug-induced liver injury (DILI) [70] Nephrolithiasis [3] (includes anaphylactic shock) (8–18%) [14]
Nausea [IV] (34%) [18]
Angioedema [6]
Pancreatitis / acute pancreatitis [6] Flushing / rubefaction (<8%) [2]
Vomiting (15%) [16] ACETOHEXAMIDE Pruritus (itching) (<4%) [3]
Hematologic Rash (2–4%) [4]
Trade name: Dymelor (Barr)
Thrombocytopenia [2] Urticaria / hives (6–8%)
Indications: Non-insulin dependent diabetes
Neuromuscular/Skeletal Type ll Cardiovascular
Rhabdomyolysis [4] Class: Sulfonylurea Tachycardia (<4%)
Renal Half-life: 1–6 hours Central Nervous System
Nephrotoxicity / kidney injury / acute kidney Clinically important, potentially hazardous Seizures [2]
injury (AKI) / drug-induced kidney injury [9] interactions with: phenylbutazones Gastrointestinal/Hepatic
Renal failure [3] Pregnancy category: C Diarrhea [2]
Respiratory Important contra-indications noted in the Nausea (<6%) [3]
Asthma [3] prescribing guidelines for: nursing mothers Vomiting (2–10%) [2]
Pulmonary toxicity [IV] (>5%) Note: Acetohexamide is a sulfonamide and can
Other
Other be absorbed systemically. Sulfonamides can
Adverse effects [2]
Adverse effects [16] produce severe, possibly fatal, reactions such as
Death [2]
Death [6] toxic epidermal necrolysis and Stevens-Johnson
syndrome.
ACIPIMOX
ACETAZOLAMIDE Skin
Photosensitivity (<10%) Trade name: Olbetam (Pharmacia)
Trade name: Diamox (Duramed) Rash (<10%) Indications: Hyperlipoproteinemia
Indications: Epilepsy, glaucoma Urticaria / hives (<10%) Class: Cholesterol antagonist
Class: Carbonic anhydrase inhibitor, Diuretic Half-life: 2 hours
Half-life: 2–6 hours Endocrine/Metabolic
Hypoglycemia [2] Clinically important, potentially hazardous
Clinically important, potentially hazardous interactions with: fibrates, statins
interactions with: arsenic, aspirin, ephedra, Pregnancy category: N/A (Not recommended
indacaterol, lisdexamfetamine, lithium,
metformin, mivacurium, triamcinolone
ACETYLCHOLINE in pregnancy)
Pregnancy category: C Trade name: Miochol (Novartis) prescribing guidelines for: nursing mothers
Important contra-indications noted in the Indications: Cataract surgery, in penetrating
prescribing guidelines for: the elderly; nursing keratoplasty, iridectomy and other anterior Skin
mothers; pediatric patients segment surgery where rapid miosis may be Flushing / rubefaction [9]
Note: Acetazolamide is a sulfonamide and can be required
absorbed systemically. Sulfonamides can produce Class: Ophthalmic agent, miotic,
severe, possibly fatal, reactions such as toxic Parasympathomimetic
epidermal necrolysis and Stevens-Johnson Half-life: N/A
syndrome. Clinically important, potentially hazardous
interactions with: none known
Skin Pregnancy category: C
AGEP [2]
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ACITRETIN See all our books at www.crcpress.com
Mucocutaneous reactions [3] Dipsia (thirst) (<10%)

ACITRETIN Sialorrhea (ptyalism; hypersalivation) Infection [2]
Trade names: Neotigason (Actavis), Soriatane (<10%) Side effects [4]
(Stiefel) Stomatitis (oral mucositis) (<10%) [2] Teratogenicity [7]
Indications: Psoriasis Tongue disorder (<10%)
Ulcerative stomatitis (<10%)
Class: Antipsoriatic agent, Retinoid
Half-life: 49 hours Xerostomia (dry mouth) (10–60%) [7] ACLIDINIUM
Clinically important, potentially hazardous Cardiovascular Trade name: Tudorza Pressair (Forest)
interactions with: alcohol, bexarotene, Capillary leak syndrome [3] Indications: Long-term maintenance treatment
chloroquine, cholestyramine, corticosteroids, Central Nervous System of bronchospasm associated with chronic
coumarins, danazol, demeclocycline, doxycycline, Anorexia (<10%) obstructive pulmonary disease, including chronic
ethanolamine, isotretinoin, lithium, lymecycline, Depression (<10%) [4] bronchitis and emphysema
medroxyprogesterone, methotrexate, Dysgeusia (taste perversion) (<10%) Class: Anticholinergic, Muscarinic antagonist
minocycline, oxytetracycline, phenytoin, Headache (<10%) [2] Half-life: 5–8 hours
progestins, St John’s wort, tetracycline, Hyperesthesia (10–25%) Clinically important, potentially hazardous
tigecycline, vitamin A Insomnia (<10%) interactions with: anticholinergics
Pregnancy category: X Neurotoxicity [3] Pregnancy category: C
Important contra-indications noted in the Pain (<10%) Important contra-indications noted in the
prescribing guidelines for: nursing mothers; Paralysis (facial) (<10%) prescribing guidelines for: nursing mothers;
pediatric patients Paresthesias (10–25%) [2] pediatric patients
Note: Oral retinoids can cause birth defects, and Pseudotumor cerebri [5]
women should avoid acitretin when pregnant or Rigors (10–25%) [2] Mucosal
trying to conceive. Somnolence (drowsiness) (<10%) Xerostomia (dry mouth) [2]
Warning: CONTRA-INDICATED IN Stroke / cerebral infarction [2]
Suicidal ideation [2] Central Nervous System
PREGNANCY Headache (7%)
Endocrine/Metabolic
GGT increased [2] Gastrointestinal/Hepatic
Skin Diarrhea (3%)
Angioedema [2] Hyperbilirubinemia [2]
Atrophy / Skin atrophy (10–25%) Hypercholesterolemia (25–50%) [3] Respiratory
Bromhidrosis (<10%) Hyperlipidemia [5] Cough (3%)
Bullous dermatosis (<10%) Hypertriglyceridemia (50–75%) [4] Nasopharyngitis (6%)
Clammy skin (<10%) Gastrointestinal/Hepatic Rhinitis (2%)
Dermatitis (<10%) Abdominal pain (<10%) Sinusitis (2%)
Diaphoresis (<10%) [2] Diarrhea (<10%) [2] Other
Edema (<10%) Hepatitis [5] Adverse effects [5]
Erythema (18%) Hepatotoxicity / liver injury / acute liver
Erythroderma [3] injury / drug-induced liver injury (DILI) [8]
Exanthems (10–25%) [2] Nausea (<10%) [2] ACYCLOVIR
Exfoliative dermatitis (25–50%) [3] Pancreatitis / acute pancreatitis [3] Synonyms: aciclovir; ACV; acycloguanosine
Fissures (<10%) Vomiting [2] Trade names: Sitavig (Cipher), Zovirax (GSK)
Hot flashes (<10%) Genitourinary Indications: Herpes simplex, herpes zoster
Hyperhidrosis (<10%) [2] Vulvovaginal candidiasis [2] Class: Antiviral, Antiviral; topical, Guanine
Palmar–plantar desquamation (20–80%) [7] Neuromuscular/Skeletal nucleoside analog
Photosensitivity [3] Arthralgia (10–25%) [2] Half-life: 3 hours (adults)
Pigmentation [3] Asthenia / fatigue (<10%) [3] Clinically important, potentially hazardous
Pruritus (itching) (10–50%) [10] Back pain (<10%) interactions with: cobicistat/elvitegravir/
Psoriasis (aggravated) (<10%) Bone or joint pain [2] emtricitabine/tenofovir alafenamide, cobicistat/
Purpura (<10%) Hyperostosis [11] elvitegravir/emtricitabine/tenofovir disoproxil,
Rash (>10%) Myalgia/Myopathy [4] meperidine, tenofovir disoproxil
Seborrhea (<10%) Osteoporosis [2] Pregnancy category: B
Skin toxicity / toxicity [3]
Ocular Important contra-indications noted in the
Stickiness (3–50%) [7]
Blepharitis (<10%) prescribing guidelines for: nursing mothers
Sunburn (<10%)
Ulcerations (<10%) Cataract (<10%)
Xerosis (25–50%) [14] Conjunctivitis (<10%) [2] Skin
Diplopia (double vision) (<10%) Acneiform eruption / acneiform dermatitis /
Hair Night blindness (<10%) [2]
Alopecia (10–75%) [21] acneiform rash (<3%)
Ocular adverse effect [2] Dermatitis [12]
Curly hair [3] Ocular itching [2]
Hair changes (<10%) Exanthems (<5%) [5]
Ocular pain (<10%) Facial edema (3–5%)
Hair pigmentation [2] Photophobia (<10%) [2] Peripheral edema [2]
Nails Vision blurred (<10%) Pruritus (itching) (<10%)
Brittle nails [3] Xerophthalmia (10–25%) [3] Radiation recall dermatitis [2]
Nail changes (25–50%) Otic Rash (<3%) [3]
Paronychia (10–25%) [6] Ear pain (<10%) Urticaria / hives (<5%) [4]
Pyogenic granuloma (<10%) [4] Tinnitus (<10%) Hair
Mucosal Respiratory Alopecia (<3%)
Cheilitis (>75%) [14] Laryngitis [2]
Dry mucous membranes [4] Central Nervous System
Rhinitis (25–50%) [2] Headache (2%) [4]
Epistaxis (nosebleed) (10–25%) [2] Sinusitis (<10%)
Gingival bleeding (<10%) Neurotoxicity [8]
Gingivitis (<10%) Other
Adverse effects [9]
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Litt’s Drug Eruption & Reaction Manual ADAPALENE
Gastrointestinal/Hepatic Lesions [2] Hematuria (5%)

Diarrhea (2–3%) Lichenoid eruption [5] Pelvic pain (<5%)
Nausea (2–5%) [3] Lupus erythematosus [17] Urinary tract infection (8%) [2]
Vomiting (3%) Lupus syndrome [3] Hematologic
Hematologic Lymphoma [8] Agranulocytosis / severe selective
Thrombocytopenia [5] Malignancies [7] neutropenia (<5%)
Local Melanoma [6] Eosinophilia [3]
Injection-site inflammation (>10%) Neoplasms [2] Hemolytic anemia [4]
Injection-site thrombophlebitis (9%) Palmoplantar pustulosis [3] Leukocytopenia (leukopenia) (<5%)
Peripheral edema (<5%) Pancytopenia (also includes bicytopenia) [2]
Neuromuscular/Skeletal Pruritus (itching) [6]
Asthenia / fatigue (12%) Sepsis [2]
Psoriasis [40] Thrombocytopenia [2]
Ocular Rash (12%) [6]
Hallucinations, visual [2] Local
Sarcoidosis / sarcoid-like reaction (cutaneous Infusion-related reactions [2]
Periorbital edema (3–5%) sarcoidosis) [9] Injection-site edema (15%) [2]
Renal Squamous cell carcinoma [5] Injection-site erythema (15%) [3]
Nephrotoxicity / kidney injury / acute kidney Stevens-Johnson syndrome [2] Injection-site pain (12%) [2]
injury (AKI) / drug-induced kidney injury Urticaria / hives [4] Injection-site reaction [30]
[13] Vasculitis (angiitis) / cutaneous vasculitis
Renal failure [4] (angiitis) [9] Neuromuscular/Skeletal
Vitiligo [2] Arthralgia (<5%) [6]
Other Asthenia / fatigue [2]
Adverse effects [2] Hair Back pain (6%) [3]
Alopecia [5] Tuberculous arthritis [2]
Alopecia areata [7]
ADALIMUMAB Alopecia universalis [2] Ocular
Cataract (<5%)
Trade names: Amjevita (Amgen), Humira Cardiovascular Optic neuritis [5]
(AbbVie) Arrhythmias (<5%) Uveitis (includes anterior uveitis) [4]
Indications: Rheumatoid arthritis, polyarticular Cardiac arrest (<5%)
Chest pain (<5%) Renal
juvenile idiopathic arthritis, psoriatic arthritis, Nephrotoxicity / kidney injury / acute kidney
ankylosing spondylitis, Crohn’s disease, ulcerative Congestive heart failure (<5%) [2]
Hypertension (<5%) injury (AKI) / drug-induced kidney injury [3]
colitis, psoriasis Respiratory
Class: Anti-Tumor Necrosis Factor-alpha (TNF-a Myocardial infarction (<5%)
Palpitation [2] Asthma (<5%)
antagonist), Antipsoriatic agent, Biologic, Biologic
Pericarditis (<5%) Bronchitis [3]
disease-modifying antirheumatic drug
Tachycardia (<5%) Bronchospasm (<5%)
(bDMARD), Cytokine inhibitor, Disease-
Thromboembolism [2] Dyspnea / shortness of breath (<5%)
modifying antirheumatic drug (DMARD),
Central Nervous System Flu-like syndrome (7%)
Monoclonal antibody
Aseptic meningitis [2] Nasopharyngitis [8]
Half-life: 10–20 days
Confusion (<5%) Pleural effusion (<5%)
Clinically important, potentially hazardous Pneumonia (<5%) [6]
interactions with: abatacept, anakinra, live Depression [2]
Encephalitis [2] Pneumonitis [3]
vaccines Pulmonary fibrosis [3]
Pregnancy category: B Fever (pyrexia) (<5%) [3]
Guillain-Barré syndrome / acute Pulmonary toxicity [7]
Important contra-indications noted in the Sinusitis (11%) [4]
prescribing guidelines for: nursing mothers inflammatory demyelinating
polyradiculoneuropathy [5] Tuberculosis [11]
Note: TNF inhibitors should be used in patients Upper respiratory tract infection (17%) [14]
with heart failure only after consideration of other Headache (12%) [9]
treatment options. TNF inhibitors are contra- Leukoencephalopathy / posterior reversible Other
indicated in patients with a personal or family encephalopathy syndrome (PRES) [3] Adverse effects [49]
history of multiple sclerosis or demyelinating Multiple sclerosis (<5%) [3] Allergic reactions [2]
disease. TNF inhibitors should not be Neurotoxicity [3] Death [9]
administered to patients with moderate to severe Paresthesias (<5%) [2] Infection (5%) [79]
heart failure (New York Heart Association Syncope / fainting (<5%) Side effects [2]
Functional Class III/IV). Tremor (<5%)
Vertigo / dizziness [2]
Warning: SERIOUS INFECTIONS AND
MALIGNANCY Endocrine/Metabolic
ADAPALENE
Creatine phosphokinase (CPK) / creatine Trade names: Differin (Galderma), Epiduo
Skin kinase increased (hyperCKemia) (<5%) (Galderma)
Acneiform eruption / acneiform dermatitis / Hypercholesterolemia (6%) Indications: Acne vulgaris
acneiform rash [3] Gastrointestinal/Hepatic Class: Retinoid
Anaphylactoid reactions / anaphylaxis Abdominal pain (7%) [2] Half-life: N/A
(includes anaphylactic shock) [2] Cholecystitis (<5%) Clinically important, potentially hazardous
Angioedema [4] Colitis [2] interactions with: resorcinol, salicylates
Carcinoma [2] Esophagitis (<5%) Pregnancy category: C
Cellulitis (<5%) [2] Gastroenteritis (<5%) Important contra-indications noted in the
Dermatomyositis [5] Hepatitis [7] prescribing guidelines for: nursing mothers;
Eczema [2] Hepatotoxicity / liver injury / acute liver pediatric patients
Erysipelas (<5%) injury / drug-induced liver injury (DILI) [11] Note: Epiduo is adapalene and benzoyl peroxide.
Granulomatous reaction [5] Nausea (9%) [2]
Henoch–Schönlein purpura [2] Vomiting (<5%) Skin
Herpes zoster [10] Genitourinary Burning / skin burning sensation (38%) [7]
Hidradenitis suppurativa (acne inversa) [2] Cystitis (<5%) Erythema (38%) [9]
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ADAPALENE Updated each week on www.drugeruptiondata.com
Pruritus (itching) (>10%) [11] Neuromuscular/Skeletal

Scaling (44%) [6] ADENOSINE Asthenia / fatigue [2]
Stinging (38%) [3] Synonym: ATP Respiratory
Xerosis (45%) [10] Trade names: Adenocard (Astellas), Adenocur Cough (6%)
Other (Sanofi-Aventis) Respiratory tract infection (4%)
Adverse effects [3] Indications: Paroxysmal supraventricular
tachycardia, varicose vein complications with
stasis dermatitis
AFATINIB
ADEFOVIR Class: Antiarrhythmic class IV, Neurotransmitter Trade name: Gilotrif (Boehringer Ingelheim)
Trade name: Hepsera (Gilead) Half-life: <10 seconds Indications: Metastatic non-small cell lung cancer
Indications: HIV infection, hepatitis B infection Clinically important, potentially hazardous in patients whose tumors have epidermal growth
Class: Antiretroviral, Nucleotide analog reverse interactions with: aminophylline, factor receptor exon 19 deletions or exon 21
transcriptase inhibitor antiarrhythmics, beta blockers, bupivacaine, (L858R) substitution mutations, metastatic
Half-life: 16–18 hours carbamazepine, dipyridamole, levobupivacaine, squamous non-small cell lung cancer progressing
Clinically important, potentially hazardous nicotine, prilocaine, QT prolonging agents, following platinium-based chemotherapy
interactions with: amikacin, amphotericin B, ropivacaine Class: Epidermal growth factor receptor (EGFR)
cobicistat/elvitegravir/emtricitabine/tenofovir Pregnancy category: C inhibitor / antagonist, Epidermal growth factor
disoproxil, delavirdine, drugs causing kidney Important contra-indications noted in the receptor (EGFR)–tyrosine kinase inhibitor,
toxicity, foscarnet, gentamicin, hydroxyurea, prescribing guidelines for: pediatric patients Tyrosine kinase inhibitor
pentamidine, tenofovir disoproxil, tobramycin Half-life: 37 hours
Pregnancy category: C Skin Clinically important, potentially hazardous
Important contra-indications noted in the Flushing / rubefaction (18–44%) interactions with: amiodarone, carbamazepine,
prescribing guidelines for: the elderly; nursing Cardiovascular cyclosporine, erythromycin, itraconazole,
mothers; pediatric patients Arrhythmias [2] ketoconazole, nelfinavir, P-glycoprotein inhibitors,
Warning: SEVERE ACUTE EXACERBATIONS Atrial fibrillation [7] phenobarbital, phenytoin, quinidine, rifampin,
OF HEPATITIS, NEPHROTOXICITY, HIV Chest pain [5] ritonavir, saquinavir, St John’s wort, tacrolimus,
RESISTANCE, LACTIC ACIDOSIS AND SEVERE Coronary vasospasm [2] verapamil
HEPATOMEGALY WITH STEATOSIS Torsades de pointes [2] Pregnancy category: D
Central Nervous System Important contra-indications noted in the
Skin Headache (2–18%) [2] prescribing guidelines for: nursing mothers;
Pruritus (itching) (<10%) Vertigo / dizziness (2–12%) pediatric patients
Rash (<10%) Gastrointestinal/Hepatic
Stevens-Johnson syndrome [2] Abdominal pain (13%) Skin
Central Nervous System Acneiform eruption / acneiform dermatitis /
Headache (9%) [2] acneiform rash [28]
Jaw pain (<15%)
Pain [2] Fissures [2]
Respiratory Hand–foot syndrome (palmar–plantar
Endocrine/Metabolic Cough (6–8%)
Hypophosphatemia [6] erythrodysesthesia) [2]
Dyspnea / shortness of breath [3] Pruritus (itching) [3]
Gastrointestinal/Hepatic Respiratory distress (11%) Rash [54]
Abdominal pain (9%) Other Skin toxicity / toxicity [3]
Diarrhea (3%) Adverse effects [2] Stevens-Johnson syndrome [4]
Dyspepsia / functional dyspepsia / Xerosis [8]
gastroparesis (3%)
Flatulence (4%) AFAMELANOTIDE Nails
Hepatotoxicity / liver injury / acute liver Nail changes [2]
injury / drug-induced liver injury (DILI) Trade names: Melanotan (Clinuvel), Scenesse Paronychia (58%) [18]
(<25%) (Clinuvel) Mucosal
Nausea (5%) Indications: Erythropoetic protoporphyria, Epistaxis (nosebleed) [3]
Vomiting (<10%) polymorphous light eruption, photodamage Mucosal inflammation [7]
Genitourinary Class: Melanocortin receptor agonist, Mucositis [10]
Hematuria (11%) Melanocyte stimulating hormone A agonist, Rhinorrhea (11%)
Photoprotective Stomatitis (oral mucositis) (71%) [22]
Neuromuscular/Skeletal Half-life: ~15 hr when administered
Asthenia / fatigue (13%) [3] Central Nervous System
subcutaneously in a controlled release implant. Anorexia [3]
Back pain (<10%) Clinically important, potentially hazardous
Fractures [2] Fever (pyrexia) (12%)
interactions with: none known Endocrine/Metabolic
Osteomalacia [8]
Renal ALT increased [2]
Skin Appetite decreased (29%) [5]
Fanconi syndrome [13]
Hyperpigmentation (see also pigmentation) Dehydration [3]
(4%) Hypokalemia [2]
injury (AKI) / drug-induced kidney injury
Irritation (2%) Gastrointestinal/Hepatic
[14]
Pigmentation [6] Diarrhea (96%) [72]
Respiratory
Mucosal Dysphagia [2]
Cough (6–8%)
Oropharyngeal pain (7%) Hepatotoxicity / liver injury / acute liver
Rhinitis (<5%)
Central Nervous System injury / drug-induced liver injury (DILI)
Headache [2] (10%) [5]
Vertigo / dizziness (4%) Nausea [16]
Genitourinary Vomiting [10]
Priapism [7] Hematologic
Anemia [3]
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Litt’s Drug Eruption & Reaction Manual ALBIGLUTIDE
Febrile neutropenia [2] Corneal erosion (4%) Central Nervous System

Leukocytopenia (leukopenia) [2] Endophthalmitis [4] Fever (pyrexia) (<2%) [3]
Neutropenia (neutrophils decreased) [6] Intraocular pressure increased (5%) [2] Headache (<11%) [9]
Thrombocytopenia [2] Lacrimation (3%) Intracranial pressure increased (intracranial
Neuromuscular/Skeletal Ocular adverse effect [7] hypertension) (<2%)
Asthenia / fatigue [18] Ocular pain (3–9%) Psychosis [2]
Respiratory Vision blurred (2%) Somnolence (drowsiness) [2]
Dyspnea / shortness of breath [3] Vitreous detachment (6%) Vertigo / dizziness (<2%) [6]
Pneumonitis [2] Vitreous floaters (6%) Gastrointestinal/Hepatic
Pulmonary toxicity [5] Renal Abdominal pain (<7%) [9]
Other Proteinuria [10] Hepatitis [6]
Adverse effects [7] Respiratory Nausea (4–6%) [5]
Death [4] Dysphonia [5] Vomiting (4–6%) [2]
Dyspnea / shortness of breath [2] Hematologic
Pulmonary embolism [2] Pancytopenia (also includes bicytopenia) [3]
AFLIBERCEPT Other Neuromuscular/Skeletal
Adverse effects [5] Asthenia / fatigue [3]
Synonym: ziv-aflibercept Death [3] Dystonia [3]
Trade names: Eylea (Regeneron), Zaltrap Infection [3]
(Sanofi-Aventis) Other
Indications: Neovascular (wet) age-related Adverse effects [6]
macular degeneration (Eylea), metastatic AGALSIDASE
colorectal cancer (Zaltrap) in combination with ALBIGLUTIDE
FOLFIRI (fluorouracil, leucovorin and irinotecan) Trade name: Fabrazyme (Genzyme)
Class: Angiogenesis inhibitor, Fusion protein, Indications: Fabry disease Trade name: Tanzeum (GSK)
Vascular endothelial growth factor (VEGF) Class: Enzyme Indications: To improve glycemic control in
inhibitor / antagonist Half-life: 45–102 minutes adults with Type II diabetes mellitus
Half-life: terminal 5–6 days Clinically important, potentially hazardous Class: Glucagon-like peptide-1 (GLP-1) receptor
Clinically important, potentially hazardous interactions with: none known agonist
interactions with: none known Pregnancy category: B Half-life: 5 days
Pregnancy category: C Clinically important, potentially hazardous
Important contra-indications noted in the Skin interactions with: none known
prescribing guidelines for: nursing mothers; Pallor (14%) Pregnancy category: C
pediatric patients Important contra-indications noted in the
Cardiovascular
Note: Eylea: Contra-indicated in patients with prescribing guidelines for: nursing mothers;
Chest pain (17%)
ocular or periocular infection or active intraocular pediatric patients
inflammation. Central Nervous System
Note: Contra-indicated in patients with a
Warning: Zaltrap: HEMORRHAGE, Depression (10%)
personal or family history of medullary thyroid
GASTROINTESTINAL PERFORATION, Fever (pyrexia) (48%)
carcinoma or in patients with multiple endocrine
COMPROMISED WOUND HEALING Headache (45%)
neoplasia syndrome Type 2.
Pain (21%)
Warning: RISK OF THYROID C-CELL TUMORS
Paresthesias (14%)
Mucosal Vertigo / dizziness (14%)
Epistaxis (nosebleed) [3] Central Nervous System
Stomatitis (oral mucositis) [6] Local
Application-site reactions (~50%) Headache [4]
Cardiovascular Injection-site reaction [2] Vertigo / dizziness [2]
Hypertension [16] Endocrine/Metabolic
Myocardial infarction (<2%) Respiratory
Rhinitis (38%) GGT increased (2%)
Venous thromboembolism [2] Hypoglycemia (2%) [5]
Sinusitis (7%)
Central Nervous System Gastrointestinal/Hepatic
Anorexia [2] Constipation [2]
Headache [2] ALBENDAZOLE Diarrhea (13%) [15]
Stroke / cerebral infarction (<2%) Dyspepsia / functional dyspepsia /
Endocrine/Metabolic Trade name: Albenza (GSK) gastroparesis (3%)
Weight loss [2] Indications: Nematode infections, hydatid cyst Gastroesophageal reflux (4%)
Gastrointestinal/Hepatic disease Nausea (11%) [20]
Diarrhea [8] Class: Anthelmintic Pancreatitis / acute pancreatitis [4]
Gastrointestinal perforation [5] Half-life: 8–12 hours Vomiting (4%) [15]
Nausea [2] Clinically important, potentially hazardous Local
interactions with: antimalarials, conivaptan, Injection-site hematoma (2%)
Hematologic dexamethasone, high fat foods
Hemorrhage [3] Injection-site reaction (11%) [16]
Neutropenia (neutrophils decreased) [13] Important contra-indications noted in the Neuromuscular/Skeletal
Local prescribing guidelines for: nursing mothers
Arthralgia (7%)
Injection-site pain (3%) Back pain (7%) [2]
Neuromuscular/Skeletal Skin Respiratory
Asthenia / fatigue [7] Cough (7%)
Fixed eruption [2]
Ocular Pruritus (itching) [4] Influenza (5%)
Cataract (7%) [3] Nasopharyngitis [3]
Conjunctival hemorrhage (25%) [3] Pneumonia (2%)
Hair Sinusitis (6%)
Conjunctival hyperemia (4%) Alopecia (reversible) (<2%) [4]
Conjunctivitis [3] Upper respiratory tract infection (14%) [4]
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Other Respiratory Petechiae (4%)

Adverse effects [4] Influenza (3%) Pruritus (itching) (24%) [7]
Nasopharyngitis (3%) Psoriasis [4]
Purpura (4%)
ALBUTEROL Rash (42%) [2]
ALCLOMETASONE Scleroderma [2]
Synonym: salbutamol Skin toxicity / toxicity [6]
Trade names: AccuNeb (Mylan Specialty), Trade names: Aclovate (GSK), Modrasone Toxic epidermal necrolysis [2]
Combivent (Boehringer Ingelheim), Duoneb (Pliva) Urticaria / hives (2%) [3]
(Mylan Specialty), Proventil (Schering), Ventolin Indications: Dermatoses
Vitiligo [3]
(GSK), Volmax (Muro) Class: Corticosteroid / Glucocorticoid, Xerosis (15%)
Indications: Bronchospasm associated with Corticosteroid, topical
asthma Half-life: N/A Hair
Class: Beta-2 adrenergic agonist, Bronchodilator, Clinically important, potentially hazardous Alopecia [2]
Tocolytic interactions with: licorice, live vaccines Mucosal
Half-life: 3–6 hours Pregnancy category: C Oral mucosal eruption [2]
Clinically important, potentially hazardous Stomatitis (oral mucositis) (22%)
interactions with: atomoxetine, epinephrine, Skin Cardiovascular
insulin degludec, insulin detemir, insulin glargine, Dermatitis [3] Arrhythmias (10%)
insulin glulisine Capillary leak syndrome [12]
Pregnancy category: C Cardiotoxicity (11%) [2]
Important contra-indications noted in the ALDESLEUKIN Hypotension (71%) [6]
prescribing guidelines for: nursing mothers Supraventricular tachycardia (12%)
Note: Combivent is albuterol and ipratropium. Synonyms: IL-2; interleukin-2 Tachycardia (23%)
Trade name: Proleukin (Chiron) Vascular leak syndrome [6]
Indications: Metastatic renal cell carcinoma and Vasodilation (13%)
Skin
metastatic melanoma Central Nervous System
Dermatitis [2]
Class: Biologic, Immunomodulator, Interleukin-2 Anorexia (20%)
Diaphoresis (<10%)
Half-life: 6–85 minutes Anxiety (12%)
Erythema (palmar) (with infusion) [2]
Clinically important, potentially hazardous Chills (52%)
Flushing / rubefaction (<10%)
interactions with: acebutolol, alfuzosin, Confusion (34%)
Mucosal altretamine, amikacin, aminoglycosides,
Xerostomia (dry mouth) (<10%) Depression [3]
antineoplastics, betamethasone, bleomycin, Dysgeusia (taste perversion) (7%)
Cardiovascular busulfan, captopril, carboplatin, carmustine, Fever (pyrexia) (29%) [8]
Atrial fibrillation [2] chlorambucil, ciclesonide, cilazapril, cisplatin, Neurotoxicity [3]
Hypertension [2] corticosteroids, cyclophosphamide, cytarabine, Pain (12%)
Myocardial infarction [2] dacarbazine, dactinomycin, daunorubicin, Rigors [3]
Palpitation [2] docetaxel, doxorubicin, enalapril, estramustine, Somnolence (drowsiness) (22%)
Tachyarrhythmia [2] etoposide, fludarabine, fluorouracil, fosinopril, Vertigo / dizziness (11%)
Tachycardia [2] gemcitabine, gentamicin, hydroxyurea, idarubicin,
Central Nervous System Endocrine/Metabolic
ifosfamide, indomethacin, interferon alfa, Acidosis (including lactic acidosis) (12%)
Dysgeusia (taste perversion) (<10%) irbesartan, kanamycin, levamisole, lisinopril, ALP increased (10%)
Tremor [2] lomustine, mechlorethamine, melphalan, AST increased (23%)
Endocrine/Metabolic mercaptopurine, methotrexate, mitomycin, Creatine phosphokinase (CPK) / creatine
Acidosis (including lactic acidosis) [8] mitotane, mitoxantrone, neomycin, olmesartan, kinase increased (hyperCKemia) (33%) [2]
Respiratory PEG-interferon, pentostatin, plicamycin, Hypocalcemia (11%)
Dyspnea / shortness of breath [2] procarbazine, quinapril, ramipril, streptomycin, Hypomagnesemia [2]
Other streptozocin, thioguanine, thiotepa, tobramycin, Hypophosphatemia [2]
Adverse effects [2] trandolapril, tretinoin, triamcinolone, uracil, Weight gain (16%)
vinblastine, vincristine, vinorelbine Weight loss [2]
Pregnancy category: C Gastrointestinal/Hepatic
ALCAFTADINE Important contra-indications noted in the Abdominal pain (11%)
prescribing guidelines for: nursing mothers; Diarrhea (67%) [3]
Trade name: Lastacaft (Allergan) pediatric patients Hepatotoxicity / liver injury / acute liver
Indications: Prevention of itching associated with Note: Contra-indicated in patients with injury / drug-induced liver injury (DILI) [2]
allergic conjunctivitis significant cardiac, pulmonary, renal, hepatic, or Nausea (35%) [9]
Class: Histamine H1 receptor antagonist CNS impairment. Vomiting (50%) [6]
Half-life: 2 hours Warning: CAPILLARY LEAK SYNDROME
Clinically important, potentially hazardous Genitourinary
interactions with: none known Oliguria (63%)
Skin
Pregnancy category: B Hematologic
Angioedema [2]
Important contra-indications noted in the Anemia (29%)
Dermatitis [2]
prescribing guidelines for: pediatric patients Leukocytopenia (leukopenia) (16%) [2]
Edema (47%) [3]
Sepsis [3]
Erythema (41%) [5]
Central Nervous System Thrombocytopenia (37%) [2]
Erythema nodosum [3]
Headache (3%) Erythroderma [4] Local
Ocular Exanthems [5] Injection-site inflammation [2]
Ocular burning (4%) Exfoliative dermatitis (18%) Injection-site nodules [2]
Ocular erythema (4%) Linear IgA bullous dermatosis [4] Injection-site reaction (3%) [2]
Ocular pruritus (4%) Necrosis / skin necrosis [2] Neuromuscular/Skeletal
Ocular stinging (4%) Pemphigus [2] Asthenia / fatigue (23–27%)
Peripheral edema (28%) Myalgia/Myopathy (6%)
Myasthenia gravis [2]
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Litt’s Drug Eruption & Reaction Manual ALEMTUZUMAB
Renal Ocular Note: Prophylactic therapy against PCP

Nephrotoxicity / kidney injury / acute kidney Visual disturbances (10%) pneumonia and herpes viral infections is
injury (AKI) / drug-induced kidney injury [4] Respiratory recommended upon initiation of therapy and for
Respiratory Cough (19%) at least 2 months following last dose.
Cough (11%) Dyspnea / shortness of breath (16%) Warning: CYTOPENIAS, INFUSION
Dyspnea / shortness of breath (43%) Interstitial lung disease / interstitial REACTIONS, and INFECTIONS
Pulmonary toxicity (11–24%) [2] pneumonitis / interstitial pneumonia [2]
Rhinitis (10%) Pulmonary toxicity [5] Skin
Other Other Carcinoma [2]
Adverse effects [3] Adverse effects [2] Erythema (4%)
Death [5] Flushing / rubefaction [2]
Infection (13%) [2] Herpes [2]
ALEFACEPT Herpes simplex [2]
Herpes zoster [3]
ALECTINIB Trade name: Amevive (Astellas) Lymphoma [2]
Indications: Chronic plaque psoriasis (in adults) Lymphoproliferative disease (64–70%)
Trade name: Alecensa (Genentech) Class: Immunosuppressant Peripheral edema (13%)
Indications: Anaplastic lymphoma kinase- Half-life: 270 hours Pruritus (itching) (14–24%)
positive, metastatic non-small cell lung cancer in Clinically important, potentially hazardous Purpura (8%)
patients who have progressed on, or are interactions with: alcohol, BCG vaccine, Rash (13–40%) [5]
intolerant to, crizotinib echinacea, leflunomide, live vaccines, natalizumab, Thrombocytopenic purpura [11]
Class: Anaplastic lymphoma kinase (ALK) pimecrolimus, sipuleucel-T, tacrolimus, Urticaria / hives (16–30%) [2]
inhibitor, Kinase inhibitor trastuzumab Vitiligo [2]
Half-life: 33 hours Pregnancy category: B Hair
Clinically important, potentially hazardous Important contra-indications noted in the Alopecia areata [3]
interactions with: none known prescribing guidelines for: nursing mothers;
Pregnancy category: N/A (Can cause fetal pediatric patients
Mucosal
harm) Note: Contra-indicated in patients with HIV.
Stomatitis (oral mucositis) (14%)
prescribing guidelines for: nursing mothers; Hypertension (11–15%)
Skin
pediatric patients Hypotension (15–32%) [2]
Lymphoma (3 cases)
Tachycardia (10%)
Pruritus (itching) (2–5%) [2]
Skin Central Nervous System Central Nervous System
Edema (30%) Anorexia (20%)
Chills (transient) (6%) [2]
Peripheral edema [7] Anxiety (8%)
Headache [6]
Photosensitivity (10%) [2] Chills (53%)
Vertigo / dizziness (<2%)
Rash (18%) [5] Depression (7%)
Gastrointestinal/Hepatic Dysesthesia (15%)
Hair Nausea (2–5%)
Alopecia [2] Fever (pyrexia) (69–85%) [6]
Hematologic Guillain-Barré syndrome / acute
Central Nervous System Lymphopenia (lymphocytopenia) (1–10%) inflammatory demyelinating
Dysgeusia (taste perversion) [3] polyradiculoneuropathy [2]
Headache (17%) [3]
Local
Injection-site bleeding (4%) Headache (13–24%) [3]
Endocrine/Metabolic Injection-site edema (2%) Insomnia (10%)
ALP increased (47%) [3] Injection-site inflammation (4%) Intracranial hemorrhage [2]
ALT increased (34%) [6] Injection-site pain (7%) Leukoencephalopathy / posterior reversible
AST increased (51%) [7] encephalopathy syndrome (PRES) [5]
Creatine phosphokinase (CPK) / creatine Rigors (87%)
Asthenia / fatigue [2]
kinase increased (hyperCKemia) (43%) [8] Tremor (3%)
Myalgia/Myopathy (2–5%)
GGT increased [2] Vertigo / dizziness (12%)
Hyperbilirubinemia (39%) [6] Respiratory
Cough (2–5%) [2] Endocrine/Metabolic
Hyperglycemia (36%) Hyperthyroidism [2]
Hypocalcemia (32%) Flu-like syndrome [2]
Pharyngitis (2–5%) Hypothyroidism [2]
Hypokalemia (29%) Thyroid dysfunction [16]
Hyponatremia (20%) Upper respiratory tract infection [4]
Hypophosphatemia (21%) Other Gastrointestinal/Hepatic
Serum creatinine increased (28%) Adverse effects (2%) [4] Abdominal pain (11%)
Weight gain (11%) Infection (2%) [3] Diarrhea (10–22%) [2]
Nausea (47–54%) [4]
Gastrointestinal/Hepatic Vomiting (33–41%) [2]
Constipation (34%) [9]
Diarrhea (16%) [3]
ALEMTUZUMAB Genitourinary
Nausea (18%) [5] Cystitis [2]
Trade names: Campath (Bayer), MabCampath
Vomiting (12%) [3] (Schering)
Hematologic
Hematologic Anemia (76%) [4]
Indications: B-cell chronic lymphcyotic
Anemia (56%) [3] Cytopenia [2]
leukemia, non-Hodgkin’s lymphoma
Lymphopenia (lymphocytopenia) (22%) Hemolytic anemia [5]
Class: Biologic, Immunosuppressant, Monoclonal
Neutropenia (neutrophils decreased) [7] Hemotoxicity [4]
antibody
Leukocytopenia (leukopenia) [4]
Neuromuscular/Skeletal Half-life: 12 days
Lymphopenia (lymphocytopenia) (97%) [2]
Asthenia / fatigue (41%) [6] Clinically important, potentially hazardous
Back pain (12%) interactions with: none known
[9]
Myalgia/Myopathy (29%) [8] Pregnancy category: C
Sepsis [2]
Thrombocytopenia (71%) [13]
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ALEMTUZUMAB Updated each week on www.drugeruptiondata.com
Local Osteonecrosis [12] vardenafil, voriconazole, vorinostat, ziprasidone

Application-site reactions [2] Ocular Pregnancy category: B
Infusion-related reactions [13] Conjunctivitis [2] Important contra-indications noted in the
Infusion-site reactions [5] Ocular adverse effect [2] prescribing guidelines for: pediatric patients
Injection-site pruritus (30–40%) Ocular inflammation [2]
Injection-site reaction (90%) [5] Scleritis [3] Cardiovascular
Neuromuscular/Skeletal Uveitis (includes anterior uveitis) [6] Hypotension [2]
Asthenia / fatigue (22–34%) Renal Orthostatic hypotension [3]
Bone or joint pain (24%) Nephrotoxicity / kidney injury / acute kidney QT prolongation [2]
Myalgia/Myopathy (11%) injury (AKI) / drug-induced kidney injury [2] Central Nervous System
Renal Renal failure [2] Headache (3%)
Nephrotoxicity / kidney injury / acute kidney Other Pain (<2%)
injury (AKI) / drug-induced kidney injury [4] Adverse effects [5] Vertigo / dizziness (6%) [19]
Respiratory Gastrointestinal/Hepatic
Acute respiratory distress syndrome [2] Abdominal pain (<2%)
Alveolar hemorrhage (pulmonary) [3] ALFENTANIL Hepatotoxicity / liver injury / acute liver
Dyspnea / shortness of breath (14–26%) injury / drug-induced liver injury (DILI) [2]
Flu-like syndrome [2] Trade name: Alfenta (Akorn)
Indications: General anesthesia, post-operative Genitourinary
Pharyngitis (12%) Ejaculatory dysfunction [3]
Pneumonia (16%) [3] pain
Class: Analgesic; opioid, Anesthetic Erectile dysfunction [2]
Pneumonitis [5]
Half-life: 83–97 minutes (adults) Neuromuscular/Skeletal
Respiratory tract infection [2]
Clinically important, potentially hazardous Asthenia / fatigue (3%)
Tuberculosis [2]
interactions with: ceritinib, crizotinib, dasatinib, Ocular
Other eluxadoline, enzalutamide, erythromycin, Floppy iris syndrome [4]
Adverse effects [8] itraconazole, letermovir, ranitidine, ribociclib,
Death [13] Respiratory
rifapentine, ritonavir, telithromycin, voriconazole Bronchitis (<2%)
Infection (43–74%) [52]
Pregnancy category: C Pharyngitis (<2%)
Sinusitis (<2%)
ALENDRONATE Cardiovascular Upper respiratory tract infection (3%)
Arrhythmias (>10%) Other
Trade names: Binosto (Mission), Fosamax Bradycardia / sinus bradycardia (>10%) [2] Adverse effects [2]
(Merck) Hypotension (>10%)
Indications: Osteoporosis in postmenopausal Vasodilation (peripheral) (>10%)
women, Paget’s disease Central Nervous System ALGLUCERASE
Class: Bisphosphonate Confusion (1–10%)
Half-life: >10 years Trade name: Ceredase (Genzyme)
Depression (1–10%)
Clinically important, potentially hazardous Indications: Gaucher disease
Intracranial pressure increased (intracranial
interactions with: none known Class: Enzyme, glucocerebrosidase
hypertension) (>10%)
Pregnancy category: C Half-life: 3.6–10.4 minutes
Shivering (3–9%)
Important contra-indications noted in the Somnolence (drowsiness) (>10%) Clinically important, potentially hazardous
prescribing guidelines for: nursing mothers; interactions with: none known
pediatric patients Pregnancy category: C
ALFUZOSIN Important contra-indications noted in the
Skin prescribing guidelines for: nursing mothers;
Angioedema [2] Trade names: Uroxatral (Concordia), Xatral pediatric patients
Erythema multiforme [2] (Sanofi-Aventis) Note: Safety and effectiveness in pediatric
Hypersensitivity [3] Indications: Benign prostatic hyperplasia patients <2 years of age have not been
Rash [5] Class: Adrenergic alpha-receptor antagonist established.
Half-life: 10 hours
Mucosal Clinically important, potentially hazardous
Oral ulceration (see also aphthous stomatitis Cardiovascular
interactions with: ACE inhibitors, adrenergic Hypertension [2]
/ aphthous ulcer / aphtha) [9]
neurone blockers, alcohol, aldesleukin,
Central Nervous System alprostadil, amitriptyline, angiotensin II receptor
Headache [2] antagonists, antipsychotics, anxiolytics and ALGLUCOSIDASE ALFA
Endocrine/Metabolic hypnotics, arsenic, atazanavir, atenolol, baclofen,
Hypocalcemia (18%) [5] beta blockers, boceprevir, calcium channel Trade name: Myozyme (Genzyme)
Gastrointestinal/Hepatic blockers, cimetidine, citalopram, clonidine, Indications: Pompe disease (glycogen storage
Abdominal pain (<7%) [8] conivaptan, corticosteroids, CYP3A4 inducers or disease type II), GAA deficiency
Dyspepsia / functional dyspepsia / inhibitors, darunavir, dasatinib, deferasirox, Class: Alfa-glucosidase, Enzyme
gastroparesis [8] Half-life: 2–3 hours
degarelix, delavirdine, diazoxide, diltiazem,
Dysphagia [4] Clinically important, potentially hazardous
diuretics, estrogens, food, general anesthetics,
Esophageal perforation [2] interactions with: none known
hydralazine, indinavir, itraconazole, ketoconazole,
Esophagitis [12] Pregnancy category: B
lapatinib, levodopa, levofloxacin, lopinavir, MAO
Hepatotoxicity / liver injury / acute liver inhibitors, methyldopa, minoxidil, moxifloxacin,
injury / drug-induced liver injury (DILI) [7] moxisylyte, moxonidine, nelfinavir, nitrates, Skin
Nausea [7] nitroprusside, NSAIDs, ombitasvir/paritaprevir/ Anaphylactoid reactions / anaphylaxis
Vomiting [4] ritonavir and dasabuvir, pazopanib, (includes anaphylactic shock) (5–8%) [2]
Neuromuscular/Skeletal phosphodiesterase 5 inhibitors, protease Flushing / rubefaction (21%)
Arthralgia [6] inhibitors, QT prolonging agents, ritonavir, Rash (54%)
Bone or joint pain (<6%) [5] sildenafil, St John’s wort, tadalafil, telaprevir, Urticaria / hives (21%)
Fractures [20] telavancin, telithromycin, tipranavir, tizanidine,
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Litt’s Drug Eruption & Reaction Manual ALLOPURINOL
Mucosal Genitourinary Endocrine/Metabolic

Oral candidiasis (31%) Urinary tract infection (5%) Hyperkalemia [3]
Cardiovascular Local Gastrointestinal/Hepatic
Bradycardia / sinus bradycardia (21%) Injection-site pain [2] Diarrhea (2%) [5]
Hypertension (5–8%) Injection-site reaction (7%) [22] Neuromuscular/Skeletal
Tachycardia (23%) Neuromuscular/Skeletal Asthenia / fatigue [7]
Central Nervous System Arthralgia [6] Respiratory
Fever (pyrexia) (97%) Asthenia / fatigue [2] Cough [4]
Pain (15–26%) Back pain [6] Nasopharyngitis [7]
Gastrointestinal/Hepatic Bone or joint pain (2%) [2] Other
Constipation (10–23%) Muscle spasm (3%) Adverse effects [11]
Diarrhea (62%) Myalgia/Myopathy (4%) [9]
Vomiting (22–49%) Ocular
Hematologic Ocular adverse effect [2] ALITRETINOIN
Anemia (31%) Respiratory
Bronchitis (4%) Trade name: Panretin (Ligand)
Local Indications: Kaposi’s sarcoma cutaneous lesions
Catheter-related infection (28%) Cough (3%)
Influenza (6%) [4] Class: Retinoid
Neuromuscular/Skeletal Half-life: N/A
Myalgia/Myopathy (37%) Nasopharyngitis (11%) [10]
Sinusitis (3%) [2] Clinically important, potentially hazardous
Otic Upper respiratory tract infection [8] interactions with: ketoconazole, simvastatin,
Otitis media (44%) vitamin A
Other Pregnancy category: D
Respiratory Adverse effects [12]
Cough (46%) Important contra-indications noted in the
Allergic reactions (9%) prescribing guidelines for: the elderly; pediatric
Nasopharyngitis (23%) Death [2]
Pneumonia (46%) patients
Upper respiratory tract infection (44%) Note: Oral alitretinoin (Toctino) is not available in
ALISKIREN the USA.
ALIROCUMAB Trade names: Rasilez (Novartis), Tekamlo Skin

(Novartis), Tekturna (Novartis), Tekturna HCT Edema (3–8%)
Trade name: Praluent (Regeneron) (Novartis), Valturna (Novartis) Erythema [2]
Indications: Adjunct to diet and statin therapy in Indications: Hypertension Exfoliative dermatitis (3–9%)
hypercholesterolemia or clinical atherosclerotic Class: Antihypertensive, Renin inhibitor Flushing / rubefaction [2]
cardiovascular disease where additional lowering Half-life: 24 hours Pigmentation (3%)
of low density lipoprotein cholesterol is required Clinically important, potentially hazardous Pruritus (itching) (8–11%)
Class: Monoclonal antibody, Proprotein interactions with: ACE inhibitors, aldosterone Rash (25–77%)
convertase subtilisin kexin type 9 (PCSK9) antagonists, atorvastatin, candesartan, celecoxib, Ulcerations (2%)
inhibitor
cyclosporine, diclofenac, furosemide, heparin, Xerosis (10%)
irbesartan, itraconazole, ketoconazole, losartan, Hair
meloxicam, moexipril, NSAIDs, olmesartan, Curly hair [2]
potassium salts, potassium-sparing diuretics, Mucosal
Pregnancy category: N/A (No data available but
sacubitril/valsartan, tinzaparin, trandolapril, Mucocutaneous reactions [2]
likely to cross the placenta in second and third
verapamil
trimester)
Pregnancy category: D (category C in first
Important contra-indications noted in the Depression [2]
trimester; category D in second and third
prescribing guidelines for: pediatric patients Headache [8]
trimesters)
Paresthesias (3–22%)
Skin prescribing guidelines for: nursing mothers; Endocrine/Metabolic
Hematoma (2%) pediatric patients Creatine phosphokinase (CPK) / creatine
Cardiovascular Note: Tekamlo is aliskiren and amlodipine; kinase increased (hyperCKemia) [2]
Cardiotoxicity [3] Tekturna HCT is aliskiren and Dyslipidemia [2]
Myocardial infarction [3] hydrochlorothiazide; Valturna is aliskiren and Hypertriglyceridemia [2]
Central Nervous System valsartan. Hydrochlorothiazide is a sulfonamide Gastrointestinal/Hepatic
Cognitive impairment [2] and can be absorbed systemically. Sulfonamides Nausea [2]
Headache [5] can produce severe, possibly fatal, reactions such
Neurotoxicity [4] as toxic epidermal necrolysis and Stevens-Johnson
Stroke / cerebral infarction [2] syndrome. ALLOPURINOL
Vertigo / dizziness [6] Contra-indicated for concomitant use with
Trade names: Duzallo (AstraZeneca), Zyloprim
Endocrine/Metabolic angiotensin receptor blockers or angiotensin-
(Prometheus)
ALT increased [3] converting enzyme (ACE) inhibitors in patients
Indications: Gouty arthritis
Creatine phosphokinase (CPK) / creatine with diabetes.
Class: Purine analog, Xanthine oxidase inhibitor
kinase increased (hyperCKemia) [3] Warning: FETAL TOXICITY
Half-life: <3 hours
Gastrointestinal/Hepatic Clinically important, potentially hazardous
Diarrhea (5%) [3] Skin interactions with: acenocoumarol, amoxicillin,
Gastrointestinal disorder / discomfort [2] Angioedema [4] ampicillin, ampicillin/sulbactam, azathioprine,
Hepatotoxicity / liver injury / acute liver Peripheral edema [4] benazepril, capecitabine, captopril, cilazapril,
injury / drug-induced liver injury (DILI) Central Nervous System cyclopenthiazide, dicumarol, enalapril, fosinopril,
(3%) Headache [12] imidapril, lisinopril, mercaptopurine,
Nausea [2] Vertigo / dizziness [8] pantoprazole, quinapril, ramipril, trandolapril,
uracil/tegafur, vidarabine, zofenopril
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Pregnancy category: C Skin

Note: HLA-B*5801 confers a risk of allopurinol- ALMOTRIPTAN Contact dermatitis [2]
induced serious skin reactions like SJS/TEN and Trade names: Almogran (Almirall), Axert Henoch–Schönlein purpura [2]
DRESS.Should be seriously considered in patients (Ortho-McNeil) Hypersensitivity [2]
of south Asian ancestry Indications: Migraine headaches Endocrine/Metabolic
Duzallo is allopurinol and lesinurad (see separate Class: 5-HT1 agonist, Serotonin receptor agonist, Hypokalemia [2]
entry). Triptan Gastrointestinal/Hepatic
Half-life: 3–4 hours Diarrhea [2]
Skin Clinically important, potentially hazardous Hepatitis [6]
AGEP [6] interactions with: conivaptan, darunavir, Other
Cutaneous adverse reaction [7] delavirdine, dihydroergotamine, ergotamine, Allergic reactions [2]
DRESS syndrome [48] indinavir, ketoconazole, methysergide, SNRIs,
Eosinophilic pustular folliculitis [2] SSRIs, telithromycin, triptans, voriconazole
Erythema multiforme [7] Pregnancy category: C ALOGLIPTIN
Exanthems (<5%) [20] Important contra-indications noted in the
Exfoliative dermatitis (>10%) [15] prescribing guidelines for: pediatric patients Trade name: Nesina (Takeda)
Fixed eruption [11] Note: Contra-indicated in patients with history, Indications: Type II diabetes mellitus
Granuloma annulare (disseminated) [2] symptoms, or signs of ischemic cardiac, Class: Antidiabetic, Dipeptidyl peptidase-4 (DPP-
Hypersensitivity [49] cerebrovascular, or peripheral vascular 4) inhibitor
Lupus erythematosus [3] syndromes, or with uncontrolled hypertension. Half-life: 21 hours
Pityriasis rosea [2] Clinically important, potentially hazardous
Pruritus (itching) [7] interactions with: none known
Purpura (>10%) [2] Cardiovascular Pregnancy category: B
Rash (>10%) [11] Chest pain [3]
Skin toxicity / toxicity [2] Central Nervous System prescribing guidelines for: nursing mothers;
Stevens-Johnson syndrome (>10%) [55] Headache [2] pediatric patients
Toxic epidermal necrolysis [73] Neurotoxicity [2]
Toxic pustuloderma [3] Paresthesias [4]
Skin
Urticaria / hives (>10%) [6] Somnolence (drowsiness) [5]
Vasculitis (angiitis) / cutaneous vasculitis Vertigo / dizziness [6]
Pruritus (itching) [2]
(angiitis) [7] Gastrointestinal/Hepatic
Hair Nausea [6]
Headache (4%) [8]
Alopecia (<10%) [2] Vomiting [3]
Mucosal Neuromuscular/Skeletal
Endocrine/Metabolic
Oral ulceration (see also aphthous stomatitis Asthenia / fatigue [4]
Hypoglycemia [14]
/ aphthous ulcer / aphtha) [3] Respiratory
Stomatitis (oral mucositis) [2] Flu-like syndrome (12%)
Constipation [2]
Cardiovascular Upper respiratory tract infection (20%)
Diarrhea [2]
Polyarteritis nodosa [3] Other Pancreatitis / acute pancreatitis [3]
Central Nervous System Adverse effects [10]
Chills (<10%) Arthralgia [2]
Fever (pyrexia) [2]
Headache [3]
ALOE VERA (GEL, JUICE, Respiratory
Nasopharyngitis (4%) [8]
Vertigo / dizziness [3] LEAF) Upper respiratory tract infection (4%) [6]
Endocrine/Metabolic Other
ALT increased [2] Family: Liliaceae
Scientific names: Aloë africana, Aloë barbadensis, Adverse effects [6]
AST increased [3]
Aloë ferox, Aloë spicata Infection [3]
Indications: Oral: anesthetic, antiseptic,
Diarrhea [5]
antipyretic, antipruritic, vasodilator, anti-
inflammatory, vermifuge, antifungal. antiulcer,
ALOSETRON
injury / drug-induced liver injury (DILI) [9]
diabetes, asthma Trade name: Lotronex (GSK)
Nausea [3]
Topical: promote healing, cold sores, ulceration, Indications: Irritable bowel syndrome
Neuromuscular/Skeletal radiations injuries, psoriasis, frostbite. Also used
Arthralgia [3] Class: 5-HT3 antagonist, Serotonin type 3
in cosmetics and for its moisturizing and emollient receptor antagonist
Asthenia / fatigue [2] properties
Back pain [2] Half-life: 1.5 hours
Class: Anthroquinone glycoside, Anti- Clinically important, potentially hazardous
Bone or joint pain [2] inflammatory
Joint disorder [2] interactions with: apomorphine, conivaptan,
Half-life: N/A CYP1A2 inhibitors, CYP3A4 inhibitors, darunavir,
Myalgia/Myopathy [3] Clinically important, potentially hazardous delavirdine, eluxadoline, fluvoxamine, indinavir,
Renal interactions with: arsenic telithromycin, teriflunomide, voriconazole
Nephrotoxicity / kidney injury / acute kidney Pregnancy category: N/A Pregnancy category: B
injury (AKI) / drug-induced kidney injury [3] Note: One blade of aloe can be used for weeks. Important contra-indications noted in the
Respiratory The severed end of the blade is self healing. prescribing guidelines for: the elderly; nursing
Nasopharyngitis [2] I have perfumed my bed with myrrh, aloes and mothers; pediatric patients
Upper respiratory tract infection [4] cinnamon (Proverbs 7:17). Note: Alosetron was approved in 2000 for use in
Other Cleopatra regarded the gel as a fountain of youth women with diarrhea-predominant irritable
Adverse effects [13] and used it to preserve her skin against the bowel syndrome (IBS-D), however infrequent
Allergic reactions (severe) [2] ravages of the Egyptian sun. serious adverse events (including ischemic colitis
Death [9] and serious complications of constipation,
resulting in hospitalization, blood transfusion,
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Litt’s Drug Eruption & Reaction Manual ALTEPLASE
surgery and death) prompted alosetron’s grapefruit juice, indinavir, itraconazole, Cardiovascular
voluntary withdrawal from the US market in ivermectin, kava, ketoconazole, posaconazole, Bradycardia / sinus bradycardia (<10%)
November 2000. Public request prompted its propoxyphene, ritonavir, saquinavir, St John’s Hypertension (<10%)
reintroduction in 2002 under a Risk Management wort, telaprevir, tipranavir Hypotension (<10%)
Plan, including a more restricted indication and a Pregnancy category: D Tachycardia (<10%)
Prescribing Program for Lotronex. Only licensed Important contra-indications noted in the Central Nervous System
for use in female patients. Contra-indicated in prescribing guidelines for: the elderly; nursing Fever (pyrexia) (>10%)
patients with constipation or a history of chronic mothers; pediatric patients Headache (>10%)
or severe constipation or sequelae from Pain (>10%)
constipation; intestinal obstruction, stricture, Skin Vertigo / dizziness (>10%)
toxic megacolon, gastrointestinal perforation, Dermatitis (4%) [5] Gastrointestinal/Hepatic
and/or adhesions; ischemic colitis; impaired Diaphoresis (16%) Diarrhea (<10%)
intestinal circulation, thrombophlebitis, or Edema (5%)
hypercoagulable state; Crohn’s disease or Genitourinary
Photosensitivity [4] Erectile dysfunction (prolonged erection /
ulcerative colitis; diverticulitis; severe hepatic Pruritus (itching) (<10%) [2]
impairment. >4 hours) (4%)
Rash (11%) [4] Penile pain (>10%)
Warning: SERIOUS GASTROINTESTINAL
ADVERSE REACTIONS Mucosal Priapism (4%) [8]
Sialopenia (33%) Urethral burning (>10%) [2]
Sialorrhea (ptyalism; hypersalivation) (4%) Local
Gastrointestinal/Hepatic Xerostomia (dry mouth) (15%) [6]
Abdominal distension (2%) Application-site burning [3]
Abdominal pain (<7%) [3] Cardiovascular Application-site erythema [3]
Colitis [12] Hypotension (<10%) Application-site pain [2]
Constipation (9–29%) [14] Central Nervous System Application-site pruritus [2]
Diarrhea (2–3%) Cognitive impairment (>10%) Injection-site ecchymoses (<10%)
Flatulence (<3%) Coma [2] Injection-site hematoma (3%)
Gastroenteritis (>3%) Depression (>10%) Injection-site pain (2%)
Gastroesophageal reflux (2%) Dysarthria (>10%) Neuromuscular/Skeletal
Hemorrhoids (<3%) Incoordination (<10%) Back pain (<10%)
Nausea (6%) Memory loss/memory impaired [2] Respiratory
Vomiting (<3%) Neurotoxicity [2] Apnea (>10%)
Genitourinary Paresthesias (2%) Cough (<10%)
Urinary tract infection (>3%) Restlessness [2] Flu-like syndrome (<10%)
Sedation [2] Sinusitis (<10%)
Neuromuscular/Skeletal Seizures (<10%) [2]
Asthenia / fatigue (3%) Somnolence (drowsiness) (>10%)
Muscle spasm (3%) ALTEPLASE
Endocrine/Metabolic
Respiratory Galactorrhea [2]
Cough (>3%) Synonym: tPA
Nasopharyngitis (>3%) Genitourinary Trade name: Activase (Genentech)
Sinusitis (>3%) Micturition difficulty (>10%) Indications: Acute myocardial infarction, acute
Upper respiratory tract infection (>3%) Neuromuscular/Skeletal pulmonary embolism
Other Asthenia / fatigue (>10%) [2] Class: Fibrinolytic, Plasminogen activator
Adverse effects [5] Half-life: 30–45 minutes
ALPROSTADIL interactions with: defibrotide, nitroglycerin,
ALPHA-LIPOIC ACID Synonyms: PGE; prostaglandin E1 ticlopidine
Trade names: Caverject (Pfizer), Edex Pregnancy category: C
Synonym: ALA Important contra-indications noted in the
(Schwarz), Muse (Vivus), Prostin VR (Pfizer)
Indications: Diabetic neuropathy, vasodilation, prescribing guidelines for: the elderly; nursing
Indications: Impotence, to maintain patent
photoaging mothers
ductus arteriosus
Class: Dietary supplement
Class: Prostaglandin
Half-life: N/A
Half-life: 5–10 minutes Skin
Clinically important, potentially hazardous Anaphylactoid reactions / anaphylaxis
interactions with: acebutolol, alfuzosin, (includes anaphylactic shock) [5]
captopril, cilazapril, enalapril, fosinopril, Angioedema [12]
Skin irbesartan, lisinopril, olmesartan, quinapril, Bruise / bruising / contusion / ecchymosis
Rash [2] ramipril (ecchymoses) (<10%)
Central Nervous System Pregnancy category: D (not indicated for use in Purpura (<10%)
Vertigo / dizziness [2] women) Central Nervous System
Important contra-indications noted in the Fever (pyrexia) (<10%)
prescribing guidelines for: pediatric patients Intracranial hemorrhage [8]
ALPRAZOLAM Warning: APNEA (in neonates with congenital Gastrointestinal/Hepatic
Trade name: Xanax (Pfizer) heart defects) Hemorrhagic colitis (5%)
Indications: Anxiety, depression, panic attacks Hematologic
Class: Benzodiazepine Skin Bleeding [3]
Half-life: 11–16 hours Edema (<10%) Hemorrhage (4%)
Clinically important, potentially hazardous Flushing / rubefaction (>10%) Other
interactions with: alcohol, amprenavir, Penile rash (<10%) Death [4]
aprepitant, boceprevir, clarithromycin, CNS Mucosal
depressants, darunavir, delavirdine, digoxin, Nasal congestion (<10%)
efavirenz, fluconazole, fluoxetine, fluvoxamine,
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ALTRETAMINE Updated each week on www.drugeruptiondata.com
inducers or inhibitors, dasatinib, deferasirox,

ALTRETAMINE AMANTADINE grapefruit juice, St John’s wort
Synonym: hexamethylmelamine Trade names: Gocovri (Adamas Pharma), Pregnancy category: X
Trade name: Hexalen (Eisai) Symmetrel (Endo) Important contra-indications noted in the
Indications: Palliative treatment of recurrent Indications: Parkinsonism, influenza A viral prescribing guidelines for: nursing mothers;
ovarian cancer infection pediatric patients
Class: Alkylating agent Class: Adamantane, Antiviral Note: Also contra-indicated in patients with
Half-life: 13 hours Half-life: 10–28 hours idiopathic pulmonary fibrosis.
Clinically important, potentially hazardous Clinically important, potentially hazardous Warning: CONTRA-INDICATED IN
interactions with: aldesleukin, amitriptyline, interactions with: cyclopenthiazide, PREGNANCY
linezolid fesoterodine, levomepromazine, memantine,
Pregnancy category: D quinine, risperidone, tetrabenazine, Skin
Important contra-indications noted in the trimethoprim, zuclopenthixol Edema [4]
prescribing guidelines for: nursing mothers; Pregnancy category: C Flushing / rubefaction (4%)
pediatric patients Important contra-indications noted in the Peripheral edema (17%) [9]
prescribing guidelines for: nursing mothers; Mucosal
Central Nervous System pediatric patients Nasal congestion (6%) [2]
Neurotoxicity [5] Cardiovascular
Paresthesias [2] Skin Palpitation (5%)
Peripheral neuropathy (31%) Dermatitis [20] Central Nervous System
Gastrointestinal/Hepatic Edema [3] Headache (15%) [4]
Abdominal pain [2] Livedo reticularis (50–90%) [23] Gastrointestinal/Hepatic
Nausea (33%) Peripheral edema (<10%) [9] Abdominal pain (3%)
Vomiting (33%) [2] Photosensitivity [2] Constipation (4%)
Hematologic Mucosal Hepatotoxicity / liver injury / acute liver
Anemia (33%) Xerostomia (dry mouth) (<10%) [11] injury / drug-induced liver injury (DILI) [3]
Leukocytopenia (leukopenia) (5%) Cardiovascular Hematologic
Neutropenia (neutrophils decreased) [2] Hypotension (<10%) Anemia [5]
Thrombocytopenia (9%) Orthostatic hypotension [3] Respiratory
Neuromuscular/Skeletal QT prolongation [4] Dyspnea / shortness of breath (4%)
Asthenia / fatigue [3] Central Nervous System Nasopharyngitis (3%)
Abnormal dreams (<10%) Sinusitis (3%)
Agitation (<10%)
ALVIMOPAN Anorexia (<10%)
Trade name: Entereg (Adolor)
Anxiety (<10%) AMCINONIDE
Confusion (<10%) [2]
Indications: Postoperative ileus Trade name: Cyclocort (Astellas)
Delirium (<10%) [4]
Class: Opioid antagonist Indications: Dermatoses
Depression (<10%)
Half-life: 10–18 hours Class: Corticosteroid / Glucocorticoid,
Gait instability [3]
Clinically important, potentially hazardous Corticosteroid, topical
Hallucinations [9]
interactions with: hydromorphone, opioid Half-life: N/A
Headache (<10%)
receptor antagonist (for longer than 7 days), Insomnia (<10%) [4] Clinically important, potentially hazardous
tapentadol Psychosis [3] interactions with: live vaccines
Pregnancy category: B Somnolence (drowsiness) (<10%) Pregnancy category: C
Important contra-indications noted in the Vertigo / dizziness (<10%) [3] Important contra-indications noted in the
prescribing guidelines for: nursing mothers; prescribing guidelines for: nursing mothers;
pediatric patients Endocrine/Metabolic
pediatric patients
Warning: FOR SHORT-TERM HOSPITAL USE Hyponatremia [2]
ONLY Gastrointestinal/Hepatic
Constipation (<10%) [8] Skin
Diarrhea (<10%) Dermatitis [13]
Cardiovascular
Hypotension [2] Nausea [3]
Myocardial infarction [3] Neuromuscular/Skeletal AMIFOSTINE
Endocrine/Metabolic Asthenia / fatigue (<10%)
Ataxia (<10%) Synonyms: ethiofos; gammaphos
Hypokalemia (7–10%)
Myoclonus [4] Trade name: Ethyol (Medimmune)
Gastrointestinal/Hepatic Indications: Nephrotoxicity prophylaxis
Abdominal pain [4] Ocular
Corneal edema [8] Class: Thiophosphate cytoprotective
Constipation (4–10%) Half-life: 9 minutes
Diarrhea [4] Hallucinations, visual [6]
Vision blurred [2] Clinically important, potentially hazardous
Dyspepsia / functional dyspepsia / interactions with: benazepril, captopril,
gastroparesis (6–7%) clevidipine, enalapril, fosinopril, irbesartan,
Flatulence (3–9%) [2] AMBRISENTAN lisinopril, olmesartan, quinapril, ramipril
Nausea [6] Pregnancy category: C
Vomiting [3] Trade names: Letairis (Gilead), Volibris (GSK) Important contra-indications noted in the
Genitourinary Indications: Pulmonary arterial hypertension prescribing guidelines for: the elderly; nursing
Urinary retention (3–4%) Class: Antihypertensive, Endothelin receptor mothers; pediatric patients
Hematologic (ETR) antagonist, Vasodilator
Anemia (5%) Half-life: 9 hours
Skin
Neuromuscular/Skeletal Anaphylactoid reactions / anaphylaxis
interactions with: conivaptan, cyclosporine,
Back pain (3%) (includes anaphylactic shock) [3]
CYP2C19 inducers or inhibitors, CYP3A4
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Litt’s Drug Eruption & Reaction Manual AMINOLEVULINIC ACID
Dermatitis [3]
Flushing / rubefaction (>10%) [4] AMILORIDE AMINO-GLUTETHIMIDE
Rash [6] Trade names: Midamor (Merck), Moduretic Trade name: Cytadren (Novartis)
Stevens-Johnson syndrome [3] (Merck) Indications: Suppression of adrenal function,
Toxic epidermal necrolysis [3] Indications: Prevention of hypokalemia metastatic carcinoma
Mucosal associated with kaliuretic diuretics, management Class: Aromatase inhibitor
Mucositis [4] of edema in hypertension Half-life: 7–15 hours
Xerostomia (dry mouth) [7] Class: Diuretic, potassium-sparing Clinically important, potentially hazardous
Cardiovascular Half-life: 6–9 hours interactions with: betamethasone,
Hypotension (15–61%) [5] Clinically important, potentially hazardous dexamethasone, doxercalciferol, oxtriphylline,
Central Nervous System interactions with: ACE inhibitors, benazepril, triamcinolone
Chills (>10%) captopril, cyclosporine, enalapril, fosinopril, Pregnancy category: D
Dysgeusia (taste perversion) [2] lisinopril, magnesium, metformin, moexipril, Important contra-indications noted in the
Fever (pyrexia) [3] potassium salts, quinapril, quinidine, ramipril, prescribing guidelines for: the elderly; nursing
Endocrine/Metabolic spironolactone, trandolapril, zofenopril mothers; pediatric patients
Hypocalcemia [2] Pregnancy category: B
Note: Moduretic is amiloride and Skin
hydrochlorothiazide. Hydrochlorothiazide is a Exanthems [8]
Nausea (53–96%) [2]
sulfonamide and can be absorbed systemically. Lupus erythematosus (>10%)
Vomiting (53–96%) [2]
Sulfonamides can produce severe, possibly fatal, Pruritus (itching) (5%)
Respiratory reactions such as toxic epidermal necrolysis and Rash (>10%)
Dyspnea / shortness of breath (4%) Stevens-Johnson syndrome. Hair
Other Hirsutism (<10%)
Allergic reactions [2] Skin Mucosal
Photosensitivity [4] Oral mucosal eruption [2]
AMIKACIN Central Nervous System Neuromuscular/Skeletal
Headache (<10%) Myalgia/Myopathy (3%)
Trade name: Amikacin sulfate (Bedford) Vertigo / dizziness (<10%)
Indications: Short-term treatment of serious Endocrine/Metabolic
infections due to gram-negative bacteria Gynecomastia (<10%) AMINOLEVULINIC ACID
Class: Antibiotic, Antibiotic; aminoglycoside, Hyperkalemia [2]
Drug-resistant antituberculosis agent Trade names: Ameluz (Biofrontera), Levulan
Genitourinary
Half-life: 1.5–2.5 hours (adults) Kerastick (Dusa)
Impotence (<10%)
Clinically important, potentially hazardous Indications: Non-hyperkeratotic actinic
interactions with: adefovir, aldesleukin,
Neuromuscular/Skeletal keratoses of face and scalp
Asthenia / fatigue (<10%) Class: Photosensitizer, Protoporphyrin IX (PpIX)
aminoglycosides, atracurium, bumetanide,
Myalgia/Myopathy (<10%) (wakefulness promoting agent)
cephalexin, doxacurium, ethacrynic acid,
furosemide, succinylcholine, teicoplanin, Respiratory Half-life: 20–40 hours
torsemide Cough (<10%) Clinically important, potentially hazardous
Pregnancy category: D Dyspnea / shortness of breath (<10%) interactions with: none known
Important contra-indications noted in the Pregnancy category: C
prescribing guidelines for: nursing mothers; Important contra-indications noted in the
pediatric patients
AMINOCAPROIC ACID prescribing guidelines for: nursing mothers;
Note: Aminoglycosides may cause neurotoxicity pediatric patients
Trade name: Amicar (Xanodyne)
and/or nephrotoxicity. Note: In photodynamic therapy: to be used in
Indications: To provide hemostasis in the
conjunction with the relevant illuminator as
treatment of fibrinolysis
approved by the manufacturer.
Skin Class: Antifibrinolytic
Dermatitis [3] Half-life: 1–2 hours
Exanthems [2] Clinically important, potentially hazardous Skin
Central Nervous System interactions with: none known Burning / skin burning sensation (>50%) [6]
Neurotoxicity (<10%) Pregnancy category: C Crusting (64–71%) [2]
Important contra-indications noted in the Dermatitis [2]
Ocular Desquamation [2]
Macular infarction [3] prescribing guidelines for: nursing mothers;
pediatric patients Edema (35%) [9]
Otic Erosions (14%) [2]
Hearing loss (hypoacusis) [6] Erythema (99%) [13]
Ototoxicity (<10%) [9] Skin
Exfoliative dermatitis (from topical
Tinnitus [3] Dermatitis [4]
treatment) [3]
Purpura [2]
Renal Hypomelanosis (22%)
Rash (<10%)
Nephrotoxicity / kidney injury / acute kidney Photosensitivity [3]
injury (AKI) / drug-induced kidney injury Neuromuscular/Skeletal Pigmentation (from topical treatment) (22%)
(<10%) [11] Myalgia/Myopathy (<10%) [7]
Rhabdomyolysis [11] Pruritus (itching) (25%) [2]
Renal Pustules (<4%)
Nephrotoxicity / kidney injury / acute kidney Scaling (64–71%)
injury (AKI) / drug-induced kidney injury [2] Stinging (>50%) [2]
Ulcerations (4%)
Vesiculation (4%) [2]
Cardiovascular
Hypotension [2]
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AMINOLEVULINIC ACID See all our books at www.crcpress.com
Central Nervous System macrolide antibiotics, methotrexate,

Dysesthesia (2%) AMINOSALICYLATE moxifloxacin, naldemedine, nelfinavir, nevirapine,
Pain [12] SODIUM nilotinib, norfloxacin, ofloxacin, orlistat,
oxprenolol, pentamidine, phenytoin,
Synonyms: PAS; para-aminosalicylate sodium pimavanserin, procainamide, propranolol,
AMINOPHYLLINE Trade name: Paser Granules (Jacobus) quinidine, quinine, quinolones, ribociclib,
Indications: Tuberculosis rifabutin, rifampin, rifapentine, ritonavir,
Synonym: theophylline ethylenediamine
Class: Antibiotic, Antimycobacterial (including ropivacaine, rosuvastatin, simvastatin, sofosbuvir
Trade names: Elixophyllin (Forest), Phyllocontin
antitubercular), Salicylate & velpatasvir, sofosbuvir/velpatasvir/voxilaprevir,
(Napp), Quibron (Monarch)
Half-life: 45–60 minutes sotalol, sparfloxacin, St John’s wort, sulpiride,
Indications: Prevention or treatment of
Clinically important, potentially hazardous tacrolimus, telaprevir, tetrabenazine, thalidomide,
reversible bronchospasm
interactions with: none known tipranavir, trazodone, vandetanib, venetoclax,
Class: Xanthine alkaloid
Important contra-indications noted in the verapamil, warfarin, zuclopenthixol
Half-life: 3–15 hours (in adult nonsmokers)
prescribing guidelines for: nursing mothers Pregnancy category: D
interactions with: adenosine, anagrelide, Important contra-indications noted in the
arformoterol, azithromycin, BCG vaccine, Skin prescribing guidelines for: the elderly; nursing
caffeine, capsicum, carbimazole, cimetidine, Angioedema [2] mothers; pediatric patients
ciprofloxacin, clorazepate, cocoa, erythromycin, Bullous dermatosis [2] Note: Amiodarone induced pulmonary toxicity
eucalyptus, febuxostat, fluvoxamine, halothane, Exanthems [10] has an incidence of about 5%-10%, and it is
indacaterol, influenza vaccine, levofloxacin, Exfoliative dermatitis [6] considered the most serious adverse effect with
mebendazole, methylprednisolone, moxifloxacin, Fixed eruption [6] mortalities reaching up to 10% of the patients.
Hypersensitivity [2] Warning: PULMONARY TOXICITY
nilutamide, norfloxacin, obeticholic acid,
Lichenoid eruption [3]
ofloxacin, oral contraceptives, prednisolone,
Lupus erythematosus [4] Skin
prednisone, propranolol, rasagiline, raspberry
Photosensitivity [3] Anaphylactoid reactions / anaphylaxis
leaf, roflumilast, ropivacaine, roxithromycin, St
Pruritus (itching) [3] (includes anaphylactic shock) [2]
John’s wort, torasemide, torsemide, Purpura [4]
triamcinolone, zafirlukast Angioedema [2]
Toxic epidermal necrolysis [2] Diaphoresis [2]
Pregnancy category: C Urticaria / hives [5]
Important contra-indications noted in the Edema (<10%)
prescribing guidelines for: the elderly; nursing Hair Erythema nodosum [2]
mothers Alopecia [4] Exanthems [5]
Mucosal Facial erythema (3%) [2]
Oral mucosal eruption [2] Flushing / rubefaction (<10%)
Skin Iododerma [2]
Dermatitis [7] Endocrine/Metabolic
Hypothyroidism [2] Linear IgA bullous dermatosis [6]
Exanthems [5] Lupus erythematosus [5]
Exfoliative dermatitis [6] Renal Myxedema [3]
Hypersensitivity [6] Nephrotoxicity / kidney injury / acute kidney Photosensitivity (10–75%) [42]
Pruritus (itching) [3] injury (AKI) / drug-induced kidney injury [2] Phototoxicity [3]
Stevens-Johnson syndrome [3] Other Pigmentation (blue) (<10%) [68]
Urticaria / hives [6] Adverse effects [4] Pruritus (itching) (<5%) [2]
Cardiovascular Psoriasis [2]
Arrhythmias [2] Purpura (2%)
Palpitation [3] AMIODARONE Skin toxicity / toxicity [5]
Tachycardia [2] Toxic epidermal necrolysis [2]
Trade names: Cordarone (Wyeth), Pacerone
Central Nervous System (Upsher-Smith) Vasculitis (angiitis) / cutaneous vasculitis
Insomnia [2] Indications: Ventricular fibrillation, ventricular (angiitis) [6]
Seizures [11] tachycardia Hair
Tremor [2] Class: Antiarrhythmic, Antiarrhythmic class III, Alopecia [5]
Endocrine/Metabolic CYP1A2 inhibitor, CYP3A4 inhibitor Mucosal
SIADH [2] Half-life: 26–107 days Sialorrhea (ptyalism; hypersalivation)
Gastrointestinal/Hepatic Clinically important, potentially hazardous (<10%)
Abdominal pain [2] interactions with: abarelix, acebutolol, Cardiovascular
Nausea [5] acenocoumarol, afatinib, amisulpride, Arrhythmias (<3%) [3]
Vomiting [2] amitriptyline, amprenavir, anisindione, Atrial fibrillation (paroxysmal) [3]
Neuromuscular/Skeletal anticoagulants, arsenic, artemether/lumefantrine, Atrioventricular block [3]
Rhabdomyolysis [5] asenapine, astemizole, atazanavir, atorvastatin, Bradycardia / sinus bradycardia [18]
Other azoles, betrixaban, boceprevir, bosentan, Cardiotoxicity [4]
Adverse effects [3] carbimazole, celiprolol, cholestyramine, Hypotension (16%) [4]
Allergic reactions [5] cimetidine, ciprofloxacin, clopidogrel, cobicistat/ QT prolongation [25]
Death [2] elvitegravir/emtricitabine/tenofovir alafenamide, Tachycardia [2]
cobicistat/elvitegravir/emtricitabine/tenofovir Thrombophlebitis [2]
disoproxil, colchicine, cyclosporine, dabigatran, Torsades de pointes [37]
daclatasvir, darunavir, degarelix, delavirdine, Ventricular arrhythmia [2]
dextromethorphan, dicumarol, digoxin, diltiazem, Central Nervous System
disopyramide, dronedarone, droperidol, Anorexia (10–33%)
echinacea, enoxacin, fentanyl, flecainide, Coma [2]
fosamprenavir, gatifloxacin, grapefruit juice, Dysgeusia (taste perversion) (<10%)
indinavir, ledipasvir & sofosbuvir, lesinurad, Headache (3–40%)
letermovir, levofloxacin, levomepromazine, Insomnia (3–40%)
lidocaine, lomefloxacin, lopinavir, loratadine, Neuromyopathy [5]
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Litt’s Drug Eruption & Reaction Manual AMITRIPTYLINE
Neurotoxicity [6] amphetamines, amprenavir, anticholinergics,

Paresthesias (4–9%) AMISULPRIDE antiepileptics, antihistamines, antimuscarinics,
Parkinsonism [4] Trade names: Barhemsys (Acacia Pharma), antipsychotics, apraclonidine, arsenic,
Parosmia (<10%) Deniban (Sanofi-Aventis), Solian (Sanofi-Aventis) artemether/lumefantrine, aspirin, atomoxetine,
Peripheral neuropathy [4] Indications: Prevention of postoperative nausea baclofen, barbiturates, brimonidine, bupropion,
Syncope / fainting [2] and vomiting (lower doses). Psychoses, cannabis extract, carbamazepine, cimetidine,
Tremor (3–40%) [4] schizophrenia (higher doses) cinacalcet, ciprofloxacin, cisapride, clonidine,
Vertigo / dizziness (3–40%) Class: Antiemetic, Antipsychotic, Dopamine clozapine, cobicistat/elvitegravir/emtricitabine/
Endocrine/Metabolic receptor antagonist tenofovir alafenamide, cobicistat/elvitegravir/
Hyperthyroidism (<3%) [10] Half-life: 4–5 hours (following intravenous emtricitabine/tenofovir disoproxil, conivaptan,
Hyponatremia [4] infusion) coumarins, CYP2D6 inhibitors, desmopressin,
Hypothyroidism (<3%) [19] Clinically important, potentially hazardous dexmethylphenidate, diltiazem, disopyramide,
SIADH [11] interactions with: amiodarone, bepridil, disulfiram, diuretics, dronedarone, droperidol,
Thyroid dysfunction [27] cisapride, disopyramide, droperidol, duloxetine, entacapone, ephedra, epinephrine,
Thyrotoxicosis [21] erythromycin, flecainide, levodopa, ondansetron, estrogens, eucalyptus, flecainide, gadobutrol,
Gastrointestinal/Hepatic ondansetron, pentamidine, procainamide, general anesthetics, gotu kola, grapefruit juice,
Abdominal pain (<10%) quinidine, sotalol, sparfloxacin, terfenadine, guanethidine, histamine, interferon alfa,
Constipation (10–33%) thioridazine iobenguane, isocarboxazid, isoproterenol, kava,
Hepatic failure [4] Important contra-indications noted in the linezolid, lithium, MAO inhibitors,
Hepatic steatosis [2] prescribing guidelines for: nursing mothers methylphenidate, metoclopramide,
Hepatitis (<3%) [3] Note: Approved by FDA for prevention of moclobemide, moxifloxacin, moxonidine,
Hepatotoxicity / liver injury / acute liver postoperative nausea and vomiting, February nefopam, nicorandil, nilotinib, nitrates, NSAIDs,
injury / drug-induced liver injury (DILI) [31] 2020. Avoid use in patients with congenital long opioid analgesics, paroxetine hydrochloride,
Nausea (10–33%) QT syndrome and in patients taking droperidol. pentamidine, phenelzine, phenothiazines,
Pancreatitis / acute pancreatitis [5] phenytoin, pimozide, pramlintide, primidone,
Vomiting (10–33%) Cardiovascular propafenone, propoxyphene, protease inhibitors,
Genitourinary Bradycardia / sinus bradycardia [4] QT interval prolonging agents, quinidine, quinine,
Epididymitis [3] Hypertension [2] quinolones, rasagiline, ritonavir, saquinavir,
Hematologic Hypotension (3%) [2] selegiline, sibutramine, sodium oxybate, sotalol,
Neutropenia (neutrophils decreased) [2] QT prolongation [10] sparfloxacin, SSRIs, St John’s wort, sulfonylureas,
Neuromuscular/Skeletal Torsades de pointes [5] terbinafine, tetrabenazine, thioridazine, thyroid
Ataxia [6] Central Nervous System hormones, tramadol, tranylcypromine, valerian,
Myoclonus [3] Agitation [2] valproic acid, verapamil, vitamin K antagonists,
Rhabdomyolysis [7] Akathisia [2] yohimbine, ziprasidone
Ocular Chills (4%) Pregnancy category: C
Corneal deposits (>90%) [2] Extrapyramidal symptoms [3] Important contra-indications noted in the
Keratopathy [6] Insomnia [4] prescribing guidelines for: the elderly; nursing
Ocular adverse effect [4] Mania [4] mothers; pediatric patients
Ocular toxicity [2] Neuroleptic malignant syndrome [5] Note: Limbitrol is amitriptyline and
Optic neuropathy [7] Sedation [3] chlordiazepoxide.
Visual disturbances (2–9%) Somnolence (drowsiness) [2] Warning: SUICIDALITY AND
Tardive dyskinesia [3] ANTIDEPRESSANT DRUGS
Otic
Vestibular disorder [3] Tic disorder [2]
Tremor [2] Skin
Renal Diaphoresis (<10%)
Renal failure [3] Endocrine/Metabolic
Galactorrhea [4] DRESS syndrome [2]
Respiratory Hyperprolactinemia (5%) [6] Photosensitivity [3]
Alveolar hemorrhage (pulmonary) [2] Hypokalemia (4%) Pigmentation [4]
Cough [2] Weight gain [10] Pruritus (itching) [3]
Eosinophilic pneumonia [2] Pseudolymphoma [2]
Interstitial lung disease / interstitial Gastrointestinal/Hepatic
Abdominal distension (2%) Purpura [2]
pneumonitis / interstitial pneumonia [2] Mucosal
Pneumonia [4] Local
Infusion-site pain (6%) Xerostomia (dry mouth) (>10%) [17]
Pneumonitis [5]
Pulmonary toxicity [29] Neuromuscular/Skeletal Cardiovascular
Asthenia / fatigue [2] Brugada syndrome [4]
Other Myocardial infarction [2]
Adverse effects [5] Dystonia [5]
Postural hypotension [2]
Death [10] Ocular QT prolongation [2]
Side effects (12%) [4] Oculogyric crisis [2]
Delirium [2]
AMITRIPTYLINE Depression [2]
Dysgeusia (taste perversion) (>10%) [2]
Trade names: Elavil (AstraZeneca), Limbitrol Hallucinations [3]
(Valeant) Headache [2]
Indications: Depression Restless legs syndrome [2]
Class: Antidepressant; tricyclic, Muscarinic Sedation [3]
antagonist Seizures [7]
Half-life: 10–25 hours Serotonin syndrome [4]
Clinically important, potentially hazardous Somnolence (drowsiness) [8]
interactions with: adrenergic neurone blockers, Vertigo / dizziness [6]
alcohol, alfuzosin, altretamine, amiodarone,
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AMITRIPTYLINE Updated each week on www.drugeruptiondata.com
Endocrine/Metabolic Exanthems (2–4%) [2] Important contra-indications noted in the

SIADH [5] Flushing / rubefaction (<10%) [5] prescribing guidelines for: pediatric patients
Weight gain [7] Peripheral edema (>10%) [46]
Gastrointestinal/Hepatic Pigmentation [2] Skin
Cholestasis [2] Pruritus (itching) (2–4%) [3] Pruritus (itching) [4]
Constipation [5] Purpura [2]
Nausea [2] Rash (<10%) Extrapyramidal symptoms [3]
Neuromuscular/Skeletal Skin toxicity / toxicity [2]
Telangiectasia [6] Gastrointestinal/Hepatic
Asthenia / fatigue [4] Abdominal pain [3]
Rhabdomyolysis [2] Toxic epidermal necrolysis [2]
Vasculitis (angiitis) / cutaneous vasculitis Diarrhea [3]
Ocular (angiitis) [2] Hepatotoxicity / liver injury / acute liver
Hallucinations, visual [2] injury / drug-induced liver injury (DILI) [3]
Vision blurred [2] Mucosal Vomiting [9]
Gingival hyperplasia/hypertrophy [33]
Otic Oral pigmentation [2] Hematologic
Tinnitus [3] Neutropenia (neutrophils decreased) [2]
Cardiovascular
Other Bradycardia / sinus bradycardia [2] Neuromuscular/Skeletal
Adverse effects [5] Hypotension [9] Asthenia / fatigue [5]
Death [3] Orthostatic hypotension [2] Other
Central Nervous System Adverse effects [3]
Death [2]
AMLEXANOX Headache [12]
Parkinsonism [2]
Trade names: Aphthasol (Discus), Aphtheal Syncope / fainting [2] AMOXAPINE
(Straken), OraDisc (Access), Solfa (Takeda) Vertigo / dizziness [16]
Indications: Aphthous ulcers, canker sores Endocrine/Metabolic Trade name: Amoxapine (Watson)
Class: Anti-inflammatory Hyponatremia [2] Indications: Depression
Half-life: ~3.5 hours Class: Antidepressant; tricyclic, Muscarinic
Clinically important, potentially hazardous Diarrhea [3] antagonist
interactions with: none known Gastritis / gastric irritation [2] Half-life: 11–30 hours
Pregnancy category: B Hepatotoxicity / liver injury / acute liver Clinically important, potentially hazardous
Important contra-indications noted in the injury / drug-induced liver injury (DILI) [3] interactions with: amprenavir, artemether/
prescribing guidelines for: the elderly; nursing Nausea [5] lumefantrine, clonidine, dronedarone,
mothers; pediatric patients Vomiting [2] epinephrine, fluoxetine, guanethidine,
Neuromuscular/Skeletal iobenguane, isocarboxazid, linezolid, MAO
Skin Asthenia / fatigue [5] inhibitors, nilotinib, phenelzine, pimozide,
Dermatitis [3] Rhabdomyolysis [2] quetiapine, quinine, quinolones, sparfloxacin,
Respiratory tetrabenazine, thioridazine, toremifene,
tranylcypromine, vandetanib, vemurafenib,
AMLODIPINE Bronchitis [2]
ziprasidone
Cough [3]
Trade names: Caduet (Pfizer), Exforge Upper respiratory tract infection [4] Pregnancy category: C
(Novartis), Istin (Pfizer), Lotrel (Novartis), Important contra-indications noted in the
Other prescribing guidelines for: the elderly; nursing
Norvasc (Pfizer), Prestalia (Symplmed), Tekamlo Adverse effects [8]
(Novartis) mothers; pediatric patients
Indications: Hypertension, angina Warning: SUICIDALITY AND
Class: Antiarrhythmic class IV, Calcium channel AMOBARBITAL ANTIDEPRESSANT DRUGS
blocker
Half-life: 30–50 hours Indications: Insomnia, sedation Skin
Clinically important, potentially hazardous Class: Barbiturate AGEP [3]
interactions with: amprenavir, carbamazepine, Half-life: initial: 40 minutes; terminal: 20 hours Diaphoresis (<10%)
cobicistat/elvitegravir/emtricitabine/tenofovir Clinically important, potentially hazardous Edema (<10%)
alafenamide, cobicistat/elvitegravir/emtricitabine/ interactions with: alcohol, dicumarol, Exanthems [2]
tenofovir disoproxil, conivaptan, delavirdine, ethanolamine, warfarin Rash (<10%)
epirubicin, imatinib, phenytoin, primidone, Pregnancy category: D Toxic epidermal necrolysis [2]
sildenafil, simvastatin, St John’s wort, tadalafil, Important contra-indications noted in the Mucosal
telaprevir prescribing guidelines for: nursing mothers; Xerostomia (dry mouth) (14%)
Pregnancy category: C pediatric patients
Important contra-indications noted in the Dysgeusia (taste perversion) (>10%)
prescribing guidelines for: the elderly; nursing Local Headache (<10%)
mothers; pediatric patients Injection-site pain (>10%) Insomnia (<10%)
Note: Caduet is amlodipine and atorvastatin; Neuroleptic malignant syndrome [2]
Exforge is amlodipine and valsartan; Lotrel is Somnolence (drowsiness) (14%)
amlodipine and benazepril; Prestalia is amlodipine AMODIAQUINE Vertigo / dizziness (<10%)
and perindopril; Tekamlo is amlodipine and Endocrine/Metabolic
Trade names: Camoquin (Pfizer), Flavoquin
aliskiren. Galactorrhea [2]
(Sanofi-Aventis)
Indications: Malaria Gastrointestinal/Hepatic
Skin Class: Anti-inflammatory, Antimalarial Constipation (12%)
Angioedema [6] Half-life: 15.7–19.5 hours Nausea (<10%)
Dermatitis (<10%) Clinically important, potentially hazardous Neuromuscular/Skeletal
Eczema [2] interactions with: none known Asthenia / fatigue (<10%)
Edema (5–14%) [22] Pregnancy category: N/A
Erythema multiforme [2]
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Litt’s Drug Eruption & Reaction Manual AMPHOTERICIN B
Ocular Enterocolitis [2] Insomnia (17%)

Vision blurred (7%) Hepatotoxicity / liver injury / acute liver Leukoencephalopathy / posterior reversible
Other injury / drug-induced liver injury (DILI) [38] encephalopathy syndrome (PRES) [4]
Side effects (5%) Nausea [13] Pain (14%)
Pancreatitis / acute pancreatitis [2] Paresthesias (<10%)
Vomiting [9] Parkinsonism [2]
AMOXICILLIN Genitourinary Rigors [2]
Vaginitis [3] Endocrine/Metabolic
Synonym: amoxycillin ALP increased (22%)
Trade names: Amoxil (GSK), Augmentin (GSK), Neuromuscular/Skeletal
Asthenia / fatigue [3] ALT increased (15%)
Clavulin (GSK), Prevpac (TAP), Trimox (Bristol- AST increased (13%)
Myers Squibb) Rhabdomyolysis [2]
Renal Creatine phosphokinase (CPK) / creatine
Indications: Infections of the respiratory tract, kinase increased (hyperCKemia) (22%)
skin and urinary tract Nephropathy [2]
Nephrotoxicity / kidney injury / acute kidney Hyperglycemia (23%)
Class: Antibiotic; beta-lactam, Antibiotic; Hypernatremia (4%)
penicillin injury (AKI) / drug-induced kidney injury [2]
Hypervolemia (fluid overload) (12%)
Half-life: 0.7–1.4 hours Other Hypocalcemia (18%)
Clinically important, potentially hazardous Adverse effects [20] Hypokalemia [4]
interactions with: allopurinol, bromelain, Kounis syndrome [7] Hypomagnesemia (20%)
chloramphenicol, demeclocycline, doxycycline, Side effects [4]
erythromycin, imipenem/cilastatin, methotrexate, Tooth fluorosis [2] Gastrointestinal/Hepatic
Abdominal pain (20%)
minocycline, omeprazole, oxytetracycline,
Diarrhea (30%)
sulfonamides, tetracycline
Pregnancy category: B AMPHOTERICIN B Gastrointestinal bleeding (10%)
Note: Augmentin and Clavulin are trade names
Trade names: Abelcet (Sigma-Tau), AmBisome injury / drug-induced liver injury (DILI) [6]
for a combination of amoxicillin and clavulanic
(Astellas), Amphocin (Pfizer), Amphotec Nausea (40%)
acid. The International Nonproprietary Name for
(Alkopharma) Vomiting (32%)
this combination is amoxicillin/clavulanic acid, and
Indications: Potentially life-threatening fungal Genitourinary
co-amoxiclav the British Approved Name.
infections Hematuria (14%)
Class: Antifungal Urinary retention (<10%)
Skin Half-life: initial: 15–48 hours; terminal: 15 days
AGEP [28] Hematologic
Clinically important, potentially hazardous Anemia (>10%) [4]
Anaphylactoid reactions / anaphylaxis interactions with: adefovir, aminoglycosides,
(includes anaphylactic shock) [17] Leukocytosis (elevated white blood cell
arsenic, astemizole, betamethasone, cephalothin, (WBC) count) (<10%)
Angioedema (<10%) [5] cidofovir, cyclosporine, digoxin, ethoxzolamide,
Baboon syndrome (SDRIFE) [11] Sepsis (14%)
fluconazole, flucytosine, ganciclovir, griseofulvin,
Bullous pemphigoid / pemphigoid [2] Local
hydrocortisone, itraconazole, ketoconazole,
Dermatitis [4] Infusion-related reactions [5]
micafungin, pentamidine, probenecid, sulpiride,
DRESS syndrome [7] Injection-site pain (>10%)
terbinafine, triamcinolone, voriconazole
Edema [2] Injection-site reaction [5]
Pregnancy category: B
Erythema multiforme [18] Important contra-indications noted in the Neuromuscular/Skeletal
Exanthems (>5%) [33] prescribing guidelines for: nursing mothers Asthenia / fatigue (13%)
Exfoliative dermatitis [2] Back pain (12%)
Fixed eruption [10] Otic
Hypersensitivity [5] Skin
Anaphylactoid reactions / anaphylaxis Ototoxicity [3]
Jarisch–Herxheimer reaction [2]
Linear IgA bullous dermatosis [3] (includes anaphylactic shock) [4] Renal
Diaphoresis (7%) Nephrotoxicity / kidney injury / acute kidney
Pemphigus [4]
Exanthems [4] injury (AKI) / drug-induced kidney injury
Pruritus (itching) [7]
Pustules [8] Flushing / rubefaction (<10%) [2] [54]
Rash (<10%) [14] Peripheral edema (15%) Respiratory
Serum sickness-like reaction (<10%) [6] Pruritus (itching) (11%) [2] Bronchospasm [2]
Stevens-Johnson syndrome [13] Purpura [3] Cough (18%)
Toxic epidermal necrolysis [14] Rash (25%) [2] Dyspnea / shortness of breath (23%)
Toxic pustuloderma [2] Skin toxicity / toxicity [2] Hypoxia (8%)
Urticaria / hives (<5%) [16] Urticaria / hives [2] Pleural effusion (13%)
Mucosal Mucosal Pulmonary toxicity (18%)
Epistaxis (nosebleed) (15%) Rhinitis (11%)
Stomatitis (oral mucositis) [2]
Cardiovascular Tachypnea / respiratory rate increased
Central Nervous System (>10%)
Anorexia [2] Chest pain (12%)
Aseptic meningitis [14] Hypertension (8%) [4] Other
Hypotension (14%) Adverse effects [6]
Dysgeusia (taste perversion) [6]
Tachycardia (13%) Death [4]
Hallucinations [3]
Headache [5] Thrombophlebitis (<10%) Infection (11%)
Somnolence (drowsiness) [3] Central Nervous System
Vertigo / dizziness [5] Anorexia (>10%)
Gastrointestinal/Hepatic Anxiety (14%)
Abdominal distension [2] Chills (48%) [6]
Abdominal pain [7] Confusion (11%)
Diarrhea [20] Delirium (>10%)
Dyspepsia / functional dyspepsia / Fever (pyrexia) (>10%) [5]
gastroparesis [2] Headache (20%)
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AMPICILLIN See all our books at www.crcpress.com
Pregnancy category: B Nausea (43–74%)

AMPICILLIN Important contra-indications noted in the Vomiting (24–34%)
Trade name: Totacillin (GSK) prescribing guidelines for: nursing mothers
Note: Serious and occasionally fatal
Indications: Susceptible strains of gram-negative
and gram-positive bacterial infections hypersensitivity (anaphylactic) reactions have AMYL NITRITE
Class: Antibiotic; beta-lactam, Antibiotic; been reported in patients on penicillin therapy.
Contra-indicated in patients with a history of Indications: Angina pectoris
penicillin Class: Nitrate, Vasodilator
hypersensitivity reactions to any of the penicillins.
Half-life: 1–1.5 hours Half-life: N/A
Clinically important, potentially hazardous Clinically important, potentially hazardous
interactions with: allopurinol, anticoagulants, Skin interactions with: furosemide, sildenafil,
chloramphenicol, cyclosporine, demeclocycline, Anaphylactoid reactions / anaphylaxis tadalafil, vardenafil
doxycycline, erythromycin, imipenem/cilastatin, (includes anaphylactic shock) [2] Pregnancy category: X
levodopa, methotrexate, minocycline, Linear IgA bullous dermatosis [3] Important contra-indications noted in the
oxytetracycline, sulfonamides, tetracycline Rash (<10%) [2] prescribing guidelines for: nursing mothers;
Pregnancy category: B Gastrointestinal/Hepatic pediatric patients
Important contra-indications noted in the Diarrhea (<10%)
prescribing guidelines for: nursing mothers Local Skin
Note: Five to 10% of people taking ampicillin Injection-site pain (16%) Dermatitis [3]
develop eruptions between the 5th and 14th day Renal Flushing / rubefaction (<10%)
following initiation of therapy. Also, there is a Nephrotoxicity / kidney injury / acute kidney
95% incidence of exanthematous eruptions in injury (AKI) / drug-induced kidney injury [2]
patients who are treated for infectious ANAGRELIDE
mononucleosis with ampicillin. The allergenicity
of ampicillin appears to be enhanced by AMPRENAVIR Trade names: Agrylin (Shire), Xagrid (Shire)
allopurinol or by hyperuricemia. Ampicillin is Indications: Essential thrombocytopenia, to
clearly the more allergenic of the two drugs when Trade name: Agenerase (GSK) reduce elevated platelet count and the risk of
given alone. Indications: HIV infection thrombosis
Class: Antiretroviral, HIV-1 protease inhibitor Class: Phospholipase A2 inhibitor
Skin Half-life: 7–11 hours Half-life: 1.3 hours
AGEP [9] Clinically important, potentially hazardous Clinically important, potentially hazardous
Anaphylactoid reactions / anaphylaxis interactions with: alprazolam, amiodarone, interactions with: aminophylline, aspirin,
(includes anaphylactic shock) [10] amitriptyline, amlodipine, amoxapine, antacids, cilostazol, enoximone, fluvoxamine, fondaparinux,
Angioedema [2] atorvastatin, avanafil, benzodiazepines, bepridil, inamrinone, milrinone, olprinone, sucralfate
Baboon syndrome (SDRIFE) [3] bosentan, carbamazepine, cisapride, Pregnancy category: C
Dermatitis [8] clomipramine, clonazepam, clorazepate, Important contra-indications noted in the
Erythema multiforme [11] cyclosporine, delavirdine, desipramine, prescribing guidelines for: nursing mothers
Exanthems (>10%) [84] dexamethasone, diazepam, didanosine, Note: Contraindicated in patients with severe
Exfoliative dermatitis [3] dihydroergotamine, diltiazem, doxepin, efavirenz, hepatic impairment.
Fixed eruption [10] ergotamine, estradiol, felodipine, fentanyl,
Hypersensitivity [5] flibanserin, flurazepam, fluticasone propionate, Skin
Linear IgA bullous dermatosis [4] imipramine, indinavir, isradipine, itraconazole, Bruise / bruising / contusion / ecchymosis
Pemphigus [6] ixabepilone, ketoconazole, lidocaine, lopinavir, (ecchymoses) (<5%)
Pruritus (itching) (<5%) [5] lorazepam, lovastatin, methadone, Edema (21%) [9]
Psoriasis [5] methylergonovine, methysergide, midazolam, Peripheral edema (7%)
Purpura [6] mifepristone, nelfinavir, nevirapine, nicardipine, Photosensitivity (<5%)
Pustules [4] nifedipine, nimodipine, nisoldipine, nortriptyline, Pruritus (itching) (<5%)
Rash (<10%) olaparib, oral contraceptives, oxazepam, Rash (8%)
Stevens-Johnson syndrome [10] phenobarbital, phenytoin, pimozide, protriptyline, Urticaria / hives (8%)
Toxic epidermal necrolysis [15] quazepam, quinidine, rapamycin, rifabutin, Hair
Urticaria / hives [16] rifampin, ritonavir, saquinavir, sildenafil, Alopecia (<5%)
Vasculitis (angiitis) / cutaneous vasculitis simvastatin, St John’s wort, tacrolimus, Mucosal
(angiitis) [4] temazepam, trazodone, triazolam, tricyclic Aphthous stomatitis / aphthous ulcer /
Hematologic antidepressants, trimipramine, verapamil, vitamin aphtha (aphthae) (<5%)
Thrombocytopenia [2] E, warfarin Cardiovascular
Local Pregnancy category: C Arrhythmias [4]
Injection-site pain (>10%) Important contra-indications noted in the Cardiomyopathy [2]
Other prescribing guidelines for: nursing mothers; Myocardial toxicity [2]
Allergic reactions (<10%) [3] pediatric patients Palpitation (26%) [2]
Tachycardia [5]
Skin Central Nervous System
AMPICILLIN/ Rash (20–27%) [6] Chills (<5%)
Stevens-Johnson syndrome (4%)
SULBACTAM Depression (<5%)
Central Nervous System Headache (44%) [10]
Trade name: Unasyn (Pfizer) Depression (9–16%) Pain (15%)
Indications: Various infections caused by Dysgeusia (taste perversion) (10%) Paresthesias (7%)
susceptible organisms Mood changes (9–16%) Vertigo / dizziness (15%)
Class: Antibiotic; beta-lactam, Antibiotic; Paresthesias (perioral) (26–31%) [4] Gastrointestinal/Hepatic
penicillin Gastrointestinal/Hepatic Abdominal pain [3]
Half-life: 1 hour Diarrhea (39–60%) Genitourinary
Clinically important, potentially hazardous Loose stools (39–60%) Erectile dysfunction [2]
interactions with: allopurinol, probenecid
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Litt’s Drug Eruption & Reaction Manual ANIDULAFUNGIN
Hematologic
Anemia [2] ANASTROZOLE ANDROSTENEDIONE
Neuromuscular/Skeletal Trade name: Arimidex (AstraZeneca) Synonym: N/A
Arthralgia (<5%) Indications: Breast carcinoma (localized – Other common trade names: Andro,
Asthenia / fatigue (23%) advanced or metastatic) Androstene
Back pain (6%) Class: Antineoplastic, Aromatase inhibitor Indications: Enhanced athletic performance,
Leg cramps (<5%) Half-life: 50 hours increased energy, to keep red blood cells healthy
Myalgia/Myopathy (<5%) Clinically important, potentially hazardous Class: Aromatase inhibitor
Otic interactions with: estradiol, estrogens, Half-life: N/A
Tinnitus (<5%) tamoxifen Clinically important, potentially hazardous
Respiratory Pregnancy category: N/A (Contra-indicated in interactions with: none known
Dyspnea / shortness of breath (12%) women of premenopausal endocrine status, Note: Protease inhibitors cause dyslipidemia
Flu-like syndrome (<5%) including pregnant women) which includes elevated triglycerides and
Other Important contra-indications noted in the cholesterol and redistribution of body fat centrally
Adverse effects (<5%) prescribing guidelines for: nursing mothers to produce the so-called ‘protease paunch’,
Note: The efficacy of anastrozole in the breast enlargement, facial atrophy, and ‘buffalo
treatment of pubertal gynecomastia in adolescent hump’
ANAKINRA boys and in the treatment of precocious puberty In 2004 the FDA requested companies to stop
in girls with McCune-Albright syndrome has not distributing products containing androstenedione.
Trade name: Kineret (Amgen) been demonstrated. Studies have shown that it does not increase
Indications: Rheumatoid arthritis, neonatal- muscle mass and that it poses the same kind of
onset multisystem inflammatory disease Skin health risks as anabolic steroids, including
Class: Biologic, Biologic disease-modifying Flushing / rubefaction (>5%) abnormal elevations in serum estrogen, increased
antirheumatic drug (bDMARD), Covid-19 Hot flashes (12–36%) [13] risk of prostate, pancreatic and endometrial
putative drug, Disease-modifying antirheumatic Lupus erythematosus [3] cancers, and increased cardiovascular disease
drug (DMARD), Interleukin-1 receptor antagonist Peripheral edema (10%) risk.
(IL-IRa) Pruritus (itching) (2–5%)
Half-life: 4–6 hours Rash (6–11%) [2] Skin
Clinically important, potentially hazardous Vasculitis (angiitis) / cutaneous vasculitis Acneiform eruption / acneiform dermatitis /
interactions with: abatacept, adalimumab, (angiitis) [2] acneiform rash [2]
certolizumab, etanercept, golimumab, infliximab,
Hair Other
lenalidomide, live vaccines Adverse effects [6]
Alopecia (2–5%)
Pregnancy category: B
Angina (2%)
prescribing guidelines for: nursing mothers
Hypertension (2–13%)
ANIDULAFUNGIN
Thrombophlebitis (2–5%) Trade names: Ecalta (Pfizer), Eraxis (Pfizer)
Fever (pyrexia) (12%) Central Nervous System Indications: Candidemia, candidal esophagitis
Headache (12–14%) [2] Carpal tunnel syndrome [2] Class: Antimycobacterial; echinocandin
Depression (5–13%) Half-life: 40–50 hours
Gastrointestinal/Hepatic Headache (9–13%) [2] Clinically important, potentially hazardous
Abdominal pain (5%) Pain (14%) interactions with: none known
Diarrhea (8%) Tumor pain (>5%) Pregnancy category: C
Nausea (8%)
Vomiting (14%) Endocrine/Metabolic Important contra-indications noted in the
Mastodynia (2–5%) prescribing guidelines for: nursing mothers;
Local pediatric patients
Injection-site edema [2] Gastrointestinal/Hepatic
Injection-site erythema [3] Diarrhea [2]
Injection-site inflammation [2] Hepatitis [2] Skin
Injection-site pain [4] Hepatotoxicity / liver injury / acute liver Angioedema (<2%)
Injection-site reaction (71%) [32] injury / drug-induced liver injury (DILI) [6] Erythema (<2%)
Nausea (11–19%) Flushing / rubefaction (<2%) [2]
Neuromuscular/Skeletal Vomiting (8–13%) Hot flashes (<2%)
Arthralgia (6–12%) Hyperhidrosis (<2%)
Genitourinary
Respiratory Vaginal dryness (2%) [3] Peripheral edema (11%)
Flu-like syndrome (6%) Pruritus (itching) (<2%)
Nasopharyngitis (12%) Neuromuscular/Skeletal
Ulcerations (5%)
Sinusitis (7%) Arthralgia (2–5%) [8]
Urticaria / hives (<2%)
Upper respiratory tract infection (4%) [2] Asthenia / fatigue (19%) [7]
Back pain (12%) [2] Mucosal
Other Bone or joint pain (6–11%) [2] Oral candidiasis (5%)
Adverse effects [6] Joint disorder [3] Cardiovascular
Death [2] Myalgia/Myopathy (2–5%) [2] Atrial fibrillation (<2%)
Infection (40%) [11] Osteoporosis (11%) Bundle branch block (<2%)
Respiratory Chest pain (5%)
Cough (11%) Hypertension (12%)
Flu-like syndrome (7%) Hypotension (15%)
Pharyngitis (6–14%) Phlebitis [2]
Other Thrombophlebitis (<2%)
Venous thromboembolism (10%)
Infection (2–5%)
Confusion (8%)
Depression (6%)
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ANIDULAFUNGIN Updated each week on www.drugeruptiondata.com
Fever (pyrexia) (9–18%) [4] miconazole, nandrolone, penicillins, Genitourinary

Headache (8%) [5] phenylbutazones, piperacillin, quinidine, quinine, Dysmenorrhea (7%)
Insomnia (15%) rifabutin, rifampin, rifapentine, rofecoxib, Local
Rigors (<2%) salicylates, sulfinpyrazone, sulfonamides, Injection-site edema [4]
Seizures (<2%) testosterone, thyroid, zileuton Injection-site nodules [2]
Vertigo / dizziness (<2%) Important contra-indications noted in the Injection-site pain [4]
Endocrine/Metabolic prescribing guidelines for: nursing mothers Injection-site pruritus [2]
ALP increased (12%) Injection-site reaction [6]
ALT increased (2%) Neuromuscular/Skeletal
Creatine phosphokinase (CPK) / creatine ANISTREPLASE Arthralgia [3]
kinase increased (hyperCKemia) (5%) Asthenia / fatigue (5–62%)
Indications: Acute myocardial infarction
Dehydration (6%) Myalgia/Myopathy (2–72%) [3]
Class: Fibrinolytic
Hyperglycemia (6%) Respiratory
Half-life: 70–120 minutes
Hyperkalemia (6%) Flu-like syndrome [3]
Hypoglycemia (7%) Nasopharyngitis (12–15%)
Hypokalemia (5–15%)
Pregnancy category: C Other
Hypomagnesemia (12%)
Important contra-indications noted in the Allergic reactions [2]
Gastrointestinal/Hepatic prescribing guidelines for: nursing mothers
Abdominal pain (6%)
Cholestasis (<2%)
Skin ANTI-THYMOCYTE
Constipation (8%)
Diarrhea (9–18%) [3] Anaphylactoid reactions / anaphylaxis GLOBULIN (EQUINE)
Dyspepsia / functional dyspepsia / (includes anaphylactic shock) (<10%) [2]
gastroparesis (aggravated) (7%) Vasculitis (angiitis) / cutaneous vasculitis Trade name: Atgam (Pfizer)
Hepatotoxicity / liver injury / acute liver (angiitis) [5] Indications: Management of allograft rejection in
injury / drug-induced liver injury (DILI) [4] renal transplant patients, prophylaxis of moderate
Nausea (7–24%) [5] to severe aplastic anemia in patients who are
Vomiting (7–18%) [6]
ANTHRAX VACCINE unsuitable for bone marrow transplantation
Class: Immunosuppressant
Genitourinary Trade name: BioThrax (Emergent BioSolutions)
Urinary tract infection (15%) Indications: Anthrax prophylaxis
Hematologic Class: Vaccine
Anemia (8–9%) Half-life: Requires 1 month to achieve immunity
Coagulopathy (<2%) (92.5% efficient)
Leukocytosis (elevated white blood cell Clinically important, potentially hazardous
prescribing guidelines for: nursing mothers
(WBC) count) (5%) interactions with: corticosteroids,
Note: Contraindicated in patients who have had
Sepsis (7%) immunosuppressive therapies, other vaccines
a severe systemic reaction during prior
Thrombocythemia (thrombocytosis) (6%) Pregnancy category: D
administration of any equine gamma globulin
Thrombocytopenia (<2%) Important contra-indications noted in the
preparation.
Local prescribing guidelines for: the elderly; nursing
Infusion-related reactions [2] mothers; pediatric patients
Note: Dr. Sue Bailey, Assistant Secretary for Skin
Neuromuscular/Skeletal Health Affairs, released a statement on June 29, Lymphadenopathy [2]
Back pain (5%) 1999 that ‘almost one million shots given, the Serum sickness [6]
Ocular anthrax immunization is proving to be one of the Central Nervous System
Ocular pain (<2%) safest vaccination programs on record.’ The Fever (pyrexia) [2]
Vision blurred (<2%) ADRs reported occurred for ‘50 service
Visual disturbances (<2%) members at one installation alone.’ Note that no
Respiratory number of military personnel was mentioned at ANTI-THYMOCYTE
Cough (7%) this installation, nor did it give any percentages for
the reactions reported.
IMMUNOGLOBULIN
Dyspnea / shortness of breath (12%)
Pleural effusion (10%) (RABBIT)
Pneumonia (6%) Skin
Respiratory distress (6%) Trade name: Thymoglobulin (Genzyme)
Diaphoresis [2]
Indications: Immunosuppression in solid organ
Other Edema (3%) [2]
transplantation
Adverse effects [4] Hypersensitivity [5]
Class: Immunosuppressant
Infection (63%) Lupus erythematosus [2]
Pruritus (itching) (<10%) [2]
Rash [2]
ANISINDIONE Stevens-Johnson syndrome [2]
Trade name: Miradon (Schering) Important contra-indications noted in the
Indications: Adjunct in treatment of coronary Central Nervous System prescribing guidelines for: nursing mothers
occlusion, atrial fibrillation Chills [2] Note: Contraindicated in patients with history of
Class: Anticoagulant, Indanedione Fever (pyrexia) [3] allergy or anaphylaxis to rabbit proteins, or who
Half-life: 3–5 days Guillain-Barré syndrome / acute have an acute viral illness.
Clinically important, potentially hazardous inflammatory demyelinating
interactions with: amiodarone, anabolic
polyradiculoneuropathy [2]
Headache (4–64%) [2] Skin
steroids, antithyroid agents, barbiturates, Anaphylactoid reactions / anaphylaxis
bivalirudin, cimetidine, clofibrate, clopidogrel, Gastrointestinal/Hepatic (includes anaphylactic shock) [2]
cyclosporine, delavirdine, dextrothyroxine, Diarrhea (6–8%) Herpes simplex (5%)
disulfiram, fluconazole, glutethimide, imatinib, Nausea (6%) Malignancies (<10%)
itraconazole, ketoconazole, metronidazole, Peripheral edema (34%)
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Litt’s Drug Eruption & Reaction Manual APREMILAST
Pruritus (itching) (<10%) Dyskinesia (24–35%) [2]

Rash (<10%) APIXABAN Hallucinations (10%) [2]
Serum sickness [7] Trade name: Eliquis (Bristol-Myers Squibb) Headache (>5%) [4]
Mucosal Indications: Reduce the risk of stroke and Impulse control disorder [2]
Oral candidiasis (4%) systemic embolism in patients with nonvalvular Psychosis [2]
Cardiovascular atrial fibrillation Somnolence (drowsiness) (35%) [2]
Hypertension (37%) Class: Anticoagulant, Direct factor Xa inhibitor Syncope / fainting (2%)
Tachycardia (27%) Half-life: 5–12 hours Vertigo / dizziness (20%) [4]
Yawning (40%) [2]
Chills (57%) interactions with: carbamazepine, darunavir, Gastrointestinal/Hepatic
Fever (pyrexia) (63%) [3] phenytoin, rifampin, St John’s wort, tipranavir, Nausea (30%) [6]
Headache (40%) voriconazole Vomiting (30%) [2]
Pain (46%) Pregnancy category: B Local
Vertigo / dizziness (9%) Important contra-indications noted in the Infusion-site granuloma (4%)
Endocrine/Metabolic prescribing guidelines for: nursing mothers; Injection-site pruritus (2%)
Hyperkalemia (27%) pediatric patients Injection-site reaction (26%) [3]
Note: Contra-indicated in patients with active Neuromuscular/Skeletal
Gastrointestinal/Hepatic pathological bleeding.
Abdominal pain (38%) Arthralgia (>5%)
Warning: DISCONTINUING ELIQUIS IN Asthenia / fatigue (>5%)
Diarrhea (37%) PATIENTS WITHOUT ADEQUATE
Dysphagia (<10%) Back pain (>5%)
CONTINUOUS ANTICOAGULATION
Nausea (37%) INCREASES RISK OF STROKE
Vomiting (<10%) APRACLONIDINE
Genitourinary Gastrointestinal/Hepatic
Urinary tract infection (18%) Trade name: Iopidine (Alcon)
Hepatotoxicity / liver injury / acute liver Indications: Post-surgical intraocular pressure
Hematologic injury / drug-induced liver injury (DILI) [2]
Leukocytopenia (leukopenia) (57%) elevation
Hematologic Class: Adrenergic alpha2-receptor agonist
Lymphopenia (lymphocytopenia) (10%)
Hemorrhage [15] Half-life: 8 hours
Thrombocytopenia (37%) [3] Other Clinically important, potentially hazardous
Adverse effects [5] interactions with: amitriptyline
Asthenia / fatigue (27%)
Myalgia/Myopathy (<10%) APOMORPHINE prescribing guidelines for: nursing mothers;
Renal pediatric patients
Renal failure [2] Trade names: Apokyn (Ipsen), Uprima (AbbVie)
Respiratory Indications: Parkinsonism, erectile dysfunction
Class: Dopamine receptor agonist Skin
Dyspnea / shortness of breath (28%) Dermatitis [3]
Half-life: 40 minutes
Other Clinically important, potentially hazardous Pruritus (itching) (10%)
Infection (37%) [4] interactions with: 5HT3 antagonists, alcohol, Mucosal
alosetron, antihypertensives, dolasetron, Xerostomia (dry mouth) (<10%)
ANTIHEMOPHILIC granisetron, levomepromazine, ondansetron, Central Nervous System
palonosetron, risperidone, vasodilators, Dysgeusia (taste perversion) (3%)
FACTOR zuclopenthixol Ocular
Pregnancy category: C Conjunctivitis (<5%)
Synonym: rFV111Fc Important contra-indications noted in the
Trade names: Afstyla (CSL Behring), Eloctate Eyelid edema (<3%)
prescribing guidelines for: the elderly; nursing Ocular pruritus (5–15%)
(Biogen Idec), Kovaltry (Bayer) mothers
Indications: Control and prevention of bleeding Xerophthalmia (<5%)
Note: Apomorphine contains sodium
episodes in Hemophilia A Other
metabisulfite which is capable of causing
Class: Antihemorrhagic, Recombinant fusion Allergic reactions [5]
anaphylactoid reactions in patients with sulfite
protein allergy.
Half-life: 20 hours (adults)
APREMILAST
interactions with: none known Skin
Bruise / bruising / contusion / ecchymosis Trade name: Otezla (Celgene)
Pregnancy category: C Indications: Psoriatic arthritis, plaque psoriasis
(ecchymoses) (>5%)
Diaphoresis (1–10%) Class: Antipsoriatic agent, Phosphodiesterase
prescribing guidelines for: nursing mothers inhibitor, Phosphodiesterase type 4 (PDE4)
Edema (10%)
Nodular eruption [5] inhibitor
Other Panniculitis [2] Half-life: 6–9 hours
Adverse effects [2] Peripheral edema (10%) Clinically important, potentially hazardous
Mucosal interactions with: carbamazepine,
Rhinorrhea (20%) phenobarbital, phenytoin, rifampin
Cardiovascular Important contra-indications noted in the
Angina (15%) prescribing guidelines for: nursing mothers;
Chest pain (15%) pediatric patients
Congestive heart failure (>5%)
Central Nervous System Central Nervous System
Confusion (10%) Depression [4]
Depression (>5%) Headache (5–6%) [31]
Dysgeusia (taste perversion) [2]
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APREMILAST See all our books at www.crcpress.com
Endocrine/Metabolic Cardiovascular
ALT increased [2] Hypertension (2%) APROTININ
Appetite decreased [2] Hypotension (6%) Trade name: Trasylol (Bayer)
Weight loss (10–12%) [7] Central Nervous System Indications: For prophylactic use to reduce
Gastrointestinal/Hepatic Anorexia (6–10%) [3] blood loss in patients undergoing coronary artery
Abdominal pain (<2%) [4] Encephalopathy [2] bypass surgery
Diarrhea (8–9%) [39] Fever (pyrexia) (3–6%) Class: Antifibrinolytic, Serine protease inhibitor
Dyspepsia / functional dyspepsia / Headache (5–9%) [6] Half-life: 150 minutes
gastroparesis [2] Insomnia (2–3%) Clinically important, potentially hazardous
Gastrointestinal disorder / discomfort [2] Somnolence (drowsiness) [2] interactions with: captopril, enalapril, lisinopril,
Nausea (7–9%) [39] Vertigo / dizziness (3–7%) [2] quinapril
Vomiting (<3%) [11] Endocrine/Metabolic Pregnancy category: B
Neuromuscular/Skeletal ALT increased (6%) Important contra-indications noted in the
Arthralgia [2] AST increased (3%) prescribing guidelines for: nursing mothers;
Asthenia / fatigue [5] Creatine phosphokinase (CPK) / creatine pediatric patients
Respiratory kinase increased (hyperCKemia) (4%) Warning: ANAPHYLACTIC OR
Nasopharyngitis (<3%) [21] Dehydration (6%) ANAPHYLACTOID REACTIONS
Upper respiratory tract infection (<4%) Gastrointestinal/Hepatic
[17] Abdominal pain (5%) [3] Skin
Other Constipation (9–10%) [9] Anaphylactoid reactions / anaphylaxis
Adverse effects [6] Diarrhea (<10%) [3] (includes anaphylactic shock) [25]
Infection [2] Dyspepsia / functional dyspepsia / Hypersensitivity [4]
gastroparesis (5–6%) Lipohypertrophy [2]
Flatulence (4%) Peripheral edema (5%)
APREPITANT Gastritis / gastric irritation (4%) Rash (2%)
Nausea (6–13%) Cardiovascular
Trade name: Emend (Merck) Vomiting (3–8%) Arrhythmias (3–4%)
Indications: Prevention of postoperative and Genitourinary Atrial fibrillation (21%)
chemotherapy induced nausea and vomiting
Urinary tract infection (2%) Atrial flutter (6%)
Class: Antiemetic, CYP3A4 inhibitor, Neurokinin
Hematologic Cardiac failure (5%)
1 receptor antagonist
Anemia (3%) Chest pain (2%)
Febrile neutropenia [3] Extrasystoles (6%)
Neutropenia (neutrophils decreased) (3–6%) Hypertension (4%)
interactions with: alprazolam, antifungal agents,
[4] Hypotension (8%)
astemizole, avanafil, betamethasone,
Local Myocardial infarction (6%)
carbamazepine, cisapride, clarithromycin, Pericarditis (5%)
colchicine, conivaptan, corticosteroids, CYP2C9 Infusion-related reactions [2]
Infusion-site pain [2] Phlebitis (1–10%)
substrates, CYP3A4 inducers or inhibitors, Pulmonary edema / cardiogenic pulmonary
dasatinib, deferasirox, dexamethasone, diltiazem, Neuromuscular/Skeletal edema (<2%)
docetaxel, eplerenone, estrogens, everolimus, Asthenia / fatigue (5–18%) [10] Supraventricular tachycardia (4%)
fentanyl, grapefruit juice, halofantrine, ifosfamide, Otic Tachycardia (6%)
imatinib, irinotecan, itraconazole, ketoconazole, Tinnitus (4%) Ventricular tachycardia (5%)
methylprednisolone, midazolam, mifepristone, Renal Central Nervous System
naldemedine, nefazodone, neratinib, olaparib, Proteinuria (7%) Confusion (4%)
oral contraceptives, paroxetine hydrochloride, Other Fever (pyrexia) (15%)
phenobarbital, phenytoin, pimecrolimus, Hiccups (11%) [9] Insomnia (3%)
pimozide, progestins, ranolazine, rifampin, Infection [3]
rifamycin derivatives, rifapentine, ritonavir,
Endocrine/Metabolic
Creatine phosphokinase (CPK) / creatine
salmeterol, saxagliptin, St John’s wort,
kinase increased (hyperCKemia) (2%)
telithromycin, terfenadine, tolbutamide, APROBARBITAL Gastrointestinal/Hepatic
tolvaptan, trabectedin, triamcinolone,
troleandomycin, vinblastine, vincristine, Trade name: Alurate (Roche) Constipation (4%)
voriconazole, warfarin Indications: Short-term sedation, sleep induction Diarrhea (3%)
Pregnancy category: N/A (Insufficient evidence Class: Barbiturate Nausea (11%)
to inform drug-associated risk) Half-life: 14–34 hours Vomiting (3%)
Important contra-indications noted in the Clinically important, potentially hazardous Genitourinary
prescribing guidelines for: nursing mothers; interactions with: alcohol, brompheniramine, Urinary retention (3%)
pediatric patients buclizine, dicumarol, ethanolamine, warfarin Urinary tract infection (2%)
Note: Fosaprepitant is a prodrug of aprepitant Important contra-indications noted in the Hematologic
for injection. Aprepitant treatment is given along prescribing guidelines for: the elderly; nursing Anemia (2%)
with a 5-HT3-receptor antagonist and mothers; pediatric patients Thrombosis (<2%)
dexamethasone. Neuromuscular/Skeletal
Asthenia / fatigue (2%)
Skin Renal
Pruritus (itching) (8%) Nephrotoxicity / kidney injury / acute kidney
Hair injury (AKI) / drug-induced kidney injury [2]
Alopecia (12%) Renal failure (<2%)
Mucosal Renal function abnormal / renal dysfunction
Mucocutaneous reactions (3%) (3%)
Stomatitis (oral mucositis) (3%) Respiratory
Asthma (2%)
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Litt’s Drug Eruption & Reaction Manual ARIPIPRAZOLE
Dyspnea / shortness of breath (4%) Mucosal Chest pain (15%)

Hypoxia (2%) Oral candidiasis (<2%) Hypotension (7–11%)
Pleural effusion (7%) Cardiovascular Myocardial infarction (4%)
Pneumothorax (4–5%) Arteriosclerosis (<2%) Ventricular tachycardia (5%)
Pulmonary toxicity (8%) Atrioventricular block (<2%) Central Nervous System
Other Chest pain (7%) [2] Fever (pyrexia) (4–7%)
Allergic reactions [2] Digitalis intoxication (<2%) Headache (5%)
Death [2] QT prolongation (<2%) Neurotoxicity (2%)
Infection (6%) Supraventricular tachycardia (<2%) Pain (5%)
Central Nervous System Gastrointestinal/Hepatic
Agitation (<2%) Abdominal pain (3–4%)
ARBUTAMINE Fever (pyrexia) (<2%) Diarrhea (6%)
Headache [2] Gastrointestinal bleeding (2%)
Trade name: GenESA (Sicor)
Hypokinesia (<2%) Hematemesis (3%)
Indications: Diagnostic aid for coronary artery
Insomnia [2] Nausea (5–7%)
disease
Class: Adrenergic beta-receptor agonist
Nervousness [3] Vomiting (4–6%)
Pain (8%) Genitourinary
Half-life: 1.8 hours
Paresthesias (<2%) Hematuria (2–12%)
Somnolence (drowsiness) (<2%) Urinary tract infection (5%)
interactions with: abacavir, clidinium,
Tremor (<2%) [3]
clomipramine, desipramine, dicyclomine, digoxin, Hematologic
doxepin, flavoxate, glycopyrrolate, hyoscyamine, Gastrointestinal/Hepatic Bleeding (5%) [3]
imipramine, mepenzolate, methantheline, Nausea [2] Sepsis (6%)
nortriptyline, oxybutynin, procyclidine, Genitourinary Thrombosis [2]
propantheline, protriptyline, scopolamine, Cystitis (<2%) Local
trihexyphenidyl, trimipramine Nocturia (<2%) Injection-site bleeding (2–5%)
Important contra-indications noted in the Local Neuromuscular/Skeletal
prescribing guidelines for: pediatric patients Injection-site pain (<2%)
Back pain (8%)
Arthralgia (<2%)
Renal
Skin Renal function abnormal / renal dysfunction
Diaphoresis (2%) Back pain (6%)
Leg cramps (4%) (3%)
Flushing / rubefaction (3%)
Neck rigidity (<2%) Respiratory
Hot flashes (3%)
Ocular Cough (3%)
Central Nervous System Dyspnea / shortness of breath (8%)
Pain (2%) Glaucoma (<2%)
Visual disturbances (<2%) Hemoptysis (<3%)
Paresthesias (2%) Pneumonia (3%)
Tremor (15%) Respiratory
Bronchitis [3] Other
COPD (exacerbation) [3] Infection (4%)
ARFORMOTEROL Dysphonia (<2%)
Dyspnea / shortness of breath (4%) ARIPIPRAZOLE
Trade name: Brovana (Sunovion) Flu-like syndrome (3%)
Indications: Chronic obstructive pulmonary Nasopharyngitis [3] Trade names: Abilify (Bristol-Myers Squibb),
disease including chronic bronchitis and Sinusitis (4%) [2] Aristada (Alkermes)
emphysema
Other Indications: Schizophrenia, bipolar I disorder,
Class: Beta-2 adrenergic agonist, Bronchodilator
Adverse effects [2] major depressive disorder, irritability associated
Half-life: 26 hours
Allergic reactions (<2%) with autistic disorder
Class: Antipsychotic, Mood stabilizer
interactions with: aminophylline, beta blockers,
MAO inhibitors, tricyclic antidepressants ARGATROBAN Clinically important, potentially hazardous
Trade name: Acova (GSK) interactions with: alcohol, atazanavir,
Indications: Heparin-induced thrombocytopenia carbamazepine, CYP3A4 inhibitors, efavirenz,
prescribing guidelines for: nursing mothers;
Class: Anticoagulant, Thrombin inhibitor itraconazole, ketoconazole, lopinavir, nelfinavir,
pediatric patients
Half-life: 40–50 minutes paroxetine hydrochloride, quinidine
Note: Studies in asthma patients showed that
Clinically important, potentially hazardous Pregnancy category: C
long-acting beta2-adrenergic agonists may
interactions with: abacavir, anticoagulants, Important contra-indications noted in the
increase the risk of asthma-related death.
antiplatetlet agents, butabarbital, collagen prescribing guidelines for: the elderly; pediatric
Contra-indicated in patients with asthma without
(bovine)collagenase, dasatinib, ibritumomab, patients
use of a long-term asthma control medication.
NSAIDs, pentosan, prostacyclin analogs, Warning: INCREASED MORTALITY IN
Warning: ASTHMA-RELATED DEATH
salicylates, throbolytic agents, tositumomab & ELDERLY PATIENTS WITH DEMENTIA-
iodine131 RELATED PSYCHOSIS
Skin SUICIDALITY AND ANTIDEPRESSANT DRUGS
Abscess (<2%) Pregnancy category: B
Edema (<2%) Important contra-indications noted in the
Herpes simplex (<2%) prescribing guidelines for: nursing mothers; Skin
Herpes zoster (<2%) pediatric patients Rash (6%) [2]
Neoplasms (<2%) Note: Contraindicated in patients with overt Mucosal
Peripheral edema (3%) major bleeding. Sialorrhea (ptyalism; hypersalivation) (4–9%)
Pigmentation (<2%) [5]
Rash (4%) Cardiovascular Xerostomia (dry mouth) (5%) [7]
Xerosis (<2%) Atrial fibrillation (3%) Cardiovascular
Bradycardia / sinus bradycardia (5%) Arrhythmias [2]
Cardiac arrest (6%)
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ARIPIPRAZOLE Updated each week on www.drugeruptiondata.com
Hypertension [3]
QT prolongation [2] ARISTOLOCHIA ARSENIC
Central Nervous System Family: Aristolochiaceae Synonyms: Arsenic trioxide (Trisenox);
Agitation (19%) [5] Scientific names: Aristolochia clematitis, Potassium arsenite solution (Fowler’s solution)
Akathisia (8–13%) [38] Aristolochia serpentaria Trade name: Trisenox (Cephalon)
Anxiety (17%) [11] Indications: Aphrodisiac, anti-allergy, Indications: Acute promyelocytic leukemia,
Compulsions [2] anticonvulsant, promotes menstruation psoriasis (in the early 1900s), devitalization of
Dyskinesia [3] Class: Immunomodulator pulp in dental procedures
Extrapyramidal symptoms [11] Half-life: N/A Class: Antineoplastic, Trace element
Fever (pyrexia) (2%) Clinically important, potentially hazardous Half-life: 10–14 hours
Headache (27%) [14] interactions with: none known Clinically important, potentially hazardous
Hypersexuality [2] Pregnancy category: N/A interactions with: abacavir, acetazolamide,
Impulse control disorder [4] Note: Aristolochia has been reported to cause alfuzosin, aloe vera (gel, juice, leaf), amiodarone,
Insomnia (18%) [22] severe kidney damage or ‘Chinese herb amitriptyline, amphotericin B, artemether/
Irritability [5] nephropathy’. Eighteen patients developed lumefantrine, bretylium, chloroquine,
Mania [2] carcinomas of the bladder, ureter and/or renal chlorpromazine, ciprofloxacin, clomipramine,
Neuroleptic malignant syndrome [14] pelvis. clozapine, disopyramide, diuretics, dronedarone,
Neurotoxicity [2] Aristolochia is banned in the European Union and droperidol, enoxacin, erythromycin, fluphenazine,
Parkinsonism [12] Japan. gadobutrol, garlic, gatifloxacin, ginger, ginseng,
Psychosis [2]
haloperidol, indacaterol, levofloxacin,
Restlessness [10]
Skin levomepromazine, lithium, lomefloxacin,
Schizophrenia (exacerbation) [2]
Carcinoma [2] mesoridazine, moxifloxacin, nilotinib, norfloxacin,
Sedation [12]
Skin toxicity / toxicity [2] ofloxacin, phenothiazines, pimozide,
Somnolence (drowsiness) (5–11%) [14]
Stroke / cerebral infarction [2] Renal procainamide, prochlorperazine, promethazine,
Suicidal ideation [6] Nephrotoxicity / kidney injury / acute kidney QT prolonging antipsychotics, quetiapine,
Tardive dyskinesia [8] injury (AKI) / drug-induced kidney injury [9] quinidine, quinine, quinolones, sotalol,
Tic disorder [3] sparfloxacin, tetrabenazine, thioridazine,
Tremor (3%) [9] toremifene, trifluoperazine, vandetanib,
ARMODAFINIL vemurafenib, ziprasidone, zuclopenthixol
Pregnancy category: D
Endocrine/Metabolic Trade name: Nuvigil (Cephalon)
Appetite increased [5] Indications: Narcolepsy, obstructive sleep prescribing guidelines for: nursing mothers;
Diabetes mellitus [2] apnea, shift work sleep disorder
pediatric patients
Galactorrhea [2] Class: Eugeroic Warning: APL DIFFERENTIATION SYNDROME
Hyperprolactinemia [2] Half-life: 12–15 hours and ECG ABNORMALITIES
SIADH [2] Clinically important, potentially hazardous
Weight gain (2–30%) [33] interactions with: cyclosporine
Gastrointestinal/Hepatic Pregnancy category: C Skin
Important contra-indications noted in the Basal cell carcinoma [5]
Constipation (11%) [5]
prescribing guidelines for: the elderly; nursing Bowen’s disease [6]
Dyspepsia / functional dyspepsia /
mothers; pediatric patients Bruise / bruising / contusion / ecchymosis
gastroparesis (9%)
(ecchymoses) (20%)
Nausea (15%) [14]
Bullous dermatosis [4]
Vomiting (11%) [6] Central Nervous System Carcinoma [20]
Genitourinary Anxiety [2] Dermatitis (43%) [6]
Priapism [3] Headache (14–23%) [10] Edema (40%) [2]
Urinary retention [2] Insomnia (4–6%) [3] Erythema (13%)
Vaginitis [2] Vertigo / dizziness (5%) [2] Erythema multiforme [4]
Hematologic Gastrointestinal/Hepatic Exanthems [5]
Neutropenia (neutrophils decreased) [5] Diarrhea [3] Exfoliative dermatitis (5%) [7]
Local Nausea [2] Facial edema (8%)
Injection-site pain [8] Other Fixed eruption [2]
Neuromuscular/Skeletal Adverse effects [2] Flushing / rubefaction (10%)
Asthenia / fatigue [5] Gangrene [2]
Ataxia [4] Herpes simplex (13%)
Dystonia [13]
ARNICA Herpes zoster (8%) [4]
Pisa syndrome (pleurothotonus) [2] Hyperhidrosis (13%)
Family: Asteraceae; Compositae Hyperkeratosis (palms and soles) (40%) [5]
Ocular Scientific names: Arnica fulgens, Arnica montana, Hypersensitivity (5%)
Vision blurred (3–8%) Arnica sororia Keratoses [20]
Renal Indications: Bruising, aches and sprains, insect Leukomelanosis [7]
Enuresis [3] bites, superficial phlebitis, diuretic, flavoring Lymphadenopathy (8%)
Respiratory agent, found in hair tonic and shampoo Melanoma [5]
Cough (3%) Class: Immunomodulator Melanosis / melanocytosis [6]
Nasopharyngitis [2] Half-life: N/A Merkel cell carcinoma [4]
Upper respiratory tract infection [3] Clinically important, potentially hazardous Pallor (10%)
interactions with: none known Palmar–plantar desquamation [16]
Other Pregnancy category: N/A
Adverse effects [6] Palmar–plantar hyperhidrosis [2]
Death [3] Palmar–plantar hyperkeratosis [20]
Hiccups [4] Skin Palmar–plantar punctate keratoses [2]
Toothache [2] Dermatitis [5] Petechiae (8%)
Pigmentation (8%) [15]
Pityriasis rosea (from organic arsenic) [2]
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Pruritus (itching) (33%) Pancreatitis / acute pancreatitis [2] azithromycin, carbamazepine, ciprofloxacin,
Purpura (20%) Vomiting (58%) [2] citalopram, clomipramine, conivaptan, CYP2D6
Squamous cell carcinoma [15] Genitourinary substrates, CYP3A4 inducers, inhibitors or
Stevens-Johnson syndrome [3] Oliguria (5%) substrates, darunavir, dasatinib, degarelix,
Urticaria / hives (8%) Urinary incontinence (5%) delavirdine, disopyramide, dolasetron, duloxetine,
Xerosis (15%) Vaginal bleeding (13%) flecainide, halofantrine, hormonal contraceptives,
Hair Hematologic imipramine, indinavir, itraconazole, lapatinib,
Alopecia [4] Anemia (20%) levofloxacin, levomepromazine, lopinavir,
Nails Bleeding (8%) mefloquine, moxifloxacin, nelfinavir, norfloxacin,
Leukonychia striata (Mees’ lines) [3] Febrile neutropenia (13%) ofloxacin, paroxetine hydrochloride, pazopanib,
Nail pigmentation [2] Leukocytosis (elevated white blood cell phenytoin, pimozide, procainamide, quinidine,
Mucosal (WBC) count) (50%) quinine, rifampin, risperidone, sotalol, St John’s
Epistaxis (nosebleed) (25%) Neutropenia (neutrophils decreased) (10%) wort, telavancin, telithromycin, terfenadine,
Oral candidiasis (5%) [2] tipranavir, venlafaxine, voriconazole, vorinostat,
Oral mucosal eruption (8%) [3] Sepsis (5%) ziprasidone, zuclopenthixol
Xerostomia (dry mouth) (8%) Thrombocytopenia (18%) Pregnancy category: C
Local Important contra-indications noted in the
Cardiovascular
Injection-site edema (10%) prescribing guidelines for: nursing mothers;
Arrhythmias [2]
Injection-site erythema (13%) pediatric patients
Chest pain (25%)
Injection-site pain (20%) Note: Artemether/Lumefantrine tablets should
Hypertension (10%)
not be used to treat severe malaria or to prevent
Hypotension (25%) Neuromuscular/Skeletal
malaria.
Palpitation (10%) Arthralgia (33%)
QT prolongation (40%) [10] Asthenia / fatigue (63%)
Tachycardia (55%) Back pain (18%) Skin
Torsades de pointes [3] Bone or joint pain (23%) Abscess (<3%)
Central Nervous System Myalgia/Myopathy (25%) Impetigo (<3%)
Agitation (5%) Neck pain (13%) Inflammation [3]
Anorexia (23%) Osteonecrosis [7] Pruritus (itching) (4%) [2]
Anxiety (30%) Pain in extremities (13%) Rash (3%) [6]
Coma (5%) Ocular Urticaria / hives (<3%) [2]
Confusion (5%) Eyelid edema (5%) Cardiovascular
Depression (20%) Ocular itching (10%) Palpitation (18%) [2]
Fever (pyrexia) (63%) Vision blurred (10%) Central Nervous System
Headache (60%) Xerophthalmia (8%) Agitation (<3%)
Insomnia (43%) Otic Anorexia (40%) [6]
Neurotoxicity [2] Ear pain (8%) Chills (23%)
Pain (15%) Tinnitus (5%) Fever (pyrexia) (25–29%) [6]
Paresthesias (33%) Renal Gait instability (<3%)
Pseudotumor cerebri [2] Renal failure (8%) Headache (56%) [9]
Rigors (38%) Hypoesthesia (numbness) (<3%)
Seizures (8%) Respiratory Insomnia (5%) [2]
Somnolence (drowsiness) (8%) Cough (65%) Mood changes (<3%)
Tremor (13%) Dyspnea / shortness of breath (53%) Seizures [2]
Vertigo / dizziness (23%) Hemoptysis (8%) Sleep disturbances (22%)
Hypoxia (23%) Sleep-related disorder [2]
Endocrine/Metabolic Nasopharyngitis (5%)
Acidosis (including lactic acidosis) (5%) Tremor (<3%)
Pharyngolaryngeal pain (35%) Vertigo / dizziness (39%) [9]
ALT increased (20%) Pleural effusion (20%)
Appetite decreased (15%) Rhonchi (8%) Endocrine/Metabolic
AST increased (13%) Sinusitis (20%) ALT increased (<3%)
Hyperglycemia (45%) Tachypnea / respiratory rate increased (8%) AST increased (<3%)
Hyperkalemia (18%) Upper respiratory tract infection (13%) Hypokalemia (<3%)
Hypocalcemia (10%) Wheezing (13%) Gastrointestinal/Hepatic
Hypoglycemia (8%) Abdominal pain (17%) [12]
Hypokalemia (50%) Other
Death [3] Constipation (<3%)
Hypomagnesemia (45%) Diarrhea (8%) [12]
Weight gain (13%) Dyspepsia / functional dyspepsia /
Weight loss (8%) ARTEMETHER/ gastroparesis (<3%)
Gastrointestinal/Hepatic Dysphagia (<3%)
Abdominal distension (8%) LUMEFANTRINE Gastroenteritis (<3%)
Abdominal pain (58%) Hepatomegaly (6–9%)
Black stools (8%) Trade name: Coartem (Novartis) Nausea [8]
Constipation (28%) [2] Indications: Acute, uncomplicated malaria Peptic ulceration (<3%)
Diarrhea (53%) infections due to Plasmodium falciparum in Vomiting [17]
Dyspepsia / functional dyspepsia / patients of 5kg bodyweight and above
Class: Antimalarial Genitourinary
gastroparesis (10%) Hematuria (<3%)
Fecal incontinence (8%) Half-life: ~2 hours (artemether); 3–6 days
(lumefantrine) Urinary tract infection (<3%)
Gastrointestinal bleeding (8%) Hematologic
Hepatotoxicity / liver injury / acute liver Clinically important, potentially hazardous
interactions with: amiodarone, amitriptyline, Anemia (4–9%) [4]
injury / drug-induced liver injury (DILI) [3] Eosinophilia (<3%)
Loose stools (10%) amoxapine, antimalarials, antiretrovirals, arsenic,
astemizole, atazanavir, atovaquone/proguanil, Hemolytic anemia [2]
Nausea (75%) [2] Neutropenia (neutrophils decreased) [2]
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Platelets decreased (<3%) Paresthesias [6]

ARTESUNATE Somnolence (drowsiness) [2]
Arthralgia (34%) Trade name: Rtsun (Wiscon) Vertigo / dizziness [2]
Asthenia / fatigue (38%) [10] Indications: Plasmodium falciparum malaria Gastrointestinal/Hepatic
Ataxia (<3%) Class: Antimalarial Nausea [3]
Back pain (<3%) Half-life: 0.5 hours Local
Myalgia/Myopathy (32%) Clinically important, potentially hazardous Injection-site pain [3]
Ocular interactions with: efavirenz Other
Conjunctivitis (<3%) Pregnancy category: N/A (Use carefully in first Adverse effects [2]
Nystagmus (<3%) three trimesters of pregnancy)
Otic Note: Artesunate therapy should be combined
Ear infection (<3%) with other antimalarials (e.g. mefloquine) if given ARTICHOKE
Hearing impairment [2] for less than 5 days.
Tinnitus (<3%) Family: Asteraceae; Compositae
Scientific names: Cynara cardunculus, Cynara
Renal Skin
scolymus
Proteinuria (<3%) Pruritus (itching) [4]
Indications: Dyspepsia, hyperlipidemia, nausea,
Respiratory Cardiovascular hangover, irritable bowel syndrome (IBS), liver
Asthma (<3%) QT prolongation [2] dysfunction, hypoglycemia. Flavoring, sweetener,
Bronchitis (<3%) Central Nervous System prebiotic
Cough (6–23%) [3] Anorexia [3] Class: Antiemetic, Carminative
Influenza (<3%) Extrapyramidal symptoms [3] Half-life: N/A
Nasopharyngitis (4%) Fever (pyrexia) [4] Clinically important, potentially hazardous
Pharyngolaryngeal pain (<3%) Headache [8] interactions with: none known
Pneumonia (<3%) Insomnia [2] Pregnancy category: N/A
Rhinitis (4%) Vertigo / dizziness [12] Note: Jerusalem artichoke (Helianthus tuberosus)
Upper respiratory tract infection (<3%) Gastrointestinal/Hepatic is a completely different plant.
Other Abdominal pain [5]
Adverse effects [5] Diarrhea [6] Skin
Death [2] Hepatotoxicity / liver injury / acute liver Dermatitis [3]
Infection (<3%) injury / drug-induced liver injury (DILI) [2]
Nausea [6]
Vomiting [16] ASCORBIC ACID
ARTEMISIA Hematologic
Synonym: Vitamin C
Family: Asteraceae Anemia [5]
Indications: Prevention of scurvy
Scientific names: Artemisia annua, Benflumetol, Hemolysis [4]
Class: Covid-19 putative drug, Vitamin
Co-artemether, Coartem, Riamet (Novartis) Hemolytic anemia [2]
Half-life: N/A
Indications: Fever, multidrug-resistant malaria, Neutropenia (neutrophils decreased) [2]
parasitemia, leukemia, colon cancer, diarrhea, Neuromuscular/Skeletal interactions with: deferoxamine, estradiol,
schistosomiasis, worms, insect bites (topical) Asthenia / fatigue [7] penicillamine
Class: Antimalarial Myalgia/Myopathy [2] Pregnancy category: A (the pregnancy category
Half-life: 10 hours Respiratory will be C if used in doses above the RDA)
Clinically important, potentially hazardous Cough [4]
interactions with: none known Other Genitourinary
Pregnancy category: N/A Adverse effects [4] Hyperoxaluria [2]
Note: This drug profile only refers to Artemisia
annua, NOT Artemisia absinthium. The latter, the Renal
main constituent of absinthe, has serious side ARTICAINE Oxalate nephropathy [8]
effects, including seizures, hallucinations, and Other
death. Trade names: Orabloc (Pierrel), Septanest Side effects [2]
Derivatives of Artemisia annua are often used in (Septodont), Septocaine (Septodont)
combination with piperaquine, or mefloquine in Indications: Local, infiltrative, or conductive
treatment of malaria. Benflumetol, Coartem and anesthesia in both simple and complex dental ASENAPINE
Co-artemether are a combination of artemether- procedures
Class: Anesthetic; local Trade name: Saphris (Merck)
lumefantrine (see separate profile).
Half-life: 44 minutes Indications: Schizophrenia, bipolar disorder
Clinically important, potentially hazardous Class: Antipsychotic
Skin Half-life: 24 hours
Pruritus (itching) [2] interactions with: beta adrenergic blockers,
Rash [2] MAO inhibitors, tricyclic antidepressants
Important contra-indications noted in the interactions with: alcohol, amiodarone,
Central Nervous System chlorpromazine, CYP2D6 substrates and
prescribing guidelines for: pediatric patients
Headache [2] inhibitors, fluvoxamine, gatifloxacin, moxifloxacin,
Note: Contra-indicated in patients with a known
Local hypersensitivity to sulfite. All named products paroxetine hydrochloride, procainamide, QT
Injection-site pain [2] above are articaine and epinephrine. prolonging drugs, quinidine, sotalol, thioridazine,
ziprasidone
Skin
Facial edema [2]
Cardiovascular
Hypotension [2]
Headache [2]
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Litt’s Drug Eruption & Reaction Manual ASPARTAME
Important contra-indications noted in the Hypoesthesia (numbness) (oral) (<10%) Gastrointestinal/Hepatic

prescribing guidelines for: the elderly; nursing Irritability (<10%) Abdominal pain (70%)
mothers; pediatric patients Pain (<10%) Hepatotoxicity / liver injury / acute liver
Warning: INCREASED MORTALITY IN Rigors (<10%) injury / drug-induced liver injury (DILI) [3]
ELDERLY PATIENTS WITH DEMENTIA- Gastrointestinal/Hepatic Pancreatitis / acute pancreatitis (15%) [24]
RELATED PSYCHOSIS Nausea (<10%) Vomiting (50–60%)
Vomiting (5%) Genitourinary
Skin Local Azotemia (66%)
Peripheral edema (3%) Injection-site bruising (8%) Hematologic
Mucosal Injection-site edema (13%) Sepsis [2]
Oral numbness [4] Injection-site erythema (41%) Thrombosis [9]
Salivary hypersecretion (2%) Injection-site hemorrhage (<17%) Other
Xerostomia (dry mouth) (2–3%) Injection-site induration (13%) Adverse effects [2]
Cardiovascular Injection-site lipoatrophy/lipohypertrophy Allergic reactions (15–35%) [2]
Hypertension (2–3%) [2] (5–8%)
Injection-site pain (14%)
Akathisia (4–6%) [10] Injection-site papules and nodules (3%) ASPARAGINASE ERWINIA
Injection-site pigmentation (15%)
Anxiety (4%)
Injection-site pruritus (13%) CHRYSANTHEMI
Depression (2%) [3]
Injection-site reaction (9%) [2] Synonym: crisantaspase
Dysgeusia (taste perversion) (3%) [4]
Extrapyramidal symptoms (6–10%) [11] Other Trade names: Erwinase (EUSA Pharma),
Headache (12%) [3] Adverse effects [2] Erwinaze (EUSA Pharma)
Hypersomnia [2] Indications: Acute lymphoblastic leukemia in
Hypoesthesia (numbness) (4–5%) [7] patients who have developed hypersensitivity to
Insomnia (6–15%) [3]
ASPARAGINASE E. coli derived aparaginase
Irritability (2%) Synonym: L-asparaginase Class: Antineoplastic
Sedation [9] Trade names: Elspar (Merck), Kidrolase (EUSA Half-life: N/A
Somnolence (drowsiness) (13–24%) [15] Pharma) Clinically important, potentially hazardous
Tardive dyskinesia [2] Indications: Acute lymphoblastic leukemia, interactions with: none known
Vertigo / dizziness (4–11%) [5] lymphoma Pregnancy category: C
Endocrine/Metabolic Class: Antineoplastic, Enzyme Important contra-indications noted in the
Appetite increased (2–4%) Half-life: 8–30 hours (intravenous); 34–49 hours prescribing guidelines for: the elderly; nursing
Weight gain (3–5%) [12] (intramuscular) mothers
Gastrointestinal/Hepatic Clinically important, potentially hazardous
Abdominal pain [2] interactions with: none known Skin
Constipation (5%) Pregnancy category: C Anaphylactoid reactions / anaphylaxis
Dyspepsia / functional dyspepsia / Important contra-indications noted in the (includes anaphylactic shock) (17%)
gastroparesis (3–4%) prescribing guidelines for: nursing mothers Hypersensitivity (17%) [2]
Vomiting (5%) Urticaria / hives (17%)
Neuromuscular/Skeletal Skin Central Nervous System
Arthralgia (3%) Anaphylactoid reactions / anaphylaxis Fever (pyrexia) (3%)
Asthenia / fatigue (3–4%) (includes anaphylactic shock) (3–40%) [4] Endocrine/Metabolic
Pain in extremities (2%) Angioedema [3] Hyperglycemia (2%) [3]
Other Hypersensitivity (6–40%) [16] Gastrointestinal/Hepatic
Adverse effects [4] Skin toxicity / toxicity [2] Hepatotoxicity / liver injury / acute liver
Toxic epidermal necrolysis [2] injury / drug-induced liver injury (DILI)
Urticaria / hives (<15%) [5] (<3%)
ASFOTASE ALFA Mucosal Nausea (2%)
Aphthous stomatitis / aphthous ulcer / Pancreatitis / acute pancreatitis (4%) [3]
Trade name: Strensiq (Alexion) aphtha (aphthae) (<10%) Vomiting (2%)
Indications: Perinatal/infantile-and juvenile-onset Oral lesions (26%)
hypophosphatasia Hematologic
Parotitis [5] Coagulopathy (3%)
Class: Enzyme replacement Stomatitis (oral mucositis) (<10%)
Half-life: 5 days Other
Clinically important, potentially hazardous Central Nervous System Allergic reactions [3]
interactions with: none known Chills (>10%)
Pregnancy category: N/A (No available data) Coma (25%)
Important contra-indications noted in the Depression (>10%) ASPARTAME
prescribing guidelines for: the elderly; nursing Encephalopathy [2]
Fever (pyrexia) (>10%) Class: Sweetening agent
mothers Half-life: N/A
Leukoencephalopathy / posterior reversible
encephalopathy syndrome (PRES) [3] Clinically important, potentially hazardous
Skin Neurotoxicity [4] interactions with: none known
Anaphylactoid reactions / anaphylaxis Seizures (10–60%) [2] Pregnancy category: A (the pregnancy category
(includes anaphylactic shock) (<10%) Somnolence (drowsiness) (>10%) will be C for women with phenylketonuria)
Calcification (4%) Stroke / cerebral infarction [2] Note: Upon ingestion, the artificial sweetener,
Erythema (<10%) aspartame is metabolized to formaldehyde in the
Flushing / rubefaction (<10%) Endocrine/Metabolic
Hyperglycemia [4] body and has been reportedly associated with
Central Nervous System Hyperlipidemia [2] systemic contact dermatitis in patients exquisitely
Chills (<10%) Hypertriglyceridemia [4] sensitive to formaldehyde.
Fever (pyrexia) (<10%) Aspartame can be found in instant breakfasts,
Headache (<10%) breath mints, cereals, sugar-free chewing gum,
derm_www - 18/8/2021 09:16 [v1.0]
ASPARTAME Updated each week on www.drugeruptiondata.com
cocoa mixes, coffee beverages, frozen desserts, Lichenoid eruption [2] Skin
gelatin desserts, juice beverages, laxatives, Pityriasis rosea [3] Urticaria / hives [2]
multivitamins, milk drinks, pharmaceuticals and Pruritus (itching) [6] Mucosal
supplements, shake mixes, soft drinks, tabletop Psoriasis [3] Xerostomia (dry mouth) [4]
sweeteners, tea beverages, instant teas and Purpura [8] Cardiovascular
coffees, topping mixes, wine coolers, yogurt. Rash (<10%) Arrhythmias [2]
Stevens-Johnson syndrome [6] QT prolongation [10]
Skin Toxic epidermal necrolysis [9] Torsades de pointes [10]
Angioedema [2] Urticaria / hives (<10%) [72]
Vasculitis (angiitis) / cutaneous vasculitis Central Nervous System
Panniculitis [3] Paresthesias [3]
Urticaria / hives [4] (angiitis) [2]
Somnolence (drowsiness) [3]
Other Mucosal
Allergic reactions [2] Aphthous stomatitis / aphthous ulcer /
aphtha (aphthae) [3] ASTRAGALUS ROOT
Epistaxis (nosebleed) [2]
ASPIRIN Nasal polyp [4] Family: Fabaceae; Leguminosae
Oral mucosal eruption [3] Scientific names: Astragalus membranaceus,
Synonyms: acetylsalicylic acid; ASA Oral ulceration (see also aphthous stomatitis Astragalus mongholicus
Trade names: Aggrenox (Boehringer Ingelheim), / aphthous ulcer / aphtha) [4] Indications: Arrhythmia, colds, upper
Anacin (Wyeth), Ascriptin (Novartis) (Wallace), Central Nervous System respiratory infections, chronic fatigue syndrome,
Darvon Compound (aaiPharma), Durlaza (New Stroke / cerebral infarction [2] colitis, diabetes, hepatitis, hypotension, herpes
Haven), Ecotrin (GSK), Equagesic (Women First), simplex keratitis
Excedrin (Bristol-Myers Squibb), Fiorinal Gastrointestinal/Hepatic
Class: Antioxidant, Immune stimulant,
(Watson), Norgesic (3M), Soma Compound Black stools [3]
Vasodilator
(MedPointe), Talwin Compound (Sanofi-Aventis), Gastritis / gastric irritation [2]
Half-life: N/A
Yosprala (Aralez) Gastrointestinal bleeding [8]
Gastrointestinal ulceration [7] Clinically important, potentially hazardous
Indications: Pain, fever, inflammation interactions with: none known
Class: Antiplatelet, Non-steroidal anti- Hepatotoxicity / liver injury / acute liver
injury / drug-induced liver injury (DILI) [4] Pregnancy category: N/A
inflammatory (NSAID), Salicylate
Half-life: 15–20 minutes Pancreatitis / acute pancreatitis [2]
Clinically important, potentially hazardous Hematologic ATAZANAVIR
interactions with: acemetacin, acenocoumarol, Bleeding [17]
amitriptyline, anagrelide, anticoagulants, azficel-t, Ocular Trade names: Evotaz (Bristol-Myers Squibb),
bismuth, calcium hydroxylapatite, capsicum, Periorbital edema [3] Reyataz (Bristol-Myers Squibb)
celecoxib, cholestyramine, cilazapril, citalopram, Indications: HIV infection
Otic
desvenlafaxine, devil’s claw, dexamethasone, Class: Antiretroviral, HIV-1 protease inhibitor
Tinnitus [17]
dexibuprofen, dichlorphenamide, diclofenac, Half-life: 7 hours
Renal Clinically important, potentially hazardous
dicumarol, duloxetine, enoxaparin, etodolac, Fanconi syndrome [2]
evening primrose, flunisolide, flurbiprofen, ginkgo interactions with: abiraterone, alfuzosin,
Respiratory amiodarone, antacids, aripiprazole, artemether/
biloba, ginseng, heparin, ibuprofen, iloprost,
Asthma [10] lumefantrine, atorvastatin, avanafil, bepridil,
indomethacin, ketoprofen, ketorolac, Pulmonary toxicity [2]
lumiracoxib, meloxicam, methotrexate, methyl bosentan, buprenorphine, cabazitaxel,
Rhinitis [3] cabozantinib, calcifediol, cisapride,
salicylate, methylprednisolone, milnacipran, Sinusitis [2]
nilutamide, NSAIDs, paroxetine hydrochloride, clarithromycin, colchicine, crizotinib,
phellodendron, piroxicam, prednisone,
Other cyclosporine, darifenacin, dasatinib,
Adverse effects [9] dexlansoprazole, diltiazem, dofetilide, efavirenz,
resveratrol, reteplase, rivaroxaban, sermorelin,
Allergic reactions [2] elbasvir & grazoprevir, eluxadoline, ergot
sulfites, tinzaparin, tirofiban, tolmetin,
triamcinolone, urokinase, valdecoxib, valproic derivatives, erlotinib, estrogens, etravirine,
everolimus, famotidine, felodipine, fentanyl,
acid, venlafaxine, verapamil, vilazodone, warfarin, ASTEMIZOLE fesoterodine, flibanserin, fluticasone propionate,
zafirlukast
Pregnancy category: D Trade name: Histeamen (Janssen) garlic, glecaprevir & pibrentasvir, indinavir,
Important contra-indications noted in the Indications: Urticaria, pruritus, allergic rhinitis irinotecan, itraconazole, ixabepilone,
prescribing guidelines for: nursing mothers; Class: Histamine H1 receptor antagonist ketoconazole, lapatinib, lidocaine, lopinavir,
pediatric patients Half-life: 20 hours lovastatin, maraviroc, marihuana, midazolam,
Note: NSAIDs may cause an increased risk of Clinically important, potentially hazardous mifepristone, naldemedine, nevirapine,
serious cardiovascular and gastrointestinal interactions with: amiodarone, aprepitant, nicardipine, nifedipine, olaparib, ombitasvir/
adverse events, which can be fatal. This risk may artemether/lumefantrine, azithromycin, bepredil, paritaprevir/ritonavir, omeprazole, oral
increase with duration of use. bosentan, bretylium, cisapride, clarithromycin, contraceptives, paclitaxel, pantoprazole,
Aggrenox is aspirin and dipyridamole; Yosprala is darunavir, dasatinib, delavirdine, disopyramide, pazopanib, pimozide, posaconazole, proton-
aspirin and omeprazole. erythromycin, erythromycin fluconazole, pump inhibitors, quetiapine, quinidine, quinine,
fluoxetine, fluvoxamine, grapefruit juice, indinavir, rabeprazole, raltegravir, ranolazine, rifabutin,
Skin itraconazole, ketoconazole, metronidazole, rifampin, rilpivirine, ritonavir, rivaroxaban,
Anaphylactoid reactions / anaphylaxis miconazole, nefazodone, nilotinib, paroxetine romidepsin, rosuvastatin, salmeterol, saquinavir,
(includes anaphylactic shock) (<10%) [8] hydrochloride, pimozide, probucol, sildenafil, simeprevir, simvastatin, sirolimus,
Angioedema (<5%) [32] procainamide, quinidine, quinine, ritonavir, sofosbuvir/velpatasvir/voxilaprevir, solifenacin,
Bullous dermatosis [4] saquinavir, sertindole, sertraline, sotalol, SSRIs, sonidegib, St John’s wort, sunitinib, tacrolimus,
Erythema multiforme [9] terfenadine, troleandomycin, voriconazole, tadalafil, telaprevir, telithromycin, temsirolimus,
Erythema nodosum [9] zileuton, ziprasidone tenofovir disoproxil, ticagrelor, tipranavir,
Erythroderma [2] Pregnancy category: C trazodone, triazolam, tricyclic antidepressants,
Exanthems [11] Note: Hismanal has been withdrawn in the USA vardenafil, vemurafenib, verapamil, voriconazole,
Fixed eruption [22] as of 1999. warfarin
Hypersensitivity [5] Pregnancy category: B
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Litt’s Drug Eruption & Reaction Manual ATEZOLIZUMAB
Important contra-indications noted in the Important contra-indications noted in the Important contra-indications noted in the
prescribing guidelines for: the elderly; nursing prescribing guidelines for: the elderly; nursing prescribing guidelines for: nursing mothers;
mothers; pediatric patients mothers; pediatric patients pediatric patients
Note: Evotaz is atazanavir and cobicistat. Note: Contra-indicated in patients with sinus
bradycardia, heart block greater than first degree, Skin
Skin cardiogenic shock, or overt cardiac failure. Beta- Peripheral edema (18%)
Jaundice (5–7%) [11] Adalat and Tenif are atenolol and nifedipine. Pruritus (itching) (13%) [6]
Rash (3–20%) [7] Kalten, Tenoret 50 and Tenoretic are atenolol and Rash (15%) [7]
chlorthalidone. Chlorthalidone is a sulfonamide
Cardiovascular Cardiovascular
and can be absorbed systemically. Sulfonamides
QT prolongation [2] Hypertension [2]
can produce severe, possibly fatal, reactions such
Torsades de pointes [2] Venous thromboembolism (>2%)
as toxic epidermal necrolysis and Stevens-Johnson
Central Nervous System syndrome. Central Nervous System
Depression (2%) Warning: CESSATION OF THERAPY Encephalitis [8]
Fever (pyrexia) (2%) Fever (pyrexia) (21%) [4]
Headache (<6%) [3] Endocrine/Metabolic
Insomnia (3%) Skin
Anaphylactoid reactions / anaphylaxis ALP increased (4%)
Neurotoxicity [2] ALT increased (2%) [3]
Pain (3%) (includes anaphylactic shock) [2]
Lupus erythematosus [2] Appetite decreased (26%) [7]
Vertigo / dizziness (3%) AST increased (2%) [6]
Necrosis / skin necrosis [3]
Endocrine/Metabolic Pruritus (itching) (<5%) Dehydration (>2%)
ALT increased (3%) Psoriasis [7] Diabetes mellitus [2]
AST increased (3%) Raynaud’s phenomenon [2] Diabetic ketoacidosis [3]
Creatine phosphokinase (CPK) / creatine Urticaria / hives [2] Hyperglycemia (5%)
kinase increased (hyperCKemia) (8%) Hyperthyroidism (2%)
Hyperbilirubinemia [7] Cardiovascular Hyponatremia (10%) [2]
Atrial fibrillation (5%) [2] Hypothyroidism (6%) [3]
Gastrointestinal/Hepatic Atrial flutter (2%)
Abdominal pain (4%) Serum creatinine increased (3%)
Bradycardia / sinus bradycardia (3–18%) [8]
Cholelithiasis (gallstones in the gallbladder) Cardiac arrest (2%) Gastrointestinal/Hepatic
[4] Cardiac failure (19%) Abdominal pain (17%)
Diarrhea (2%) [3] Heart block (5%) Colitis [6]
Hepatotoxicity / liver injury / acute liver Hypotension (25%) [2] Constipation (21%) [2]
injury / drug-induced liver injury (DILI) [3] Postural hypotension (12%) Diarrhea (18%) [4]
Nausea (6–14%) [4] Supraventricular tachycardia (12%) Gastric obstruction (>2%)
Vomiting (3–4%) Ventricular tachycardia (16%) Hepatitis [3]
Genitourinary Nausea (25%) [6]
Central Nervous System Vomiting (17%)
Urolithiasis [4] Depression (12%)
Hematologic Somnolence (drowsiness) (2%) Genitourinary
Neutropenia (neutrophils decreased) (5%) Stroke / cerebral infarction [2] Hematuria (14%)
Neuromuscular/Skeletal Syncope / fainting [2] Urinary tract infection (22%)
Asthenia / fatigue (2%) Vertigo / dizziness (15%) Hematologic
Back pain (2%) Gastrointestinal/Hepatic Anemia (8%) [4]
Myalgia/Myopathy (4%) Diarrhea (3%) Lymphopenia (lymphocytopenia) (10%)
Renal Nausea (3%) Sepsis (>2%)
Nephrolithiasis [5] Neuromuscular/Skeletal Local
Nephrotoxicity / kidney injury / acute kidney Asthenia / fatigue (26%) Infusion-related reactions (3%)
injury (AKI) / drug-induced kidney injury [7] Leg pain (3%) Neuromuscular/Skeletal
Respiratory Respiratory Arthralgia (14%) [2]
Upper respiratory tract infection [2] Dyspnea / shortness of breath (6%) Asthenia / fatigue (52%) [12]
Other Wheezing (3%) Back pain (15%)
Adverse effects [5] Myalgia/Myopathy [2]
Other Neck pain (15%)
Infection (~50%) Adverse effects [5]
Renal
ATENOLOL ATEZOLIZUMAB injury (AKI) / drug-induced kidney injury
(>2%)
Trade names: Beta-Adalat (Bayer), Kalten (BPC), Trade name: Tecentriq (Genentech) Respiratory
Tenif (AstraZeneca), Tenoret 50 (AstraZeneca), Indications: Locally advanced or metastatic Cough (14%) [2]
Tenoretic (AstraZeneca), Tenormin urothelial carcinoma in patients having disease Dyspnea / shortness of breath (16%) [4]
(AstraZeneca) progression following platinum-containing Hypoxia [2]
Indications: Angina, hypertension, acute chemotherapy, bladder cancer, non-small cell lung Pneumonia (>2%) [2]
myocardial infarction cancer Pneumonitis (3%) [3]
Class: Antiarrhythmic class II, Beta adrenergic Class: Immune checkpoint inhibitor, Monoclonal
blocker, Beta blocker antibody, Programmed death-ligand (PD-L1)
Other
Half-life: 6–7 hours (adults) Adverse effects [8]
inhibitor
Clinically important, potentially hazardous Infection (38%)
Half-life: 27 days
interactions with: alfuzosin, calcium channel Clinically important, potentially hazardous
blockers, cisplatin, clonidine, digitalis glycosides, interactions with: none known
diltiazem, disopyramide, epinephrine, Pregnancy category: N/A (Can cause fetal
indomethacin, reserpine, verapamil harm)
Pregnancy category: D
derm_www - 18/8/2021 09:16 [v1.0]
ATOMOXETINE See all our books at www.crcpress.com
Oral ulceration (see also aphthous stomatitis

ATOMOXETINE ATORVASTATIN / aphthous ulcer / aphtha) (<2%)
Trade name: Strattera (Lilly) Trade names: Caduet (Pfizer), Lipitor (Pfizer), Stomatitis (oral mucositis) (<2%)
Indications: Attention deficit hyperactivity Liptruzet (Merck Sharpe & Dohme) Cardiovascular
disorder Indications: Hypercholesterolemia Hypotension [2]
Class: Anti-attention deficit hyperactivity Class: HMG-CoA reductase inhibitor, Statin Central Nervous System
disorder (anti-ADHD), Norepinephrine reuptake Half-life: 14 hours Ageusia (taste loss) / taste disorder (<2%)
inhibitor Clinically important, potentially hazardous Cognitive impairment [2]
Half-life: 5 hours interactions with: alcohol, aliskiren, Depression [3]
Clinically important, potentially hazardous amiodarone, amprenavir, antifungals, atazanavir, Dysgeusia (taste perversion) (<2%)
interactions with: albuterol, amitriptyline, azithromycin, bexarotene, boceprevir, bosentan, Headache [5]
cinacalcet, citalopram, delavirdine, droperidol, ciprofibrate, clarithromycin, clopidogrel, Neurotoxicity [2]
duloxetine, levalbuterol, levomepromazine, cobicistat/elvitegravir/emtricitabine/tenofovir Paresthesias (<2%)
linezolid, lisdexamfetamine, MAO inhibitors, alafenamide, cobicistat/elvitegravir/emtricitabine/ Parosmia (<2%)
moxifloxacin, paroxetine hydrochloride, sotalol, tenofovir disoproxil, colchicine, conivaptan, Vertigo / dizziness [2]
terbinafine, terbutaline, tipranavir, venlafaxine, cyclosporine, CYP3A4 inhibitors, dabigatran, Endocrine/Metabolic
zuclopenthixol danazol, daptomycin, darunavir, dasatinib, ALT increased [3]
Pregnancy category: C delavirdine, digoxin, diltiazem, dronedarone, Creatine phosphokinase (CPK) / creatine
Important contra-indications noted in the efavirenz, elbasvir & grazoprevir, eltrombopag, kinase increased (hyperCKemia) [5]
prescribing guidelines for: nursing mothers; erythromycin, estradiol, etravirine, everolimus, Diabetes mellitus [2]
pediatric patients fenofibrate, fenofibric acid, fibrates, fluconazole, Gynecomastia (<2%)
Warning: SUICIDAL IDEATION IN CHILDREN fosamprenavir, fusidic acid, gemfibrozil, Gastrointestinal/Hepatic
AND ADOLESCENTS glecaprevir & pibrentasvir, grapefruit juice, Cholelithiasis (gallstones in the gallbladder)
imatinib, imidazoles, indinavir, itraconazole, [2]
Skin letermovir, liraglutide, lopinavir, macrolide Diarrhea (5–14%)
Pruritus (itching) (>2%) antibiotics, midazolam, nefazodone, nelfinavir, Hepatitis [3]
Mucosal niacin, niacinamide, norethisterone, oral Hepatotoxicity / liver injury / acute liver
Xerostomia (dry mouth) (>5%) [9] contraceptives, P-glycoprotein inhibitors, injury / drug-induced liver injury (DILI) [11]
Cardiovascular posaconazole, protease inhibitors, quinine, red Nausea (4–7%)
Cardiotoxicity [3] rice yeast, rifampin, ritonavir, rivaroxaban, Pancreatitis / acute pancreatitis [8]
Tachycardia [2] saquinavir, silodosin, St John’s wort, telaprevir, Genitourinary
Central Nervous System telithromycin, tipranavir, topotecan, trabectedin, Urinary tract infection (4–8%)
Aggression [3] verapamil, voriconazole, warfarin Neuromuscular/Skeletal
Anorexia [5] Pregnancy category: X Arthralgia (4–12%)
Depression (>2%) [3] Important contra-indications noted in the Asthenia / fatigue [5]
Headache [9] prescribing guidelines for: the elderly; nursing Back pain [3]
Hypomania [2] mothers; pediatric patients Muscle spasm [2]
Insomnia [7] Note: Caduet is atorvastatin and amlodipine; Myalgia/Myopathy (3–8%) [36]
Irritability [8] Liptruzet is atorvastatin and ezetimibe. Pain in extremities (6%)
Mania [2] Rhabdomyolysis [43]
Mood changes [5] Skin Statin-induced necrotizing autoimmune
Nervousness [3] Acneiform eruption / acneiform dermatitis / myopathy [14]
Seizures [2] acneiform rash (<2%) Tendinopathy/Tendon rupture [2]
Somnolence (drowsiness) [11] Angioedema [2] Otic
Suicidal ideation [6] Bruise / bruising / contusion / ecchymosis Hearing loss (hypoacusis) [2]
Tic disorder [7] (ecchymoses) (<2%) Renal
Tremor (>2%) [2] Dermatitis (<2%) Nephrotoxicity / kidney injury / acute kidney
Vertigo / dizziness (>5%) [10] Dermatomyositis [4] injury (AKI) / drug-induced kidney injury [5]
Endocrine/Metabolic Diaphoresis (<2%)
Eczema (<2%) Respiratory
Appetite decreased [27] Cough [2]
Weight loss [5] Edema (<2%)
Facial edema (<2%) Nasopharyngitis (4–13%)
Gastrointestinal/Hepatic Jaundice [2] Other
Abdominal pain [12] Lupus erythematosus [2] Adverse effects [11]
Constipation [2] Lymphocytic infiltration / Jessner lymphocytic Allergic reactions (<2%)
Dyspepsia / functional dyspepsia / infiltration [2] Death [7]
gastroparesis [3] Petechiae (<2%) Multiorgan failure [2]
Hepatotoxicity / liver injury / acute liver Photosensitivity (<2%)
injury / drug-induced liver injury (DILI) [12] Pruritus (itching) (<2%)
Nausea [18] Rash (>3%) [2] ATOVAQUONE
Vomiting [10] Seborrhea (<2%) Trade names: Mepron (GSK), Wellvone (GSK)
Genitourinary Skin toxicity / toxicity [2] Indications: Pneumocystis carinii infection
Erectile dysfunction [4] Toxic epidermal necrolysis [2] Class: Antimalarial, Antiprotozoal
Urinary hesitancy [2] Ulcerations (<2%) Half-life: 1.5–4 days
Neuromuscular/Skeletal Urticaria / hives (<2%) Clinically important, potentially hazardous
Asthenia / fatigue [11] Xerosis (<2%) interactions with: efavirenz, etoposide,
Other Hair histamine, hypoglycemic agents, indinavir,
Adverse effects [10] Alopecia (<2%) lopinavir, metoclopramide, rifabutin, rifampin,
Bruxism (teeth grinding) [2] Mucosal rifapentine, ritonavir, tetracycline, zidovudine
Cheilitis (<2%) Pregnancy category: C
Glossitis (<2%)
Another random document with
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leaders demanded of Andros that he surrender both his office and
himself. The man refused and fled to his stronghold, whence he
defied the patriots and continued to the last to declare his power,
though like water now fast escaping from his grasp.
Surrounding their ex-master they made him a prisoner, not a
refugee, and at length he gave in and was captured and sent to
confinement, along with the others of his recent government.
With an instinct for conventions, the citizens were soon
assembled. Howsoever great had been their heat in their moment of
rebellion and triumph, they were calm enough to be wise when the
time arrived to declare for themselves. They reinstated Bradstreet
and the Council of ’86. They declared the old Government in force
and their former charter ipso facto restored, unimpaired by the
interim of nearly three years of maladministration.
William and Mary received the report of all these swiftly terminated
proceedings with a favor which was not unblended with
astonishment. Admiring the Protestant spirit, which it had become
their own special province to uphold, they lost no time in confirming
the entire course of actions, even to the temporary resumption of
their old charter privileges and powers, by the patriots across the
sea. And there, for a time, they were contented to permit the matter
to rest. The affairs of England they had found so completely
engrossing that they had no time to spare toward regranting a
specific charter to Massachusetts.
Increase Mather, suspicions of privileges and liberties not
absolutely signed, sealed and delivered, remained at his post,
working continuously and sedulously to obtain that monarchical
support and confirmation of the colony’s prerogatives which his
many compatriots had sent him to secure.
Sir William Phipps, on the other hand, realized the busy state of
mind in which William and Mary had been so abruptly plunged, and
he therefore deferred further work with Mather for a time more
suitable. Then, when he learned that the French Catholics in
America had formed alliances with the Indians and were already
overrunning the Protestant territory and committing daily
depredations, he made up his mind once more to return to the field
of action, in which he might be able to render more effective service
than he could by remaining in England.
He arrived in the summer of that fateful year, ’89, and offered
himself to Bradstreet at once. The period of warfare in which he
thereupon engaged was one of great length and of much bitterness.
Alternating defeat and victory left the advantages with the French
and Indians, so far as hopes of ultimate success were concerned.
The colonists had to make such long, tedious marches that decisive
victories for their arms were almost impossible. The enemy gained in
confidence, audacity and numbers.
In despair the General Court finally offered two sloops of war, free,
together with all the profits of plunder which might result from the
enterprise, to any man who would undertake to reduce to ashes
Penobscot, St. John’s and Port Royal, the seats of the French and
Indian power. The offer attracted Phipps, who foresaw, in the
execution of the task, an infinite amount of adventure and action.
He enlisted men for the undertaking. Yet matters grew worse with
such alarming rapidity that before the enterprise could be placed in
readiness for work, it became necessary to raise a small fleet of
vessels prepared for war-like operations. Thus seven sloops and
seven hundred men, under command of Sir William, sailed away to
the North on their sinister errand.
Port Royal, secure and arrogant, in her fancied isolation from
attack, was surprised and taken. The French were routed with great
loss. The town was looted until hardly so much as a sauce-pan was
left by the thorough-going warriors of New England. The plunder,
while not enormously valuable, nevertheless was sufficient to help
materially in meeting the expenses of the venture. But its indirect
effect on the colonists was not so happy. Cupidity is so often the
jackal that follows righteous indignation.
The Puritans foresaw opportunities to punish the enemy, at the
enemy’s own expense. A second expedition, to go against Quebec,
was planned, the patriots expecting in confidence that, like the first, it
would surely succeed, if Phipps were at its head, and that the
plunder would more than repay the initial expenses of the expedition.
Sir William, having expressed his doubts of the wisdom of this
over-ambitious scheme, nevertheless commanded the fleet once
more as it sailed away, eager for further conquest.
The enterprise was doomed to failure from the first. It dragged out
interminably, it developed jealousies, it was ill-planned. Such a
bedraggled, failure-smitten lot of lame-duck sloops returned to
Boston that the council were simply appalled. They had expended so
much of their meager hoard of funds on the venture, that the
treasury was practically bankrupted.
Blame rained upon the head of Phipps, for not having succeeded
against impossible conditions. Driven to extremities, by the woeful
lack of plunder, the colony-fathers were obliged, for the first time in
their history, to issue paper currency. The notes ranged in value from
denominations of two shillings up to ten pounds.
Still an undimmed patriot, ready to serve his country in whatsoever
direction an opportunity was afforded, Williams Phipps gave his gold
for the colony’s bills, absorbing thus a very considerable sum. His
example induced investments in the paper from all directions.
Nevertheless the currency soon came tumbling down in value, till a
pound in paper was worth less than three-fourths of its face.
The sailors, and other working people, lost heavily, in these times
of trouble and weakened confidence. Yet eventually the money was
all redeemed at par by the Massachusetts government.
Sir William, weary of being reviled for his pains, returned to
England once again and resumed his labors with Increase Mather, to
secure to the colony a definite charter.
CHAPTER V.
OLD ACQUAINTANCES.
Adam Rust failed, even in the intricacies of collecting violins and

the pursuit of health for the old beef-eaters, to find the depths of
forgetfulness she sought, but which could not come to a nature such
as his had always been. Indeed seclusion, away from the gaiety of
Court and his fellow-beings seemed rather to develop the old, half-
forgotten memories in his brain, whereon had once been shadowed
the sufferings of King Philip, his Indian foster-father, and all his race
of hunted people.
The beef-eaters, also, were not absolutely contented, away from
their own country and the haunts wherein they were wont to brag, to
drink and to swagger. Yielding at last to their importunities, Adam
returned with the pair to London.
Once in the foggy capital again, he was soon pounced upon, by
old associates, with whom he found it exhilarating once again to
consort. A treatise on rare violins and their makers, over which he
had labored and pondered for months, or even years, was now
neglected.
He sharpened his wits, had a look at his sword and brightened up
his disused tinsel of conversation. He soon began to believe the
greatest forgetfulness, after all, is where the Babel of tongues is
loudest, and that the most absolute solitude is to be found in the
midst of the largest throng.
The social functions of the new King were fewer, less brilliant and
not to be compared, in point of popularity, with those of James. The
Dukes, the Marchionesses and lesser lights were therefore
constrained to make the more of their private parties. There was, in
consequence, no stint of hunting, drinking and dancing—all as
condiments poured about the omniprevalent piece de resistance—
making love.
At the Duchess of Kindlen’s, Adam found the set he had known
particularly well. He was welcomed back to their circle as a long-lost
fixture without whose presence no one was at all able to explain how
they had managed to go on existing. They fitted him back in his
niche with a promptness which might have been flattering, had he
not been aware that they wished merely to feed upon him as a new
entertainer, or an old one refurbished.
He was not surprised to learn that Lady Violet had been married in
his absence. He was duly informed of this event, which he described
as an irreparable calamity in his life, by Lady Margaret, who was
more of a brilliant blossom of feminine charm and enticements than
even before.
“But you, my dear Lady Margaret,” he said, “you have been true to
my memory? You have never learned to love another?”
“I never learned to love you, Adam,” she said.
“Then it must have been a matter of spontaneous combustion,” he
concluded. “You always did manage your compliments adroitly.”
“Confirmed villain,” she answered, “a woman would be mad who
loved such a bubble of flattering reflections as you have always
been.”
“I was not accusing you of sanity,” he told her frankly. “I was
merely inquiring whether or not you have learned to love somebody
else, in my absence.”
“And if I had, what then?”
“I should wish to pause for reflection, before determining whether I
should be more sorry for the other fellow or for myself.”
“Fiend!” she said, mildly, “you shall never know.”
“Know what?—know where to place my sympathy?”
“You shall never know whether I have learned to love another, or
not.”
“Well, neither will you—that one’s consolation.”
“But at least I shall know how I feel toward you, Adam Rust.”
“So shall I,” said the cheerful Adam. “I have always known. If you
should say you were dying, I should know you were dying to run
away with me, forthwith. It’s not your fault, you can’t help it.”
“I never dreamed of such a thing in my life!” she said.
“Then you ought at once to consult a physician for a bad case of
insomnia. I thought your eyes looked a bit weary.”
“You vile thing!” she answered. “Ted never said such a thing as
that in his life.”
“Then you have been trying to learn to love Ted? I thought you had
a faithless look about you—all except about your eyes. Alas, from
the way you talk I know you must be married already to this Ted.”
“I’m not!” she said, unguardedly. “I refused only to-night to set the
day.”
“This was a thoughtfulness toward me I had not expected,” said
Rust, complacently. “But you are betrothed, and this was unkind.”
“Unkind to whom?” she demanded.
“To Ted—and to me.”
“You will like Ted,” she told him, more artfully.
“At the other end of a duel, yes—immensely.”
“He’s a terrible swordsman,” she said, to urge him on.
“Yet how poorly he fenced with you.”
“What do you mean?”
“You won. You got him—poor devil.”
“Wretch! Ted at least would never pick on a woman.”
“If it’s Ted Suffle,” said Rust, “I saw him pick on his teeth, to-night,
and that is worse——in company.”
“His tooth aches terribly!” said Lady Margaret, defending poor
Suffle gallantly.
“He indulges in too much sweets,” Adam remarked, unmoved.
“Treat him the way you do me and he’ll soon be better.”
“I wish Ted could hear the way you talk to me,” she said.
“If he could hear the things you say to me, he would demand that
duel quicker,” Rust responded. “Tell me something outrageous to say
to the fellow, so that he will be obliged to challenge.”
“Nonsense,” she said, looking at him slyly, “don’t be silly. You
wouldn’t fight a duel over me.”
“Ah, but think what a lot of ladies would think me a hero,” he
replied with enthusiasm. “And I might also be banished from the
country. You can never tell where luck and lightning will strike next.”
“Go away, Adam,” she said. “You are perfectly monstrous.”
“I’ll go and have a look at Ted,” he answered, calmly. “If he is a
gentleman he will probably insult me without delay.”
To Lady Margaret’s utter dismay and astonishment, he sauntered
off at once and actually went to where Suffle was standing, and had
himself presented.
“I have asked for this honor,” he said, “the sooner to offer my best
congratulations on your betrothal. Lady Margaret has told me a little
about it. She is the happiest girl I have ever seen in all my life.”
“You are a good chap to say so,” said Suffle. “Do you know, I
fancied I should like you, Mr. Rust, the moment I saw you.”
“I should like to give you my friendship as a wedding present,”
Adam told him, honestly, knowing at once that Suffle was a fellow he
could really somewhat like. Then he added, more equivocally: “I
have known Lady Margaret so long that I shall take great happiness
in seeing the consummation of this happy event.”
CHAPTER VI.
JUGGLING WITH FIRE.
Lady Margaret was a beautiful woman. The next time he met

her, Adam realized that this was true. He stood looking down upon
her, where she sat on a low divan which was made to throw two
persons very close together, and into which he had avoided
squeezing. The young woman looked up at him winningly, a
slumberous passion in her garnet-brown eyes. Her creamy white
bosom rose and fell in a calm voluptuousness, the twin beauties of
which were more than suggested.
Rust could not recall that he had ever seen shoulders more
superb, nor a throat more delightfully round and built upward in
curves to the perfect chin at the top. In contrast with her lustrously
dark eyes and her almost black eyebrows, spanning her forehead
with their dainty arches, her old-gold hair was an amazing crown of
loveliness.
She had led him away from the company, “to look for Ted,” with an
art which had for once deceived the crafty rover completely. Now, as
he looked upon her, assuming a coldness it was utterly impossible to
feel, and be a man, he noted a beauty in her bare arms which made
him think of the perfect lines of a tiger’s paw. He could have
suggested nothing to make them more splendid.
Indeed she was well-nigh matchless as a creation of nature and
polite society. Her shimmering satin gown clung to her form as if
ardently. Her pretty gold-slippered feet and her slender ankles, in red
silk, open-work stockings, defied a glance to ignore them.
“Adam,” she said, smiling up at him archly, “I wish you were a girl
—just for a few moments, you know.”
“You would suffer by the contrast between us,” said Rust.
“You would know what a—what a bore he is,” she went on,
regardless of his comment. “And it would serve you right.”
“You doubtless mean the King,” he replied. “Your expedients are
cruel. Make anything out of me—a camel, if you like,—but not a girl.”
“I mean Ted,” she said, a little desperately. “You know I mean Ted.
You know what a bore he is.”
“Then you have spoiled him since morning.”
“You have no right to be the only man who isn’t a bore,” she went
on.
“You’ll be telling me I am the only man you ever loved, in a
moment,” he answered. “I can feel it coming.”
“And if I did,” she said with a passionate glance, “what then?”
Adam was frightened, as he had never been before in his life. He
took out his handkerchief and flecked a bit of dust from his boot,
nonchalantly.
“I should advise you to be bled for fever,” he said. “And I should
know the old affection you had for me once had departed forever.
Couldn’t you break my heart in some simpler way, dear Lady
Margaret?”
“It was all your fault for going away,” she told him. “You knew I
liked you before you went away.”
“Oh yes,” he responded gaily, “but I saw that your passionate love
for me was waning, so I went away to kindle it over again.”
“Do be serious for a moment,” she murmured, vexed with his
calmness and his raillery. “You know Ted is a dreadful bore.”
“Then since you have given him the love that once was mine, my
cue is to become a bore instanter.”
“You would never know it, if I loved you madly,” she said, looking
up into his face with her declaration centered in her eyes.
“Yes, I would,” he corrected, placidly. “If you loved me madly you
would tell me about it; you know you would.”
Her breath came fast. Her bosom rose and fell rapidly. “You
wouldn’t believe me if I did,” she said.
“If you told me you loved me madly,” said Adam, “I should know
you didn’t. So please let me go on with my fond delusions.”
She was silent a moment. He could feel her burning gaze on his
face. “Adam,” she said presently, “do sit down.” She moved to make
half room enough for him on the divan.
“What, and make you stand?” he replied. “Never!”
She placed her hand on the arm of the seat, where she knew his
fingers would return when he had finished scratching at a tiny white
speck on his coat-lappel. He observed her motion and thrust his fist
in his pocket.
“Oh, I am dying,” she presently whispered, after another silence.
“How interesting,” Adam cheerfully commented. “What are you
dying for, a glass of water, or a new set of diamonds?”
“You know what I am dying for,” she said, tremulously, in a voice
hardly above a whisper. “You said if I were dying, you—you would
know what for.”
“Oh, did I?” Adam mused. He was pale behind his calm. His hands
were perspiring, coldly. “Yes, of course. I said you would be dying to
run away with me. And now you would try to prove that this was all
wrong. My dear Lady Margaret, this is unkind.”
She arose from her seat. She was driven to her wits’ end for
anything to say.
“Silly boy,” she answered, as she came toward him, and then she
quickly added: “Oh, Adam, would you mind just clasping this strap?”
The strap was a narrow bit of finery which crossed her bare
shoulder. She had artfully loosened the golden clasp and now came
to present shoulder, strap, clasp and all for re-arrangement.
“There is nothing I can do with greater ease,” said Rust, “There
you are,—done already.” He had performed his office with amazing
dexterity and with a touch so fleeting that she would never have
known when it alighted.
“Oh, you haven’t done it right, my dear foolish Adam,” she said,
with a delicious little chuckle. “I’ll put my arm across your shoulder,
so. Now, make it right, do, Adam, please.”
She dropped her exquisite arm on his shoulder as she spoke and
edged closer. She turned so that her face was so near to his that he
could feel how glowing warm she was. Her breath fanned against his
cheek, hotly. The man felt a sense of intoxication stealing upon him.
Yet he was fixing the clasp as briefly as before, when she made a
movement with her slipper.
“Oh, I am falling,” she said in a little cry, and throwing both arms
about him, to support herself, she was clasped close to his breast,
for a moment, before he could seem to re-establish her balance. In
that brief time a mad horde of thoughts ran riotously through his
brain. She was beautiful; she loved him; she had fascinated
something in him always. Could he not be happy, loving her and
having her love in return? Why not run away with her—to the
Continent—anywhere—and fill the aching void in his nature with love
and caresses!
His heart was beating furiously. He trembled. A fever leaped into
his brain. Through his arms shot a galvanic contraction, as they
halted in the act of closing about the superb, slender figure he was
holding. It seemed as if he must kiss her, on her lips, her throat—her
shoulder!
“Adam, I am dying!” she whispered to him again, as he held her.
“Don’t die standing up,” he said, with a sudden recovery of the
mastery over himself. “Sit down and do it calmly.”
He swayed her aside, and there was nothing she could do but to
take the seat she had occupied before.
“How provoking of me to trip on my gown,” she said, looking up at
him sullenly. “Do you think we shall have snow to-morrow?”
“I shall pray against a precipitation of icebergs,” said Adam. “There
is nothing suggestive of love in ice.”
CHAPTER VII.
A BEEF-EATER PASSES.
The rigors of the London winter pursued the beef-eaters

relentlessly, tapping them remindfully on the shoulder, now and
again, with a cold, or a spell of bronchitis, and then, under cover of a
fog, some deadly affliction fastened upon the pair all at once. The
rover found them, after an absence from their quarters of two days,
so ill that first one and then the other was crawling from his bed to
minister to his comrade, so that both grew rapidly worse.
Adam looked at the two of them ruefully, when at length he came
to where they were. He had never known them ill in this manner
before. They cared nothing for eating; they slept but little. Their eyes
were bright. They were perfectly cheerful, in a feeble sort of way.
After the Sachem had come they declared they wanted for nothing,
provided he would talk to them, sing a little and let them lie there and
see him, or hear him play on his favorite violin.
He brought them every comfort which money could buy. He
cooked for them, served them and ate at their board—which was a
board indeed, reaching from one bed to the other, where they could
easily get at what he spread on its surface for their pleasure. But the
choice wines he fetched, and the fruits and the delicate bits of game
and fish, remained almost wholly untasted.
Adam was soon at a loss to know what to do. He tried to get at
their symptoms.
“Pike, you rogue,” he said, “I want to know where you feel bad.
You are ill, you know; now where is the pain?”
“By my sword-stroke,” said Pike, in a worn-down voice, “I have no
pain. I may be tired, to-day, but to-morrow, bring me a pirate and I
shall eat him without the trouble of slicing him first.”
“Tired, that’s it,” agreed Halberd. “I’m a bit tired myself, this
afternoon, but by cock’s crow to-morrow I could enjoy pulling the tail
out of a lion and beating the beast to death with the bloody end of it.”
“Well, doesn’t your stomach ache, or your head hurt you?” insisted
Adam. “When you cough like that, doesn’t it hurt your chest?”
“No, I like it, for the tickling,” said Halberd.
The two old scamps were afraid of being taken across the channel
to Spain again, or down into France, or perhaps across to Morocco.
After three days of his “tinkering” unsuccessfully, with his faithful
companions, Adam called in a doctor.
The worthy physician promptly bled the two patients. Little Pike
became quieter, if possible, than before. Halberd, on the contrary,
was somewhat wrought up in his feelings.
“By my steel!” said he, when the doctor had departed, “this puny
Sir Nostrum has let more of my juice with his nonsense than ever
was taken by swordsman out of my carcass. Faith! I’ll pulp the fellow,
and he comes again!”
Adam laughed, for Halberd suddenly got back a monstrous
appetite. He likewise abounded in pains, which he permitted the
Sachem to soothe; and he otherwise improved past all belief. He had
been a little ill, and his sympathy with Pike had made his ailment
mischievous.
Pike, however, had no such rally in him. He put in his time
smoothing the coverlet with slow, feeble movements, while he lay
there looking at Adam with dumb affection until one could almost
fancy he was wagging a tail, with weak, joyful jerks.
He got the Sachem to sing him the love song of the many seas, for
Pike had once had a heart full of love for a maiden himself, and while
the experience was nothing jollier than a funeral on the day set for
the wedding, nevertheless he liked the lively song, with all its various
maids and misses mentioned, for he conceived them all to be the
self-same girl, after all, simply transported to different climes.
While Adam was singing and playing, with the merriest spirit he
could conjure, the wistful old Pike had the impudence to close his
eyes and die.
A faint smile lingered on his face; whether as a result of his joke
on Adam and Halberd, or his pleasure derived from the song, could
never be known.

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A Note from the Editor

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The aims of this edition remain:

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Vigilance at point of care:

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Contents of the book, and how to use them

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2. Important eruptions / reactions

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Being a drug reaction sleuth!

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